#272: Dr. Dawn Mussallem - Expert Advice on Diet, Supplements, and Mindset After a Breast Cancer Diagnosis
Dr. Dawn Mussallem presenting at 2024 Plant-Stock
Dr. Dawn Mussallem joins Rip for Part 2 of an enlightening discussion on the vital role of personalized precision lifestyle medicine in breast cancer prevention and recovery.
They dive deep into the importance of nutrition, emphasizing whole food plant-based diets, supplements, and the power of social connections in enhancing health outcomes.
Dr. Mussallem shares her insights on various supplements, including the benefits and risks associated with Vitamins D, B12, and the impact of iron during cancer therapies, alongside the benefits of herbs and spices like turmeric and ginger in supporting overall health.
The conversation also highlights the significance of sleep hygiene, social connections, and managing stress.
While there is no "one size fits all" approach to cancer treatment and recovery, this episode aims to empower listeners to ask questions, seek knowledgable physicians, and prioritize overall physical and emotional health in their recovery.
Episode Highlights
4:37 Navigating Breast Cancer Awareness
8:12 Supplements and Recommendations
11:26 The Importance of Vitamin D
19:18 Understanding B12 and Other Nutrients
21:33 Examining Zinc and Selenium
28:35 Exploring Algae Oil and Omega-3s
34:22 The Role of Creatine
37:14 The Truth About Berberine
39:54 The Power of Mushrooms
45:50 Coping with Chemotherapy Nausea
47:23 The Importance of Sleep
58:27 Addressing Alcohol Consumption
1:07:21 The Value of Social Connections
1:13:47 Spiritual Connections and Wellness
1:17:22 Success Stories in Healing
1:30:05 Wrapping Up with Key Takeaways
Episode Resources
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Part 1 of Our Breast Cancer Series with Dr. Dawn Mussallem -
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Full Transcription via AI Transcription Service
I'm Rip Esselstyn, and you're listening to the PLANTSTRONG Podcast.
Welcome to PLANTSTRONG Podcast
[0:05] My PLANTSTRONG family, grab your pens and paper because the doctor is in the house. We're back with Dr. Dawn Mussallem for part two of our series around Breast Cancer Awareness Month. And you won't want to miss a second of this episode. It is super valuable. Today, she shares her recommendations around supplements, herbs, spices, and her favorite whole foods that aid in the prevention and healing from breast cancer. All that's coming up right after this message from PlantStrong.
[0:43] PLANTSTRONG community, Rip here, and I've got something really special to share with you today. We've been listening closely to all of you through our recent community survey. Thank you to so many of you that responded and it's really clear that you want support in a few key areas one how to eat more plants two how to stay consistent eating more plants and three how to thrive while living a whole food plant-based lifestyle and guess what i've heard you loud and clear this is why i'm excited to invite you to a free live webinar it's going to be on Tuesday, October 29th at 2 p.m.
[1:24] Eastern Time, where I'll be diving into the three secrets to unlocking the benefits of eating more plants. These are the same strategies that I've used to help thousands of people just like you stay on track, stay motivated, and truly thrive. We know that staying consistent can be tough, whether it's figuring out what to eat, meal prepping or just dealing with the day-to-day challenges, but I want you to know we've got you covered. This webinar is packed with actionable tips and real-life strategies that you can start using immediately. And here's the best part. Everyone who signs up will get four weeks of free access to our PLANTSTRONG meal planning software. This is one of our most powerful tools. It's filled with hundreds of easy, delicious recipes to make your plant-based journey super smooth.
[2:19] And it's really nice to have access to this right before the holidays are upon us. Know that you'll be able to test drive our best Thanksgiving menus. You can build your grocery list and even get grocery delivery all while you're trying out the membership just for signing up for the webinar. Now, if you can't make it live, no worries. Everyone who registers is going to receive a recording of the event.
[2:48] Trust me, you won't want to miss being there in real time to get all of your questions answered as well. So mark your calendars Tuesday, October 29th, 2 p.m. Eastern, and then head to the link in the show notes to register for this free event. It's going to be a game changer for anyone looking to eat more plants now and in the year ahead. Look forward to seeing you then. Thanks.
[3:13] Today, you are going to be treated to a front row seat for a priceless conversation. With Dr. Dawn Mussallem on the lifestyle pillars of medicine that can aid in healing from breast cancer or any cancers for that matter. Even if this disease has never touched you or a loved one, you can benefit from Dawn's knowledge and all of her recommendations. Dawn is a breast cancer and lifestyle medicine physician at the Mayo Clinic Comprehensive Cancer Center located in Jacksonville, Florida, and she works daily with patients who have received a breast cancer diagnosis. Many are coming in on multiple vitamins, supplements, and herbs, and Dawn works with each of them individually to provide precision patient care. What supplements have been shown to aid in recovery while on chemotherapy and radiation? Which ones are more cautionary? Today, Dawn is going to dive deep into the science to share her overall thoughts on these and other topics, including her favorite whole plant-based foods. In fact, if you're listening to this podcast on the day that it's released, which is October 24th.
[4:30] Dawn is inviting you to attend a free webinar called Hope and Healing,
Navigating Breast Cancer Awareness
[4:35] Navigating the Breast Cancer Journey. It is from 4.30 to 6.30 p.m. Eastern in time, and it's going to provide knowledge for the journey ahead, as well as nutrition, yoga, and meditation practices. I'll leave the link to join for free in today's show notes. But for now, let's get right to our conversation with our own Wonder Woman, Dr. Dawn Mussallem.
[5:05] It is so good to see you again for part two, part two of our conversation with you during Breast Cancer Awareness Month. Thank you so much for being part of this series and for coming on for the second time in the month of October. So Dawn, how are you doing today?
[5:29] I'm doing fabulous. There's so many exciting things going on. It's Breast Cancer Awareness Month, as you know. So we're having a lot of energy centered around that at Mayo Clinic. Did a really excited employee-facing breast cancer risk reduction talk yesterday with Lifestyle at the core of that. Had an amazing lunch for our staff of grain bowls, edamame and tofu and some whole food plant, only no oil dressing for them. So it was exciting. And how are the staff receiving this message?
[6:04] They love it. They really are. You know, so in Jacksonville, we currently have a Blue Zones initiative within our city and Mayo Clinic is a supporter of that. So we are actually in the process of working to be a Blue Zones certified worksite. So our staff has really been quite engaging. We got the green light for the farm project. So we are going to be having a farm for our employees to actually get fresh produce as they leave work. So that's another exciting project. And so we really focus on a lot of these whole food plant-based initiatives. We have a fitness center for our staff that's open 24 hours a day, seven days a week, free. It's no charge. The only day it's closed, I learned recently during hurricane season, is we do close during hurricanes. Because we figured it's not safe for staff to go work out. Only for one of my surgeons to post on social media, him working out in the fitness center when we closed it during hurricane season. We're like, oh, no. Well, and you've had a few of those as of late.
[7:04] Yes, I know. Yeah. Prayers to those families. That's for sure. We've been fortunate. We've been quite spared in this Jacksonville area. So we've been very fortunate. Yeah. So last time, you know, I had to run out the door to go watch my son play in a water polo match. And so there was some ground that we weren't able to cover here. And if my memory serves me correctly, Dawn, last time you did a fabulous job talking about a lot of the very seminal research that is out there right now regarding whole food, plant-based nutrition, and breast cancer. All the positive effects that it can have on breast cancer. We talked about, for example, Neil Barnhart's study and the benefits of whole soy products. We talked about the nurses' health study. But today I want to talk about things like, what's your recommendation when it comes to supplements, sleep, social connections, that people can, you know, they can hit the ground and they can implement some of these things like tomorrow.
Supplements and Recommendations
[8:12] So for starters, does that sound good? Love it. So important. This is a big part of what folks come in asking about. Yeah, yeah. So for starters then, why don't we start with supplements? And I think I'm specifically wondering, And maybe this, and maybe this bleeds into people that haven't had breast cancer and they're not breast cancer patients, but just women and men in general. But what supplements do you recommend for your breast cancer patients who are also hopefully going down the whole food plant-based path?
[8:51] Yeah. I love how you said that. There's no magic bullet. I mean, that's the quickest thing that I want to make sure that we emphasize here. And the American Institute for Cancer Research says for both cancer prevention and cancer survivors that supplements are not recommended unless there's a specific indication. And I just briefly mentioned that, you know, there is this nutrient gap that is a definite risk due to some of the nutrient depletion that's in current crops. And certainly if someone's having more of a carnivore style diet, they're definitely going to potentially have some of those micronutrient depletions as well. So to answer your question specifically, that's where we have to really lean in on the science and also being very comprehensive with our evaluations for patients, because all vitamin deficiencies, mineral deficiencies must be corrected. I would say the number one that I like to at least highlight is as soon as cancer patients get anemia, they automatically think they think they have iron deficiency. And that is usually not the case in the majority of cancer patients I see undergoing treatment. The cause of their anemia is the chemotherapy, you know? Okay. Okay.
[10:06] Yeah. And this is a big risk factor. And I want to really like highlight this fact because I see so many women coming in to see me and they're taking iron. And I asked them why. And they say, because I'm anemic. And so this is an important thing. There's been cancer research to show that iron supplementation is harmful during chemotherapy.
[10:25] Iron is, you know, something, part of the reason we stay away from animal protein, you know. So it's really, really important that you do discuss with your doctor why you're taking supplements. And we want to be certain that there is a true deficiency when you're taking some of these things. When it comes to the supplements, I do recommend though, the Cancer Update Project from the American Institute for Cancer Research, this was published within the last two years for breast cancer patients specific in this report. And they looked at vitamin D and vitamin D deficiency is very common in our country. And vitamin D isn't really a vitamin. It's really a hormone and the levels should be checked. We shouldn't just guess the majority of Americans do come in deficient. You know, obesity is one of the things playing into this sunscreen. People don't spend any time outside. So having your vitamin D check is imperative. How does how does obesity play into vitamin D?
[11:20] It has to do with the dilution of what is basically required to optimize the
The Importance of Vitamin D
[11:25] serum levels of vitamin D. This is very important because with the American Institute for Cancer Research, they did show that for cancer survivors following a diagnosis of breast cancer, we could improve overall survival as well as breast cancer specific survival with optimization of normal vitamin D3 levels. And so what I find in my patients is actually bringing that level up a little bit higher than even that kind of just very barely normal range, bringing them up to about the 50 range is where I find in my women with breast cancer is a sweet spot. That's when I find that, you know, these women taking these anti-estrogen drugs, which 75% of breast cancers, as you've discussed in our episode and some of the amazing other interviews you've done this month, 75% of breast cancers are estrogen receptor positive breast cancer. Those women are put on anti-estrogen drugs, which can, for some women, cause some achiness. My patients, the achiness isn't quite as common as I see it reported in the community. Likely it's because my patients are really adhering to this plant-based diet, which is lower inflammation anyways, but getting that vitamin D level closer to 50, 55, I found that that achiness tends to decrease. It's really quite interesting. And how do you get the vitamin D to 50 in the 50 range? What is your recommended prescription?
[12:49] Oh, I like that. That's a good question because I think a lot of doctors don't realize this. So if a patient comes in and their vitamin D level in the bloodstream, let's say is 25. And I really want to get my patients up to about that. Which is what mine almost always is. I'm in the sun and, you know, I'm not obese.
[13:11] And I'm like, wow, 25. Like, how high should I be? And what do I need to do to get there? So for every 1000 international units of vitamin D3 that you take, it's going to increase you 10 points. That's about what you should see. Every 1000 international units that you take, you are you talking about on a daily basis? Yeah, so I would give you 3000 international units a day to bring you up to that 50 range. Okay. Okay. Now, it's important that the vitamin D is checked. So once I make that adjustment, I like to recheck it, you know, generally within, you know, eight to 12 weeks, because you don't want to overshoot it. And we do know that there's kind of we used to call this, you know, medicine, we still do like this J shape curve, or U shape curve, you do a lot of benefit and risk reduction up to a certain point, but then maybe you enter this area of risk. And if you get too much vitamin D, you run the risk of making the calcium possibly go too high. There's even been reports when vitamin D gets too high, you may potentially even increase the risk of bone fractures, which is something really interesting to start reading about so you know have those vitamin d levels checked winter and summer is what i like to do because most people may need a little bit more in the winter a little bit less in the summer and i individualize it so individualized precision care is ideal if you can work with your primary care doctor your cancer survivorship team to discuss it so that's supplement number one vitamin d right right right um.
[14:38] I'm just, so any, any, any more, any other side effects that you know of from vitamin D supplementation outside of, if you get too high, potentially, you know, bones crumbling?
[14:55] No, I personally don't see it, but again, I don't want my patients really exceeding that 55, 65 range. I really try to keep them, you know, in that, in that 50 range. And usually they do a really good job doing that. And it's really quite interesting. I usually talk to my patients that notice how you feel as that level goes up. And then that way you can kind of gauge if you notice you feel a little achy again, you know, send me a message and let's check your vitamin D. And a lot of times there's some consistency with that, which I find interesting. The other thing I would, I would say is vitamin D3. A lot of doctors use vitamin D2.
[15:28] And they'll give it just one time a week at a really high dose. I really like physiologic feeling for patients to get vitamin D3 daily. That's what I recommend personally. And if I'm correct here, the D3 is actually a vegan form of D and the D2 comes from lanolin sheep's wool, which is kind of an animal based. Is that correct? Is that what your understanding is? Well, some of the D3 can come from animal-based sources as well. So, you know, if someone is vegan, that may be something that they want to explore. Right. Right. I know that the D3, cause we supplement in our milk. I know that we have a vegan form of D3. So that was, that was very important to us. Um, what, so I would imagine that a lot of your patients are live in Florida. Is that accurate?
[16:25] Well, actually, you know, my practice is telehealth. So I do see women from all around. And I see some of the patients even from up in Rochester, which that's almost as close to the North Pole as you get pretty cold up there. So I see folks from all across the country. So it's not consistent. Florida. But quite frankly, I see just as much vitamin D deficiency in my Floridians. You know, the majority of them are going out to the beach and sitting in the sun without sunscreen. They're under an umbrella with a hat and their sunscreen on. So they're not getting vitamin D. And I do, for another thing we'll be talking about, as you mentioned, sleep. I really want my patients as soon as that sun comes up. I want them to get that first morning sun, no sunscreen, try to get their large parts, you know, chest, back, shoulders, face, try to get that in the sun. So they get some of that natural vitamin D synthesis, you know, and again, it's interesting. We're talking about survivors when they look about, look at vitamin D supplementation and cancer risk reduction, reducing the risk of cancer occurring altogether. We just really haven't seen that data show, you know, we know that people who get natural levels of vitamin D from exercising in the sun, the way it should be done, that is protective, but the supplements don't always pan out to show the risk reduction of the cancer causing. So these studies I'm talking about are specific for cancer survivorship and improving outcomes. All right. I think we've beaten up vitamin D enough here.
[17:52] Next subject or next supplement that you would like to discuss. You know, I think because the majority of your audience is whole food plant only, you know, it's important to bring up vitamin B12. And I typically check vitamin B12. But more commonly, I do check an MMA with that. That's a confirmatory test to make sure at the tissue level, you are in fact getting enough vitamin B12. And I do feel that in my whole food plant only patients, it's important to make sure that they have their vitamin B12 checked once or twice a year also. So now there's a lot of fortified foods, you know, some of the various plant milks have vitamin B12. I use a ton of nutritional yeast. I'm sure you do too, Rip. You can get vitamin B12 from that. I have my own vitamin B12 levels checked and it was high when I recently had it checked. I was kind of overshooting it, you know, so I backed off.
[18:45] Vitamin B12, there was an interesting study that was published by Ambrosome. And what they showed is people who took vitamin B12 before chemotherapy and during chemotherapy actually had a poor outcome. You know, a lot of people just take vitamin B12 just to take it. They don't need it. So it's important if you have a deficiency or if you're low, take it. If you're on a diet that you're not getting it from normal sources, such as a whole food plant only diet, then you probably need some B12.
Understanding B12 and Other Nutrients
[19:13] But most people overshoot the level over the age of some experts say 50 to 65. Definitely over the age of 65. There's a much more increased risk of vitamin B12 deficiency, regardless of what style diet you're on. just because of absorption issues. So again, it's a shout out, have the level checked, have your doctor adjusted accordingly. Sometimes there's absorption issues. So it may need to be done via an injection. I typically, if they're doing it in a supplement, I just do a sublingual form for them, sublingual pill.
[19:42] Right, right. It's interesting. My vitamin B12 is typically between 500 and 900. And we did a production run of 30,000 units of our oat walnut milk that's fortified with D-calcium and vitamin B12. We have 25% of the RDA of B12 in there. and literally I had a garage. And so I had it on, you know, my cereal, I was drinking it like instead of water, it was crazy. And then the last time I had my levels tested and I hadn't taken any B12, uh, except for that it was 1350.
[20:24] So it got flagged for being too high. Yeah. I mean, and we don't really know if that's a problem, you know, it's a water soluble vitamin. in. So you PP it out. But the question is, is it's high. Should it be high? I mean, could it cause problems? This is really interesting in this cancer study to see this, you know, report of increased mortality in people that were doing vitamin B12 who didn't need it both before and during their cancer treatment. That's an important part of what that study showed. It was in both sections. So anyways, have your levels checked. Yeah. Yeah.
[20:59] And do you have a preference as far as taking daily, weekly? I know some people like 5,000 microgram tablet once a week. Some people are like 500 microgram once a day, whatever floats your boat. No, I do. I like it daily. I mean, I like to be as close to physiologic as possible. So it just makes more sense to me. That's how my style is with practicing. I have them do it daily if they were requiring a supplement. I like that. I like that a lot. What are your thoughts on zinc and selenium?
Examining Zinc and Selenium
[21:33] Oh, good question. I check my patient's levels. I find something very interesting. I find that. I'm taking a lot of blood. I'm going to make him iron deficient. I take so much blood. I'm kidding.
[21:48] I find a lot of zinc deficiency in my patients. And you know what's funny is because my patients are quite healthy. I find a lot of selenium toxicity in my patients.
[21:57] So zinc deficiency needs to be corrected. And so I correct that with obviously zinc supplementation.
[22:05] Selenium deficiency for cancer survivors is something we absolutely don't want, particularly during radiation. There's been some interesting studies that have shown optimization of selenium, ensuring the selenium levels are normalized. It seems to improve the treatment effect of radiation, which is very interesting science. And we don't always have the exact explanation as to why this is, but there's been an observation and association they've seen, but we certainly don't want to go into the range that they're toxic. And so what I find in my patients is they tend to eat a lot of Brazil nuts. You know, some of these women come in to see me, they've already tried to onboard based on webinars and videos and books they've read that, Oh, Brazil nuts are good. Selenium is important. And so all of a sudden they're having like 10 Brazil nuts a day and that's not a good idea. So have your selenium levels checked Brazil nuts again, because of this whole nutrient, depletion or not, you know, you may only need one Brazil nut versus maybe you need three and there's never going to be consistency in that Brazil nut that you're consuming necessarily. So I typically say, you know, one up to three Brazil nuts a day, but I don't want my patients going more than that. I know myself, I love Brazil nuts and I found this really great brand that's just, it's so, it's such high, it's really good tasting. And they can also optimize LDL. And I know Rip, you and I were kind of comparing that my LDL is way better than yours. And so maybe that's why.
[23:27] There's several parts that Brazil nuts help to lower LDL cholesterol, which is kind of interesting, but you don't want to eat too many Brazil nuts. And quite frankly, I can't believe they don't put a warning on the bag because you can really get yourself into trouble with Brazil. So be cautious. Well, yeah. Brazil nuts, peanut butter, ice cream.
[23:52] No, it's funny. Dr. Greger, I think, started the whole one Brazil nut a day for your selenium. I don't know. Probably in how not to die. And it's like, yeah, just have one Pringles potato chip. I know i keep my brazil nuts in the freezer so when you in my wallets too so when you eat them they're like extra crunchy they're so delicious i i hear you loud and clear there for sure i have three today i have to confess, good good thank you for your confession, what about what about algae oil yeah you know i'm a believer you know there is mixed opinions on this, but the women I am seeing, you figure the majority of women I'm seeing are being put on anti-estrogen medications. They're in menopause. So there is a lot of thought that women in menopause are not efficient at converting the omega-3 plant-based fatty acids over to DHA or EPA.
[25:00] I do recommend that my patients take algae omega, you know, one to two pills a day. I don't think we need to go too high with it. I also occasionally check fatty acid profiles of my patients. I don't get too in the weeds with it, but occasionally I do if I'm a little bit worried about some of their balance of their overall nutritional intake. And, you know, I would say that not all of my patients are whole food plant only. A lot of my patients are still having a little bit of fish. And, you know, if they are, I want to make sure they're not getting too much because I don't want them getting heavy metals. I don't want them getting microplastics. The waterways now are so contaminated with so many different toxins that it bioaccumulates in the fish. And then we eat the fish. So if my patient is going to do fish, you know, I'd rather them do like sardines or anchovies, but if they're going to do fish, more fatty fish, like wild salmon, I typically say, it's almost funny, one to three ounces.
[25:56] That's a little bit like, that's just like a few bites right oh it's hardly it's hardly anything yeah yeah one to three ounces up to three times a week and that's it and that recommendation comes from the environmental working group basically the seafood calculator that's super cool that looks at your gender your age and i'll tell you the max amount of fish you should consume considering current levels of toxic exposure we want to minimize people from so i love that you know well and then also when they tell pregnant women to basically stay away from fish because of the uh different you know levels of whatever it is pcps dioxin mercury um yeah yeah how much do i want to be taking in um of those things i completely agree yes yeah um.
[26:46] Can we go back just for a second? So to the algae oil, that is a kind of, I would imagine that's a form of the alpha linoleic acid, the short chain ALA. And so for the listener, you're saying that conversion from this kind of mother form of the omega-3s, some people it gets kind of, it gets difficult to get broken down into the longer chain that you said the DHA and the EPA.
[27:19] And so this is a reason for the algae oil. Help me out a little bit. Yeah, that's exactly right. So we believe that estrogen, so when we're young for women, we believe that we're more efficient at doing that conversion. But as we go into menopause and we're estrogen deficient, without that estrogen present, we may not be as efficient at making that ability to convert into EPA and DHA. And so if someone wants to be natural to avoid supplements, just have your doctor check your level to make sure it's adequate. I recently had a woman that really didn't want to take supplements we checked her level she was fine you know she was doing some different seaweeds and stuff and she was just fine it wasn't an issue for her uh but again going back to my women on these medications these aromatase inhibitors that feel achy there has been some reports that for joint pain that fish oil can be effective for that so i found that.
[28:19] So two things that I really try to do to help women with those aromatase inhibitor joint pains is get the vitamin D to 55 and do, you know, one to two algae omega a day. And that has really worked well with my patients in addition to regular exercises,
Exploring Algae Oil and Omega-3s
[28:33] you would imagine, that I'm encouraging. And so I do tend to use the algae omega and then usually up to one tablespoon of flaxseed. But I don't really have my patients do much more than one tablespoon of flaxseed. I think that's enough for my patients. Yeah, yeah. Wonderful. Thank you for revisiting that. Let's talk about calcium because it seems like so many women are concerned about getting enough calcium. They're concerned about osteoporosis, osteopenia. And what is your recommendation with your cancer patients?
[29:06] You know, this is really a concern I have. This is a substantial concern because it seems like every doctor recommends, hey, take 1200 milligrams of calcium in the patients out there. It's like the quick thing to say, right? Oh, you're getting older. Oh, you're on this anti-estrogen drug. You have lower estrogen levels and physiologic. You have an increased risk of osteoporosis. Take 1200 milligrams of calcium. Bye. They don't even tell them what calcium is more effective, right? So some patients are taking Tums or they're taking calcium carbonate, neither of which are very readily absorbed into the bloodstream. In order to absorb calcium, you want it in a more acidic environment. You know, so calcium citrate would be a much more favorable or a superior form of calcium for an individual to consume. Now, with that being said, what I recommend to patients is.
[29:59] We know that when it comes to calcium intake, it mattered most when we were kids, by the way, right? There really hasn't been solid data to prove that taking calcium supplements as adults really matters. What is important, you get it in your diet. So I want my patients, I recommended them once a month, I want them in tune with what they're eating. And so once a month, I ask them to do a 24-hour food. They do this for me before...
[30:29] Each appointment they have with me. So they're familiar with doing this. And I want them to calculate out how much calcium they're getting from their diet. And almost all my patients are getting 800 to 1000 in their diet, the majority of them. So if that's the case, I just have them take, you know, whatever it takes to get them up to 1200. So if I have a woman, she's 800 milligrams of calcium in her diet, I ever add a 400 milligram calcium citrate supplement. If she's getting 1000, I have her at 200 milligrams of calcium citrate. If someone in their diet is getting 1500, they're getting a higher level in their diet. I don't worry about it if they're getting it from their food, but I don't want them to overcompensate with that supplement. That's how I recommend it. And the patients really like that individualized recommendation. And I really want my patients to try to aim to get it from their food, their plant milk. I mean, by golly, almond milk, the majority of them have like 450 milligrams of calcium. rip i think your um milks have 300 do i remember that correctly 300 milligrams of calcium 300 which is 100 of yeah it's.
[31:32] Perfect. 450 is high. It's almost too high. I don't like it that high in some of the almond milk. So I warn my patients that they're getting two cups of that. They're already at 900. They definitely don't need to do. Well, I think that's a really smart protocol, Dawn. I like the way you customize it like that.
[31:51] Especially if people are following the whole food plant-based diet and they've subscribed to trying to do one to two servings of whole soy products a day, especially like tofu that's typically fortified with it. That's a wonderful way to be getting calcium. I know that I've read about, you know, how getting sometimes supplementing with calcium or too much calcium can also increase your risk of heart disease, if I'm not mistaken. I think I heard that from Colin Campbell a long time ago.
[32:26] You're exactly correct. We don't know the implications of this. In fact, after my heart transplant, I had spoke with my cardiac surgeon. We had a long discussion on this because he is actually whole food plant based. And we were just having a discussion based on this calcium supplementation. He was seeing a lot of women coming in, needing valve replacements and having some interesting calcium deposition. Like when he's doing the surgery, it kind of felt different. So he asked me, what do you think? I thought you're absolutely right. I think it is a definite problem that we're not paying attention to so much that I actually sent a message through, um, to one of our cardio oncologists, we have a whole section of cardiology that is focused on cancer patients. And I said, how about we do a study that looks at the hundreds and thousands of patients we've followed over the years on calcium supplementation to see if there was increased cardiac events, you know, so it's, it's a study we're currently talking about investigating because I think we need more information to answer this question. Yeah. Uh, yeah.
[33:28] So creatine, that seems to be like the hot ticket these days. And I'm wondering if you think it's justifiably so. I think it potentially is justifiably so. And the last thing I want, particularly for women undergoing cancer treatment is you don't want to lose muscle. Muscle is precious tissue in your body, muscle and bone, muscle and bone, muscle and bone. But muscle is metabolically active. You know, muscle is important as we age. Muscle is just something we must focus on. You get adequate protein from a plant-based diet. I'm never worried about that. But could we be missing a little bit of creatine?
[34:04] So women, it would be three grams a day. Men, it would be five grams a day for creatine supplementation. You really do not have to load. I don't know if you remember it. You know, I used to do fitness contests back in the day. And so we would load our creatine at that time. And man, you'd feel so gross. You feel so puffy when you do that loading phase.
The Role of Creatine
[34:22] So I don't recommend loading, but I do think that there could be a role for three grams, women, five grams for men. There's also some reports that maybe it's important for cognitive health. What I would say is we need more research to really prove this kind of enhanced benefit of both muscle metabolism, as well as possibly cognitive performance. But I never want a person on a whole food plant only diet to ever find out a decade, two, three, four, five down the road that we we missed something. So I do not feel creatine would ever cause harm. We have so much research on it. It's probably the most researched supplement out there. It's safe and nor do you need to spend money on it. The only thing for women, myself included, I just don't like how it makes me feel. I feel kind of puffy and I don't like that. So, you know, I do have some of my women taking it, particularly those that are really active. Like I said, I wouldn't say it's a.
[35:15] I have a probably about 10% of my patients are whole food plant only. It may be a little bit higher than that where they don't touch any animal products. And honestly, it's, it's probably higher than that now, but I would say the majority of my patients are getting just a little bit of fish, maybe just one serving a week, two servings a week, just a tiny bit. And they're getting some creatine from that. So it's funny. I've, I've never taken creatine, but I am going to have one of the foremost authorities on creatine on the podcast here at the end of our, in the beginning of November.
[35:47] And then just as a way, I'm going to, I'm going to try it. I'm going to try it for a month and see what happens. I know when I was in the fire academy, you know, for six months, all these guys were just trying to get buffed up and everything. And as soon as they started the creatine, they all gained about 10 pounds. You know, they, you mentioned puffy, they looked like they were getting puffier, uh not necessarily you know more shredded and every one of them the first thing we had to do every morning was run two miles around the track and we would typically go pretty hard and all these guys started cramping up it was the the weirdest thing so i don't usually see that it is really fascinating the research with muscle repair you know regenerating like the atp so you're a little stronger to do more sets to do more reps so it should enhance athletic performance it should not hinder it, but the cramping up was interesting. And, you know, I don't know when that was, who knows what else was in that supplement.
[36:45] This was in 1997.
[36:50] That's how I was taking it back then too. Yeah. I remember. So I think these were a little different then, but yeah. Yeah. Yeah. What about berberine? So berberine has a really narrow therapeutic window, meaning like, you know, it's like a sweet spot, you know, if you go too high, you get toxic, if you're too low, it's not going to even help you therapeutically.
The Truth About Berberine
[37:12] So it's this very narrow window. I think berberine is very fascinating, though, it has the potential to really optimize blood sugar, and, you know, possibly even cholesterol. But I do love it for its blood sugar benefits. You know, I think that there has been a lot of recent reports that are, you know, floating out there. So it's a common one. I have my patients coming in and they're already on. So it sounds like it's really being sensationalized. So I typically will say if my.
[37:44] Uh, of course, you know, usually we're just controlling this with diet and I don't need these sorts of supplements, but in the event, there is a sort of situation and 500 milligrams with usually breakfast and dinner. I'll do, I just keep it pretty simple, but you must talk to your doctor about this before you start it again, because of the potential liver toxicity. These aren't things I like to start necessarily during chemotherapy. Um, but I have, I do use it occasionally, um, during treatment, um, for some of my women, it seems to dampen down diarrhea for some women as well on certain treatments. Right. What exactly is berberine? Do you know where it comes from? What it is? You know, I can't answer that for you. I should know that, but I actually can't answer exactly what constituent it's coming from in terms of what plant. Oh, good. We finally stumped Dawn. We can look it up now. We should look it up. It'll drive me crazy.
[38:35] You know, I looked at some expert the other day, and you know what? They were using an iPad when they were talking. I was like, oh, that's so smart. But there is this new database that Mayo Clinic supports, Cleveland Clinic, all the very large medical centers. And it gives you, so it's an, let's see, from several plants, most notably the genus Berberus. Man, I could probably just guess that, right? So it's an alkaloid derivative. So it comes from several plants. That's really interesting. Berberus and Bulgarus. So anyways, there we go. And it comes from a few other plants too. Plants to the rescue. Plants, plants, plants. Plants strong. So that search engine is called Open Evidence. It's fascinating. You know, it pulls from all the major academic centers. So you're getting solid evidence. It's an artificial intelligence search engine. So, you know, chat GPT, you need to be very careful with. You can end up with information that's not accurate. But yeah, so it's really cool. And then when you pull it up, It gives you references. So it'll go to therapeutic and biologic activities of berberine, berberine isolation from, and it'll give you more studies to pull from. It's really, you'll get like lost in it. It's pretty fun.
The Power of Mushrooms
[39:54] Brave new world. Let's talk about, let's talk about some mushrooms, lion's mane and turkey tail. What are your thoughts on these guys? So let's start with turkey tail, because that is another common one my patients come in taking. You know, there's hundreds of years of research, you know, from Asia with the benefits of turkey tail during chemotherapy that show improved health related quality of life. This is my concern with turkey tail. It does augment the immune system. So people with celiac disease should not use it. It potentially makes you more sensitive.
[40:30] Myself, people with organ transplants should not use it. It can augment the immune system to push you into rejection. So if we have these warnings on this sort of a supplement, it tells us it's working. So it is enhancing the immune system. In fact, interesting, interesting fact. I don't know. That sounds right. But during COVID, this was a concern. You know, people, if they were taking turkey tail, the destruction from COVID was in what was like an overdoing of our immune system when it would kind of attack the lung tissue. And so turkey tail was something I told all my patients, do not, do not use. This is very risky. They could use more of a balanced mushroom supplement, but not turkey tail itself because it augments the immune system so much. So let's talk about breast cancer. Could it have a therapeutic opportunity to enhance treatment effects?
[41:20] Well, maybe, but maybe with risk. So I am extremely worried about turkey tail used in combination with immunotherapy. You would think this would be a really great thing because you're augmenting the immune system. So maybe in old people, maybe it could be okay. We're helping both things work together. But I've seen a few young women end up with some autoimmune sequelae, one with colitis, one with pneumonitis, and both of them were taking turkey tail. The oncologist sent them to see me to say, hey, what do you think? Are they taking anything that you're concerned about? And I started to see this pattern. So I sent a message out to our team that please, before you start the immunotherapies, ask patients if they're taking turkey tail we did a study at mayo that showed 91 of our patients are taking supplements at least five and a large percentage of these had direct drug interactions and a lot of patients you know this is hopeful for them and they don't even think of telling the doctor they just think these things are benign but i'm really worried about the harm that turkey tail can cause in combination with immunotherapy so i never want patients using it in that setting.
[42:27] I have had some women with metastatic cancer who were on, you know, just long standing medication management that there is no confirmed drug interaction. And I do review the drug interactions of different pathways extensively. And so for some of them, I use turkey tail to enhance their quality of life. But it's pretty rare because I have so many other things that I can use that I just don't have to worry about. And what I find with patients is when they take a supplement, first of all, this stuff's expensive. There's a lot of financial toxicity with cancer. You must be careful with the brands you're buying because some of these brands can have heavy metals, contaminants. If it's not a high quality product, you really don't know what you're getting yourself into. You could be getting far less than you are actually paying for or far more than you're paying for. And either one can end up, you know, to be a problem. So I want folks to be very, very careful. I use a database to determine what brands to use. It's called Natural Medicine Database. It's a database that Mayo Clinic provides for me to search what brands would be effective. It also is a company that goes through or a search engine that goes through and rates them, you know, which ones may have heavy metals, which ones are safer. And also, I feel Consumer Lab is another nice search engine for patients to look up some of these questions they may have. Consumer Labs has been around for quite some time, and that would be more patient facing or consumer facing that membership. Got it.
[43:52] What do you think? Are we good with supplements? Should we move on or is there anything else that I, did I miss anything that you can think of? I think you hit it. You know, you asked Lion's Mane. I didn't hit on that. So I love, I'll shout out Dean Ornish's, you know, recent study with his amazing lifestyle medicine application to care, but he used some unique supplements and Lion's Mane was one of them. So I think Lion's Mane is going to certainly have a place in the future for cognitive protection, maybe even cognitive enhancement. Um again during chemo i i just don't like to use supplements one of the best ways to ward off chemo brain is exercise so i always whenever it comes to supplements everything we do in medicine is first do no harm you know as soon as you enter that arena of supplements you could be entertained the idea of some harm so you want to be very very careful there's no way you can hurt yourself with healthy eating and you shouldn't hurt yourself with exercise as long as your shoelaces are tied and you know the lights are on kind of a thing right so yeah yeah yeah let's you um.
[44:53] You had to go through chemo, didn't you? I did. Yeah. Yeah. Yeah. So in that regard, you can probably relate to a lot of your patients that are having to go through chemo in a way that I would imagine a lot of physicians can't. It really is such a gift that I can be in that space with them. I would never trade in what I went through. You know, and when you're going through chemo, there's not necessarily nausea that we are not necessarily like overt vomiting, I should say, that we see with patients now, but a lot of them have the low level nausea. They just feel kind of queasy. They're not throwing up. It's not like you see in the movies, but that's an awful feeling. You know, I think nausea is potentially one of the worst feelings someone could ever experience. And so ways to mitigate nausea are something that I really like to support patients
Coping with Chemotherapy Nausea
[45:46] with because it is such a quality of life reducing feature. And there are some integrative modalities that I use. And if you don't mind, I would love to mention this because this is a super cool thing. The C-band, you know, the little cheap things you can buy on Amazon are like $7. Those C-bands you wear if you go on a boat. Yeah, totally.
[46:07] Yeah, little acupoints, the P6 acupressure point. There was an amazing study that did show that it reduced the feeling of retching, nausea, and vomiting in cancer patients undergoing chemotherapy. You were at the day of chemo and then four days after chemo, so five days total. I have all my patients do that who are on chemotherapy that are known to cause higher levels of this nausea feeling. And it gives them a lot of relief. So that's a fun fact for nausea. And I usually pair it up with some acupuncture if that nausea continues to be a problem. A lot of folks will use ginger. But, oh, I do actually have to do ginger tea, like a nice little turmeric ginger tea or a chamomile ginger tea.
[46:50] PLANTSTRONG. Chamomile ginger or chamomile turmeric tea is my favorite, actually. That's yours. Yeah. Yeah. Yeah. Yeah. Well, thank you for that. So anything more on Lion's Mane? Are we good? Yeah. I mean, you know, Dean Ornish's study really promoted that. And I think that there is definitely a place in cancer patients. I guess it's not something I like to entertain for chemo brain, but I see a lot of them are starting to take that. I would worry about drug interactions, but in the survivorship phase, I give the green light with lion's mane.
The Importance of Sleep
[47:20] The only problem would be, I feel financial toxicity, it's pretty darn expensive. And you would just want to make sure that you're getting a brand that's high quality. I want people to be very careful with that because it's a hot item right now. So everyone's coming on the market, promoting it. So we need to be very careful to use high quality products. Right. So we just talked a little bit about chemo. I have a follow-up question on kind of chemo and radiation. Specifically, if you know if it has an effect on the microbiome, and if so, do you have any recommendations for your breast cancer patients?
[47:55] Yeah, thanks for asking that, Rip. And that's actually area of research that we're currently actively putting protocols together to continue to investigate this further to understand what is the chemo doing the gut microbiome. But the space that we are actively looking at study design and we have a current protocol we're working at getting funded is actually looking at a whole food plant-only diet that is a medically tailored meal to look at the impact of optimizing the gut microbiome and the impact of that optimization that we know helps to regulate the immune system for the chemo immunotherapy to actually be more effective at the level of the tumor.
[48:31] So extremely exciting study. So I had a really exciting meeting earlier today about getting the study funded. And I'm hopeful we've been denied multiple times, actually, it's hard to get these sort of studies off the ground, because you're competing against, you know, some of these other novel drug therapies, immunotherapies, but I think hopefully we will be getting it funded here soon to help to answer that question i'm not i stick to the basics you know i want my patients to get food diversity sometimes it can be a little bit hard during cancer treatment but i really work closely with them with the various foods that they can tolerate to really enhance trying to get at least 30 different plant foods a week to help to enhance that gut microbiome you know trying to make sure we don't overuse antibiotics unnecessarily thinking about crazy things like mouthwash like you know it starts in the mouth i think you've said that before even right so you know let's let's just try to keep things as basic as possible. I don't like to overuse probiotics. I don't think that we're really good at using precision probiotics currently at this time right now anyways. So I'm not a big promoter of probiotics, honestly. Yeah. Yeah.
[49:36] What about like, so I love the fact that you said you just kind of go back to the basics, right? I mean, let's go back to the basic blocking and tackling, which is kind of whole food plant-based. You mentioned, you know, the 30 different varieties of whole plant-based foods. I think going back to the American Gut Project, which is what they recommended. But I know that you also are a fan of resistant starches and fermented plants. Can you talk a little bit about both those things?
[50:07] Yeah, I mean, beans are, you know, amazing. And breast cancer research, there was really cool data that showed that melanoma, that was like the first place that they started using the immunotherapies really regularly. And they found that, wait a minute, these people with a more diverse gut microbiome are having improved effects. So every doctor in the world starts giving probiotics. No one got better, right? And then they kind of looked a little bit further and they found it was really the resistant starch and beans seem to be like the magic. So this was American Institute for Cancer Research. By golly, this is what year would this have been? This is probably like 2015, 2016 that I'm sitting in a meeting. I'm like, this is so cool. Like beans, like everyone's spending all this money on probiotics. And when someone's immunocompromised, there was actually a question like, could probiotics be harmful? And there are some strains of probiotics that we kind of want to say, no, time out. There could be something, you know, called translocation where it could be in the GI tract and maybe absorbed and cause potential blood infections. So, again, first, do no harm. Get out of the body's way. Let it do what it needs to do. Nourish the body with what it needs. This is so simple, you know. And so it's just so nice to be in the space with the patient and just help to simplify this. Still give them hope that they have an active role to participate in their care. But it doesn't mean that they have to spend gobs of money on supplements to accomplish that particular goal. Totally.
[51:31] And, you know, with the thing with resistant starches, another great form of resistant starch comes in potatoes.
[51:37] Yeah potatoes and they're so high in potassium so my women are having a lot of diarrhea and some of the treatments and everyone's like oh i eat my banana i'm like just have a potato.
[51:50] Potato a little medium potato has more potassium than banana really i mean it's incredible and what i have to do is heat the potatoes on the weekend put them in the refrigerator right so so the glycemic load is a little bit lower so i think that's great the only thing i think that's funny is i hear some experts saying toast bread put in the refrigerator then heat it up i'm like okay you're taking it too far that's gross no wow yeah that sounds so great no i have heard it now though yeah i don't do that i'm not that great i'm not that committed i guess i'm like nope i'm gonna toast my bread my my sprouted bread and enjoy it on the spot that's what i'm gonna do what about fermented plants yeah i love kimchi for for folks i think it's great um tempeh you You know, so I'm definitely a promoter of those various foods, too. I have to be a little bit careful with some of that when they're undergoing chemotherapy. If their counts are dropping, I don't like to be too pushy, but into the survivorship phase, total green light.
[52:46] A lot of them will do some of the plant based yogurts and not all the plant based yogurts even have fermented product in it. So they would want to be mindful of that. And a lot of the plant based yogurts are just so processed. I'm not super. I personally don't use them myself. and so we really kind of go through to make sure if they're using them it's one that's going to be okay a lot of them are just doing it um because they like the the experience of that sort of a thing i usually recommend what's in be a plant-based woman warrior uh and the um zander tart where where you take the tofu with the raspberries and a little bit of maple syrup and lemon rind and some lemon juice and i have a mix that up it's kind of like a tofu derivative or you know a yogurt derivative of course there's no cultures in that either but it's good And then I think that's also a shout out in terms of what other fermented foods do you do? I like, you know, I'm okay with sourdough bread. I would much rather my patients do sprouted bread. But if they want to do a true sourdough bread, you know, if you go to your grocery store and it's like the soft bread and it says sourdough, you need to make sure it truly is sourdough. Most of the store are not. But if someone's getting real sourdough, I have a lot of patients that make it themselves. They enjoy doing that. So I give them the green light on that as well for further content. Well, you mentioned sprouted. Um.
[54:06] What I've been doing lately is I've been getting the Ezekiel 4-9 sprouted wraps. And I just throw them in the toaster for a minute and a half. And then I throw on oil-free hummus, two big handfuls of arugula, usually four slices of tofu, sriracha sauce, and then a little bit of avocado. And I'm in heaven. Oh, yeah, that sounds so good. So can I share a funny story? I think I may talk maybe too much. I'm sorry if I am. So this is funny. So when I have my transplant, you know, I obviously only do plant foods. And so to get my protein, I would do edamame at lunchtime and a wrap. And so I had my wrap and there was edamame in it. I had to make it for me and I was eating it. And, you know, I really couldn't move. I had all these tubes in me. So I'm eating it and the edamame are rolling on the floor.
[55:02] Edamame rolling out of my wrap sandwich onto the floor. And I'm like, oh, don't mind me. Don't step on the edamame. Help me clean that up. And in a week, I'll be able to do this on my own. But right now I need some help. And I know they're probably like, can she stop eating those darn sandwiches? It was really cute. It was a good memory. It is. Wow. Wow. All right. So we're almost approaching an hour here. And I feel like we haven't even gotten started. But no, but we have. So let's talk about sleep. And I know you're not technically a sleep expert, but I think you've got some pretty good thoughts on sleep regarding, you know, maybe hygiene and alcohol and even...
[55:47] People that are having sleep apnea. So if you could address some of those things. It's so important, sleep. And I joked about it when you and I chatted the last time, but gosh, you can eat perfect, you can exercise perfect, but if you're not sleeping, you're really just working against yourself. So you have to prioritize sleep seven to nine hours a night. You don't need more than that, by the way. I had a woman the other day that was getting like 12 hours. I'm like, ooh, let's set your alarm at nine hours and get your day. Let's start enjoying the fact that we're alive.
[56:18] Get up, call me. I'll give you some energy. We'll get the day going. So up to 70% of cancer survivors have insomnia. That's a huge number. And the first thing that I really want to shout out again, as you mentioned, Rip, is that sleep hygiene. You know, the number one reason people, in my opinion, feel insomnia is because it's way too much blue light exposure during the day and not enough daylight. So we talked earlier, I tell my patients, as soon as you wake up, I want you to get up, look at that gorgeous sunshine, get that sunlight and you start to actually increase your melatonin by doing that. So that's good, right? You want that melatonin by the time you go to bed at night, but if you're on the screen being exposed to all that blue light during the day, that blue light starts to slowly drop the melatonin as we go. So So blue light, I have my patients use blue light glasses or if they're on screens, get blue light protectors. Very important. Sleep apnea. You know, about 26 percent of adults have sleep apnea. But about 20 percent of those are are actually people that don't snore. And we know that sleep apnea can increase blood pressure. So if I have a patient who has high blood pressure, you know, and I notice that they've never had sleep apnea testing and they're on two or three medications for blood pressure. I'm thinking, gosh, this is so crazy. Like no one's checked their sleep apnea or overnight oximetry.
[57:43] I send probably 95% or more of my patients for an overnight oximetry because it is critical to make sure there's not sleep apnea. If sleep apnea is present, you're not metabolically optimized. It's more likely that your blood sugar is going to be less regulated. It's also likely that your cholesterol is going to be higher. So I am a big believer in overnight oximetry testing for all of my patients. I love it. My, you know, it's so, it's so cool at Mayo. I have like experts and like all the different specialties that love this stuff. So Dr. Joseph Chung, he is currently researching the impact of a whole food plant only diet on inflammation and sleep apnea to show reduction in that sleep
Addressing Alcohol Consumption
[58:25] apnea score, just the implementation of this diet. So it's been fun working with him with some of the studies in that space. Um, And then, you know, it's important also to, you know, ask like, okay, why, why can't you sleep? You know, is it stress of the diagnosis? Is it hot flashes? It's usually hot flashes for my patients. So I'm really aggressive at treating those hot flashes for the women I see, because a lot of the medicines that I'm giving are causing those hot flashes. And man, that's so disrupting from, they wake up, they're shoving the sheets off, they're soaking wet, then they're cold. It's just such a rough night. I really, my heart goes out to them. Is that is that something that you've experienced the hot flashes oh yeah so I it's interesting so I I kind of stumbled across something this is why I love being a patient.
[59:11] Like oh good figure this out this is great and then I was like oh she's so smart like oh no I just was a patient I figured it out for myself not smart at all it just helps to be a patient.
[59:21] So hot flashes so I was on they put me on magnesium years ago because of all my heart issues and i took it for a while and i stopped taking i'm like i hate taking supplements right and i, didn't think about it right and i get hot and then my daughter's like you need to take your magnesium so i started taking it again yeah and it told me i'm like wait a minute when i'm on magnesium i have no hot flashes when i'm not on it i do you know so what's going on so i started introducing my patients hey take some magnesium glycinate at night when you go to bed let me know what you feel from it they'd come back and man i'm sleeping better why do you think you're sleeping better. I think my hot flashes have reduced. He said, interesting. So I did a study a few years back and sure enough, we see a reduction in hot flashes with the magnesium glycinate. This is important. Magnesium glycinate is nicely absorbed in the bloodstream and it goes where it should go. It also crosses a blood brain barrier. So it gives you this beautiful relaxation. It's really nice. It can help you relax and sleep. And then it seems to help hot flashes a little bit, not dramatic, but there's a little bit of a benefit. So I love it to help sleep. It's my first supplement that I lean in on is magnesium glycinate. Wow.
[1:00:32] Yeah, no. And that was, and so I know that this was, is it a different kind of supplement specifically for the hot flashes? But it's something we didn't mention in the supplementation because I guess so it's so, because it's so specific. Well, and I waited because I knew I was hoping it happens to sleep. So I was like, I'm just waiting. I was going to mention, I was like, oh, we're going to bridge back then. Oh, you're being sneaky. Okay. Yeah. I talk too much. I try to be really clever about where I'm going to put my words. Oh, well, you are. You are. But so is magnesium glycinate, is it a liquid? Is it a pill? What is it? So I usually use a capsule and, you know, you do want to look at the different brands and I don't think I could probably recommend brands in here. I would be careful doing that, but it's important that you look at the label because some magnesium glycinate, you have to take four pills to get 400 milligrams. And the dose I recommend for patients is 400 milligrams at night. Some of my patients do between 400 to 500 milligrams at night.
[1:01:34] So that's how much I want you to take. is you need to look at that label. There are a few brands that are out there that one pill equals 400 to 500 milligrams. And those are the ones I have my patients taking. Okay. There are some powders you can do. You know, if someone is taking four pills before they go to bed at night, I'm not super thrilled about that. That's a lot of pills just sitting on your, in your GI tract. So there's nice powders you can do as well with the magnesium. Just take a look at the label and find out what they're sweetening it with. If there's any fillers, when you get into that whole powder territory, you start to run the risk of other additives being added into it. So just be mindful. Is there any other reasons why somebody would want to be taking this supplementation?
[1:02:14] Well, the majority of Americans are deficient in magnesium. So, you know, I get them on it to help them with their sleep, knowing that I'm closing this nutrient gap of magnesium that is very prominent in our country. Also for bone optimization, you know, for bone optimization, calcium magnesium vitamin d some folks advocate for k2 uh we need a little research i think it is interesting and i don't think it should cause harm the k2 research with breast cancer is interesting though because dietary k2 looks very harmful but it comes from high fat animal products so it would be harmful that makes sense right that doesn't translate to k2 as a supplement necessarily being harmful but there's this little bit of noise in the research so you know i i i I do like some of the studies on K2, to be quite honest. So I'm not against my patient taking it if they want to be on it. I think that there's enough data to show the safety. And I think there's certainly data that promotes that maybe it's a reasonable consideration for bone organization. Well, I mean, and I would imagine that most people that are eating a whole food plant-based diet are getting, I would imagine, ample magnesium from their nuts and seeds and other...
[1:03:30] You know, sources that magnesium comes from. They should be. And this isn't one we can really test easy and normal laboratories because the normal magnesium level isn't one that looks at the red blood cell magnesium. So if I check a magnesium, it's always going to be normal in my patient. It's not the more sensitive tests that I have available to me at Mayo Clinic. So you're right. And it's not a supplement that I really worry about the risk of overdosing a person, you know, in women who are pregnant, who are preeclamptic, they give them very high doses of magnesium to the point that the reflexes go down. So we know when you start to get too high, your reflexes are down and there's no way to get someone up that high because you're having to give IV doses at a really high rate. So it would be pretty impossible to cause harm with magnesium.
[1:04:17] But keep in mind, magnesium citrate, magnesium oxide, those will cause a lot of GI upset magnesium citrate will cause diarrhea, you know? So, okay. Okay. Let me ask you this. Yeah. So you, you, you mentioned kind of the, the avoidance, especially as we're getting on in the day of the blue light, what are your thoughts on alcohol? Because I know so many people that tell me they, they have a glass or two of alcohol now or wine and it just, it's, it sends their sleep into a tailspin.
[1:04:57] Absolutely. And alcohol is a carcinogen. You know, we have to step away from that. If someone wants a glass of wine, you know, once, twice a week or at special occasions in connection with others, I think it's probably OK, but they shouldn't go over that amount, particularly for women. You know, men, the U.S. guidelines are men can have up to two drinks a day. But if you look at Canada's guidelines are currently two drinks a week for both men and women. So absolutely, it can it can impede the sleep hygiene. It also can trigger those hot flashes more for women. So I really don't want my patients to over consume alcohol. And I really do limit them, you know, more, no more than one up to three drinks a week and never know, never more than one drink on any one occasion and never drink alone. You know, if you're going to have it, have it because you're enjoying it in a social connection. I don't think that we need to, you know, have alcohol to enjoy ourselves in a social connection. I certainly don't. But you know, it's a normal way of life for a lot of people. Ritually, culturally, we look at blue zones, it's a part of, you know, the power of nine and blue zones.
[1:06:08] You know, but in those areas of the world, people are living very different lifestyles than we do. So I think we need to really heed caution when it comes to alcohol consumption. Seventh leading cause of death in our country. And it's a direct link to increasing the risk of premenopausal breast cancer, breast cancer in young women, as well as postmenopausal. There's not many things that trigger premenopausal breast cancer in terms of lifestyle. And this is one of them. So we have to be careful. Yeah. So you mentioned, you know.
[1:06:35] Kind of like never, never drive drunk. You mentioned never drink alone, which, which leads me to the next topic. I'd love to discuss with you because I feel like it's been very prominent as of late. I know that. So I, I, you know, I had a Dr. Amy commander, uh, on the podcast last week, love her. She is, you and her are like cut from the same cloth. You're just so wonderful.
[1:07:03] And, you know, one of the things that with the work that she's doing is she's really like highlighting the social connections and how important it is for people to connect.
The Value of Social Connections
[1:07:15] And I'd love to hear from your vantage point, what you think are the, how important it is. I think you refer to it as horizontal connections and then vertical connections. Yeah. And Dr. Commander is doing amazing work. She's such a dear friend. So it's really exciting in this space of lifestyle medicine to have our connections as well. Horizontal connections are that, right? They're the loving connections we share with one another. And I love that. And it's so important that patients get involved with those loving support groups and surround themselves by love and harmony and peace. So I really want to encourage that horizontal connection. It was reported that about 60% of Americans feel lonely. That's a significant number. And Dr. Murthy, our US Surgeon General, he wrote a report on loneliness. And so this is a big area of discussion currently, because we know that those weak social ties are just as harmful as being obese or being an alcoholic.
[1:08:18] So it's very concerning. And there's actually been a study that connected it to the The equivalent of having 15 cigarettes a day is the same impact on mortality as loneliness, which is crazy. You know, there's increased risk of premature death from any cause when it comes to loneliness. So we really need to pay attention to this. Yeah, no, that is that is crazy pills. And I think in my life, especially as I've gotten older, Dawn, about some of my friends that I used to see all the time that, you know, for whatever reason, they're not married. They don't have families. And they're at an age now where some of them have retired. And they lead very lonely, monk-like existences at home or in their apartments. And, uh, and then when I do get together with them, I can see that they have gone downhill rather quickly. Um, so it's, it is, I think it wreaks havoc on, on your body, on your brain, on your, your wellness, all those things.
[1:09:29] Well, I think this is a, you know, big shout out to these events that you do, you know, when you see that connection and that love and that engagement, it's like the energy the room just raises. And I think that that's so special to be actively involved in community. And that's also, you know, a big reason if someone doesn't have family, you know, sometimes these things aren't avoidable. It's just how it ends up being. Consider volunteering. One of the best things you can do. You're you're giving back. It's an act of service and it really helps to define, you know, that, and you shared that nice quote from Picasso. Amy and I shared both of our favorite quote is that the meaning of life is to find your gift, but the purpose is to share it with others. You know, so volunteering can help you to fulfill that need for that horizontal connection, which I love. Yeah.
[1:10:18] Well, and it's one of the reasons, I mean, I look back at what happened with COVID and how many people hightailed it into their homes, their apartments, and weren't going out, weren't seeing people. Uh i especially i know so many high school like adolescents that it really affected in a major way and their only connection to the world was through their you know their their cell phones and you know how unhealthy that is and that just leads to i think even in a heightened state of, of loneliness and isolation. Um, so you're right. And that doesn't close the gap that they think they're getting a social connection by doing their various social media, Snapchat, Instagram, Facebook, but that doesn't close the need that doesn't erase the need for true social connections. So very good point, which is why I am such a fan of pickleball.
[1:11:27] I can't even tell you what pickleball has done to save the the lives and the social connections of so many people that i know it's crazy well that's cute you mentioned that because when they look at these sport that's linked to longevity you know what it's racket sports so that's and so maybe it's this maybe it's that connection i had a meeting earlier today with a rennie ma she She was my hospital administrator that came with me to plant stock this year and got to play pickleball with you and John Mackey. And she's so good in pickleball. So we have a team actually that plays in our city and she helps that team come to victory every year. So Mayo Clinic took home the goal. Wow. Fierce team. I remember she was good. She was good. And she was, and she was very competitive.
[1:12:16] So intense, but yeah, go Renny. So we love that. We love how intense she is. So that's good. But you know, real quick, you mentioned also, I love the ability to talk about connections with my patients because it's easy to talk about horizontal connections. Everyone knows what that is, but when it comes to spirituality, that's kind of an awkward thing to talk about to a patient, Right. Like, how do you how do you break the ice on that one so I can easily use, you know, the American culture of lifestyle medicines, six pillars of connection and go into this horizontal as well as vertical. And so vertical connections are belief in something bigger than yourself. And gosh, if we think we're all that matters and we're that inward thinking, you're going to just succumb to your cancer in a pretty rough way. That's all I'm going to say. As soon as you get cancer, all of a sudden you find spirituality. You find the fact that life is something bigger than what you're all about. And that is like the saving grace, no pun intended, to the beauty that can unfold from that teachable moment or the teacher of life of what cancer can really be. And that's where people can really lean in to just the essence of the experience of going through what they're going through and learning from it. You know, stoic philosophy. I love it because they really give so many deep lessons that can help to build our resilience.
[1:13:41] And I think that this is one of them is just knowing that life is truly about
Spiritual Connections and Wellness
[1:13:46] something bigger than ourself. And so, yeah, I would say out of all the pillars of lifestyle medicine, it's probably the most important part of it.
[1:13:56] Um more important than the food i hate to say it yeah because if you don't have that belief in that meaning and desire you're not gonna have as much interest in showing up for yourself right like this is like the substance of what we're about so i don't know like i'm just like jubilant.
[1:14:21] I think that's like what what matters to me is it's just like that knowing you know and i've got to learn the hard way that i i trust in that process with some of my experiences yeah let me ask you this so what what is your vertical spiritual connection.
[1:14:40] You know, I am not formally, you know, formally religious, I would say. I grew up going to church. I still go to church occasionally. I'm not like as good as I should be or one tells, but I just, I pray. I believe in God. For me, it's God. I know some people use source or universe, whatever it is to you. But for me, it's God. And I pray and I give gratitude. So that's how I use my gratitude practice is I thank God all the time. I'm constantly thanking God, you know, for whatever it may be for the October supermoon. Like, holy cow, is that magical? And it was so amazing the power of that. Or after the hurricane, I saw so many amazing pictures. It's like, oh, my gosh, how could someone deny the fact that there's a God? You know, it's just like magnificent how the sky lights up. So I guess what I would say is I do hear a lot of people relate to nature as their God. And I can see that because I see that deep reflection in some of the miracles that just seem to appear. So for me, that's how it unfolds in my life. And it's just that knowing, you know, I had had that near death experience in 2016 that it's, I feel like as if I met in a way, the spirit of, of a larger force than me.
[1:16:03] So I was very blessed to experience the power of that existence kind of one within me in that four minutes that I was in that space. So I would never deny it for me. That's what works for me. You know, we should never compare our stories to other people and nor should we judge other people. You know, I've had we all you know, I think it's only natural to probably go towards judgment. We really want to try to not do that. We want to just try to have acceptance and kind thoughts for others. And to know that every one of us come from different experiences, maybe different sorts of traumas, different backgrounds. And so these thoughts that we have are things that we just have to work on and have to process and understand more deeply. Dr. Dawn Mussallem for president.
[1:16:55] No, no. I mean, gosh, you know, I mean, it's just so exciting for me. And I just think when it comes to the whole food plant-based nutrition, I've said this before, it's just such an opportunity to just nourish and love yourself, right? love others, love self, be self-compassionate, be gentle with self, show up for you. That's so important. Um, whether you have cancer or not, that would be my message. Yeah. Um.
Success Stories in Healing
[1:17:23] So let's, wow, you know, Dawn, this is, I just love talking to you.
[1:17:29] Can we finish with fun, some fun spices and herbs that you recommend to your patients? Yeah. So, you know, when it comes to herbs, I love omelet fruit. And I know Christy Funk loves this one too. She's just so amazing for the messages that she spreads to such a wide audience. So omelet fruit is Indian gooseberry. You can get it in a powder or a supplement. I have the majority of my patients on this. You know, a lot of my patients come in wanting to take collagen and I actually don't encourage collagen for my patients because there is some cancer research that I find is concerning. So I like collagen. It's good for skin. It's good for hair, but bigger than that, it's a powerful antioxidant. It's a powerful anti-inflammatory. And there's some crazy cool research with what it can do with cholesterol. There is research showing that it can lower ldl and triglycerides by 20 and i see exactly that in my patient population it's fascinating wow i love amla and you guys have a green tea indian gooseberry tea which is yummy that's uh yeah thank you with an amla amla base yeah yeah yeah yeah the indian right so so i love amla you know i love ginger cook with tons of ginger you know use the fresh ginger root. Like if you're using a smoothie, I'll just pull off a big piece and wash it. I don't even peel it, throw it in your blender, make your smoothie or use ginger spice. So that's great. Ginger tea is great.
[1:18:57] Turmeric E. Turmeric is a supplement. I don't recommend very much. Lots of drug interactions. Interacts with chemotherapy. Women, breast cancer, tamoxifen, do not do it. Turmeric is a supplement with tamoxifen will deactivate the ability to make tamoxifen into It's active form that will treat your breast cancer. So no to the supplement of turmeric, unless your doctor says it's safe. Now it's totally safe as a food. So cook with it as much as you want. Just don't take it as a supplement. So I use a lot of turmeric as a food for my patients. What's Dawn, what's the difference? Is the pill form not just ground up turmeric?
[1:19:39] The dosing is so much higher in the pill. You're getting higher doses when you're taking it. So I give them the green light as a food, as a spice and their curry, whatever they're doing. But I just don't want them doing it as a supplement. That's my big it's so hard to absorb turmeric anyways. You know, it really is hard to absorb it. Um, so the likelihood of a toxicity interacting with some of these various chemos and with tamoxifen may not be as substantial as I'm kind of, you know, describing, but let's not take a chance because that would be detrimental. And again, it's first do no harm and gosh, it's so delicious in our food, you know, so use it in your food. That's my recommendation in regards to that. Ceylon cinnamon is amazing for blood sugar. So I recommend, you know, a half a teaspoon, up to one teaspoon a day. I have them add it to their overnight oats. I recommend the Ceylon cinnamon because it doesn't have the Coumarin is what's reported in it. So it's maybe a little bit safer. So I love the cinnamon.
[1:20:42] Oh, I know another really cool seasoning is cardamom. And this is thought to be like the queen of spices. This is kind of corny. Like this goes back to my naturopathic years, but it's a very feminizing herb. So I think for women undergoing breast cancer treatment, I give my patients like a very healthy granola recipe where they don't use oil. There's like just a tidbit of maple syrup in it. Some other nice things and cardamom and cinnamon. And they love it. It smells delicious. So I love cardamom. Some cool fatty liver studies that showed that it can improve the liver function, the liver enzymes, as well as reduce some inflammation, oxidative stress with that cardamom. So it's a powerful antioxidant. I love cardamom, so consider it. Those are my favorite spices. That's interesting about the fatty liver. I mean, I know that it seems like non-alcoholic fatty liver disease is like skyrocketed. No kidding. It sure is. And that's my next plan of attack. Next study. I'm going to take that breast cancer study and put it over in our liver transplant team, because that makes me pretty sick to know that we're actually doing liver transplants for people that have fatty liver when we can reverse it with a whole food plant-based diet. Right? Yeah. Let me ask you this, Dawn.
[1:22:01] And first, let me make a statement and then tell me if you think this is correct. And that is, it seems to me that the number one cancer in women is breast cancer. The number one cancer in men is prostate cancer. Maybe in both, you know, a common denominator is colorectal cancer. What is it about the is that an accurate statement or not uh i'd have to look at the most recent reports in that but you're bringing a very good point up when we think of these lifestyle cancers absolutely and we know lung cancer is still the cancer that people tend to die from but that's not one that's always you know a lot of those lung cancers aren't necessarily from smoking all the time it can be combined so when we look at the ones you're talking about i think i know where you're getting at from a lifestyle perspective. Well, my question is, what is it about the breast tissues? What is it about the prostate that somehow is attracting these cancer, I guess you'd call it, these mutations to occur and for the cancer to take place there? Do we know?
[1:23:10] You know, there's more than just those cancers that are increasing. You know, we see a lot of endometrial cancer, ovarian cancer, as you said, the colon cancer. And I feel so much of this is lifestyle mediated. You know, we know that alcohol drives the risk of cancer. We know obesity, overweight drives the risk of cancer. That adipose tissue carries along so many deleterious side effects, pathways that it interrupts.
[1:23:35] You know, we know the nutrition. You know, JAMA, the Journal of the American Medical Association in 2022 said food is a leading cause of death in our country. You know, we know it's so harmful. And when we look at a recent report on the incidence, the rise in cancers among young people, we see this very concerning rise among breast and colon cancer in young people. And you know i'm i'm out of the arena of prostate cancer so i i can't speak to is it they're seeing an increased rise in younger prostate cancer patients as well but i would expect they probably are i i should be careful with that though but with the breast and colon cancer you know this report is because of lifestyle in colon cancer people aren't getting enough fiber and breast cancer is for a myriad of reasons um you know and we look at the various toxic exposures that individuals pollution. We look at the preservatives that are in food. There was a really interesting report that was published this year that, and this is concerning, mono and diglycerides. It's in everything. It's in baby formula. It's in plant-based yogurts. It's in plant-based ice creams.
[1:24:43] It's in almost every plant-based milk. Yeah. Exactly. Mono and diglycerides increase the risk in the study. This is a French study. They followed for seven years, increase the risk of breast cancer. 24%. Are you ready? This for prostate cancer? It gives me, I have chills right now. Set ready to say this 46%. These are associations guys. So it's not like it's good, but it's still, that's a big number. That's you don't need mono diglycerides. The wraps rip. You brought up that you like the Ezekiel wrap. I have a picture. I show my patient. Hey, this is, this is a safe wrap. Let's look at the ingredients. When you go to the grocery store, find something similar. You know, it doesn't have to be this, but that's the one I personally use as well. The majority of wraps out there all have mono and glycerides. The vegan butters, all mono and glycerides. So it makes this stuff kind of soft. And then Karen Gann, another thing in plant-based milks, there was 32% increased risk of breast cancer, the association. So, you know, there's so much out there. If we could just back up and make life more simple, like do what our grandparents did, So, you know, move around, love a lot more, worry a lot less, get some sleep and eat your plants. Lots of vegetables, fruits, whole grains, fibers, you know, beans, get your resistant starches and spice. Spice has such powerful medicinal value. Get lots of variety. Yeah. My sister Jane loves to say plants, plants, plants and dance, dance, dance.
[1:26:05] I have a picture of Jane dancing. Yeah, I love that. That's so cute. That's so cute. Love it. Yeah. So Dawn, I don't want to, I don't want to be too greedy with my time with you. So I want you to end, let's end my, my time with you today. If you could share just one, and I know, I know you've got dozens and dozens and dozens, but just one of your patient success stories. So we can kind of leave on a super high note today. Yeah i'm gonna share the one that i think is the most powerful and you know i when i talked at Plant-Stock i talked about how i don't even like to use that word hope because i think there's a dichotomy like hope is like you're still kind of wondering if i like knowing like i like to meet people from this knowing there's still this you know part of breast cancer when women are stage four that they tell women you know there's no cure i kind of don't like that because i was in that space once where they said, Oh, you have so long to live. I hate that. Like we are not for Dick. I'm here 23 years later. I had, you know, of course I had the non-Hodgkin's lymphoma, but same thing. I give it X amount of time. Michelle Mecca. She knows I talk about her story widely. She was a fitness competitor, well-known, beautiful, amazing woman.
[1:27:23] Really exercising, right. But diet, you know, in that, in that space of fitness, she was doing a lot of animal protein. Not saying that was a trigger, but it was present. She gets breast cancer, very aggressive. HER2 positive, estrogen receptor negative. A few years later, it recurred to her brain. So she went through radiation. She went through various treatments. She went through surgery as well, because after the radiation, they wanted to make sure that what they were still seeing on imaging didn't have cancer in it. And in fact, she is now cancer free. Here is a woman with metastatic cancer to her brain. She's whole food plant based. I was climbing a mountain in Canada. This is true story.
[1:28:07] Like dying, right? I get a message. I'm like, God, Michelle just saved my life. Literally. It says, Hey, Dr. Mussallem, you're not going to believe this, but I can't stop thinking about broccoli. She's like, it's like a true addiction. She's like, I just constantly want it. So it's so cute. So she's whole food plant-based now doing amazing travels around the world, talking about her journey, her story. She remains on medicines every single day. These medicines are tough. Like her life isn't easy it's like constantly resistance she's on this one medicine that causes ulcerations of her hands and feet god bless her she was a fitness competitor she still spends a lot of time in the gym you should see her muscles still and she wears like special gloves and special socks so she can still do her exercise because she knows knows how important it is um but yeah incredible i mean i have chills talking about just incredible woman so resilient and just nailed it won that competition on metastatic breast cancer. So just applause to her is a good story of knowing that it is possible in women with metastatic breast cancer that you can get rid of this disease. You're going to be on treatment possibly for maybe even most of her life. But the good news is she's flourishing. So really awesome.
[1:29:20] Well, I think that's a great segue because in my book, you will always be one of the most incredible, fascinating success stories. You epitomize resiliency, as we talked about, I think, last time.
[1:29:41] Toxic happiness in the best way, right? And just a force of life that radiates alive.
[1:29:56] And I love my life. and you've, you know, you're, you're living true to that Picasso quote. So way to, way to be Dawn.
Wrapping Up with Key Takeaways
[1:30:06] I, I, listen, I just, I can't tell you how grateful I am for you coming on the podcast, not once, but twice this month to share all of your, your knowledge and expertise. Everybody's going to be so much better off for it. And you know, I just, I can't wait till the next time we We get to either be on the podcast together or be together in person at one of the PLANTSTRONG retreats. I can't wait either, Rev. Thanks for the amazing work you do for inspiring everyone. And you bring such good energy to this. You know, it's so exciting in your family too. So it's really a beautiful example of what life can look like when you put the effort in. So thanks for everything. Thanks for having me here. I appreciate it. Hey, we got you the first one, Fistbump, . Thank you. Come on. Oh, there you go. Boom. All right. PLANTSTRONG. Bye.
[1:31:04] Boy howdy i took away so many wonderful ideas and advice from this episode and i hope that you did as well we are so lucky to have someone like Dr. Dawn Mussallem on our team rooting for each and every one of us now once again if you're listening to this episode the day that it comes out which is October 24th. As a reminder, you can register and attend this free webinar. It's called Hope and Healing, Navigating the Breast Cancer Journey. It'll be tonight, and I'll be sure to drop that link in today's show notes. I would encourage you, please share this episode with anyone who you think might benefit. We know that navigating a difficult diagnosis is confusing, it's paralyzing, but we also want to empower you to make the healthiest decisions that you can for you. Thank goodness that we have doctors like Dr. Dawn Mussallem who also feel the same way. Until next time, always, always keep it PLANTSTRONG.
[1:32:14] The PLANTSTRONG podcast team includes Carrie Barrett, Laurie Kortowich, and Ami Mackey. If you like what you hear, do us a favor and share the show with your friends and loved ones. You can always leave a five-star rating and review on Apple Podcasts or Spotify. And while you're there, make sure to hit that follow button so that you never miss an episode. As always, this and every episode is dedicated to my parents, Dr. Caldwell B. Esselstyn, Jr. And Anne Crile Esselstyn.
