Introduction and Dr. Liz Bohamu2019s Breast Cancer Story

Hi there, it's Dr. Jenn Welcome back to the Breast Cancer Breakthroughs Summit. I have a special treat for you. That's I have a brilliant functional medicine provider who is such a special person, and she is my friend and my inspiration.

And she was really the first person that I encountered that really created the vision for me that I could leave surgery and actually help millions of women by practicing functional medicine and changing the way that we look at breast cancer.

Now, I have Dr. Liz Boham with me and she actually comes to breast cancer and her functional medicine story in a, I'm sure unasked for and unique way.

But she comes the story because she was diagnosed with breast cancer and it was while you were in training? I was in my residency, yes. So you got a very unintentional education, but you have shared that experience with the world and made many, many women journey better because of it.

So, first of all, I want to welcome you. I'm so glad you're here. Thank you. Dr. Jenn it's great to be with you and all of your people summit. It's really great.

Jenn, I'm so I'm so glad you're here. I should give a little background about you because you are the partner of the very famous Dr. Mark Hyman, and you work at the UltraWellness Center, and you've been there since 2007.

So really a long time you've been practicing integrative medicine at the Canyon Ranch in Maddox, Massachusetts, and you were partners with the Albany Clinical Nutrition Specialists.

So you've been in this space for a long time, really working in an amazing place, making an incredible contribution. But it really started off with your journey.

And because you were you you were originally internal medicine or family medicine, what was your training? Yeah. So I'm board certified in family medicine.

My undergraduate and graduate degree was in nutrition, so I was always interested in nutrition and using food as medicine. I'm I'm actually a registered dietitian before I went to medical school.

And so I was all into prevention. You know, that was like my big thing. I really had no idea what medical school training was going to bring because I didn't have physicians in my family.

And then so I'm in the middle of all learning all about this acute care medicine, but still believing in prevention. And then I'm in my training, my residency training for family medicine.

And I found a mass and I was 30 and I had no family history of breast cancer. And I never thought I was going to have breast cancer. Like I came up with all sorts of diseases for myself.

But breast cancer was not one of them. But I was you know, I was I was lucky from the standpoint of being around a lot of physicians. And I had just trained with a breast surgeon and everybody moved forward, even though I never thought it was breast cancer.

You know, it was not I wasn't thinking it was breast cancer, but it ended up being a triple negative breast cancer. And so I did go through chemotherapy and radiation after the surgery.

And so, yeah, 24 years ago. Wow. Wow. So I guess the first question I have to ask is I'm sure that a lot of people feel this way. Is that how does someone who is focused on nutrition, who is so focused on prevention and wellness, not as it happened, that that person gets breast cancer?

Because I'm sure a lot of people ask that question. And I did, too. You know, I was I was pissed off, to be honest with you, like I went through those five stages of grief.

But definitely anger was one of them because I was like, I'm 30 years old. And back then, you know, it was rare for a 30 year old to get breast cancer.

And I definitely didn't know anybody in their twenties. Unfortunately, we're seeing a rise in in young women getting breast cancer. And so now it's still not as common to get it when you're 30.

But it's unfortunately a little more common these days than it was even back then. But I was I was I was angry and actually functional medicine was a great place for me to sort of sort through all of this and make sense of it because like, we know that prevention is important and lifestyle is important and what you eat and what you do for exercise and and how you manage stress in your sleep.

But we also know there's more things going on. Right? We know that our genetic may have an influence. We know that our environmental exposures have an influence.

We know that our mom's environmental exposures have an influence. We know that our microbiome has an influence. So there's so functional medicine really helped me sort of learn about that.

We have to take all of these different aspects into account and ask the question, why for that individual person? So for for me, in terms of my lifestyle factors, you know, I wasn't that good at managing stress.

I was working nights, I wasn't getting enough sleep. I was angry with, you know, the decisions I made. Right. So there was there was like the stress piece that I had to work on.

But then it sort of also taught me there were other things in my body that weren't working great, right?

Why Breast Cancer Can Happen Despite Healthy Habits

Like my microbiome and my my gut health needed a lot of attention the way that I detoxified needed a lot of attention. So what is wonderful about functional medicine is it helps us work with that individual person so we can figure out for that person where do they need to focus.

Right? Yeah. And I'm sure that in learning about functional medicine, it was eye opening because what we typically consider healthy and what is actually healthy are oftentimes not the same day trend.

I don't know about your practice, but I routinely have people come to me and say I'm healthy, but I have breast cancer and this makes sense to them. I mean, they really believe this.

And I think one of the problems with breast cancer is that you don't feel sick unless it's very, very advanced. Mm hmm. Right. And so it's kind of it sneaks up on you and people don't realize that there actually is something there that is out of balance, that is leading to this breast cancer diagnosis.

And really, it helped me realize what was out of balance in my body and what I needed to do to put things into better balance and create that healthy terrain so that hopefully it won't come back or it hasn't yet and hopefully it won't.

Right. But but all of that made me healthier anyway, right? Because because working on how I interacted with the world and manage stress and taking time for myself and getting more rest, that helps all of the whole my all of my health issues.

Right. And helps my body be able to heal much better as a whole. That's very true. And ultimately, breast health is health, right? So the same things that we're doing to drive our breast health.

We're doing to drive our overall overall health. Yeah. So let's let's start to get into what are those lifestyle factors that contribute to an increased risk of breast cancer.

Because when you were diagnosed at 30, it was pretty rare to see breast cancers that young, but it's not so rare anymore. And we're seeing them at younger and younger ages.

And I suspect it's because our environment and the way that we live is actually worse. Yeah, I mean, I think that you're right. The question as to why are we seeing more and more younger breast cancers?

You know, one thing that that that comes up a lot is the that we're eating more and more processed food. We're not getting as much physical movement and exercise and that we as a whole are heavier, that we have more weight.

Right. That we're heavier or more obese. And because we do know that our diet and our weight and our exercise all contribute to risk of breast cancer.

But I do think, especially with certain populations and especially with the younger population, we also have to really acknowledge the fact that our environment and our environmental exposures are playing a huge, you know, having a huge impact here.

So I think that, you know, outside of lifestyle, we know that our toxin exposures and as I mentioned earlier, you know, our mother's toxin exposures and our grandmother's toxin exposures are impacting our risk.

And I think that we can't just I don't think it's only lifestyle that's that's impact, you know, is the reason why we're seeing this this increase in in lots of cancers in younger people, including breast cancer.

Yeah. Yeah. Talk about a little bit what you are referring to when you talk about mothers and grandmothers, toxin exposure. Connect the dots for people.

So in case they don't understand that relationship. So, you know, they've done a lot of research on endocrine disrupting chemicals. Right. So the endocrine disrupting chemicals are chemicals in the environment that, you know, exogenous chemicals in the environment that interfere with our hormone action in our body.

So there are many endocrine disrupting chemicals out there. Lots right in one of the ones we know the most about is BPA. Right. So we started to learn about BPA that that that substance in hard plastic, but also in the lining of cans or and on in dental sealants and on receipts that you receive.

You know, we know that BPA is an endocrine disrupting chemical. And what that means is that it it can impact hormone action or hormone metabolism or hormone, all sorts of things that that the hormones do in our body.

Environmental Toxins, Endocrine Disruptors, and Transgenerational Risk

And so they've shown that when women have exposure to endocrine disrupting chemicals, either when they're a fetus. So, you know, they're inside their mother's belly.

Right. That that's going to influence that that can influence their risk of getting breast cancer 30 years later or 50 years later. And what's fascinating about endocrine disrupting chemicals is that it's not like a linear relationship, like a lot of toxins.

We think about, okay, if you have a little bit of exposure to lead, that's not good. But if you have a lot, that's even worse. But they're doing some research with endocrine disrupting chemicals and seeing that there's not necessarily a linear relationship.

It's more the timing of the exposure and that there may be some exposures that impact epigenetics, which means that which is your genetic expression. And so they're there.

They've been they've been doing some research to see how does that impact a woman's risk? Trans generationally, right. So so so that if your if your grandmother had exposure to some endocrine disrupting chemical, how does that impact a woman that grandchild risk of breast cancer?

So I think that there's a lot that, you know, we don't completely understand or appreciate in this area, but those scripting chemicals are are way more pervasive.

And all of these toxins that we're getting exposed to that we didn't used to get exposed to 100 years ago, you know, you know, from from like the BPA, the plastics, the parabens, the phthalates, triclosan and, you know, and then just other pesticides and herbicides, I think have, have and have an influence.

Absolutely. Yeah. And we've actually seen I'm like forgetting what the name of that drug was that was given to women in pregnancy. D. S. Yes, right. And so those, those children, children of, of women who were treated with DS end up having a whole host of cancers as a result.

And so that was, I. Think in 1971, I think it was 1971. But but women, you know, it was used for years to prevent miscarriage. And it's hard sometimes to find out, you know, to get those records, you know, sometimes we're in a situation, we're trying to get those records to find out what what exposure a woman had.

And it's sometimes very hard to get those records. And now that we're talking about grandchildren, potentially, it's it's it is very hard to always put the put the pieces together.

Yeah, absolutely. Absolutely. So we kind of can't help those things that we've been exposed to. Right. But I mean, I help. Yeah. I'm sorry. I don't mean to cut you off. Oh, no.

I was just going to say, like, how do we start from today with whatever hand we were dealt and try to make it better? Absolutely. So I think that's really interesting because lifestyle can have an influence here.

So we don't want to just throw up our hands and say, well, who knows what my mother was exposed to or what I was exposed to when I was a teenager. But there are things that you can do and we're learning about that can influence how that toxin can influence us.

Right. So there's been some really interesting research looking at how phytonutrients, right? So the phytonutrients are the components of our plant foods.

So in plant foods, let's just take spinach, right? You have vitamins and minerals, but you also have phytonutrients. And these components are the are these parts of our plant foods that have this tremendous ability to impact our health.

So some phytonutrients have been shown to lower inflammation and some phytonutrients have been shown to support detoxification. And some phytonutrients have been shown to decrease angiogenesis, which means that the sending of blood vessels to a tumor that help it grow or lower aromatase, which can shift how hormones change in the body.

But there's been some really interesting research looking at how phytonutrients can block the harmful effects of plastics in the body. So really an interesting study that looked at.

So if you have more of phytonutrients in your diet, that that can actually block the action, the negative actions that plastics like BPA can have in the body and can and may then therefore decrease the growth and spread of a cancer.

So it's it's fascinating. So we always talk with women about getting those 8 to 12 servings of phytonutrients in a day and so get it, you know, eating from the rainbow, which is meaning that you get all sorts of different colorful plant foods in your diet because that's where you're going to get all sorts of different phytonutrients.

And and and, you know, there's so many things that fall into this phytonutrient category from ellagic acid and lycopene and, and, but also like the ones we hear a lot about in the breast cancer world, the glucosinolates.

Right? They come from your cruciferous vegetables. They go on to produce soft urethane in the body and sulforaphane is like is magical from a from a estrogen metabolism perspective from helps our body make glutathione own which helps the body detoxify from toxins.

It feeds the good bugs in the gut. It's a real strong antioxidant and it can decrease DNA damage that occurs from carcinogens that we get exposed to in the environment.

And so, you know, cruciferous vegetables, broccoli, broccoli sprouts, brussel sprouts, kale, cauliflower are so rich in this substance. And so we are always encouraging that for that reason, right?

Yeah, absolutely. So we hear a lot about this term estrogen dominance and there is a preconceived notion that the reason that women get breast cancer is because they have too much estrogen.

And there's estrogen dominance. So can you talk about that a little bit? And then can we talk about estrogen detoxification as well? Yeah. I mean, I think what's really important in this area is what we're talking about in terms of estrogen metabolism and detoxification.

So, you know, sometimes women will have a what falls in the category of estrogen dominance picture, like they maybe have more breast tenderness around their period or more PMS or they're more prone to endometriosis or fibroid production or.

Right. So so the feeling is that they're not able to metabolize and detoxify their estrogen as well.

Phytonutrients, Cruciferous Vegetables, and Detox Support

And that's something that we really focus on a lot in functional medicine is we will focus on looking at how does that woman metabolize and detoxify estrogen.

So so, you know, I for example, I had after like ten years after I had breast cancer, I had a blood clot. Right. And in my subclavian vein, well, that also, you know, we're more prone to blood clots when our estrogen is higher.

Right. So but what's important to really focus on is how are you mobilizing that estrogen? So we'll look at things like genetic variations and snips, things like the low penetrance genes.

So we're always focused on those high penetrance genes like Baraka. Right, which is important to look at. But we also know that there are these low penetrance genes that lots of women have variations in.

But when brought together, are they influence how a woman multiple things in their body, but also how they metabolize and detoxify their estrogens and and it's not just the estrogen that's already done its job and you're working to get rid of, but it's also some of these Zino estrogens, right?

These estrogen talk, these these toxins from the environment that we were talking about earlier that impact estrogen, the estrogen receptor in the body, unfortunately, like BPA, it's in parabens, right?

So so, you know, we look at things like serum T and some other genetic snips that are influencing how that occurs in the body. And we can also measure it directly.

You know, there is a test that we can look at that looks at how is the body actually metabolizing their estrogen or our estrogen, how are we doing it?

And also look at the gut microbiome, because we know that the the balance of good and bad bacteria in the gut influences how you get rid of multiple toxins, including things like estrogen that's already done its job and it's time to move it out of the way.

Right. So you want to eliminate it through the gut, but if you have an imbalance in the gut microbiome, if you've got like what we call a dysbiosis, an imbalance in the bugs, you can have an elevation of this enzyme beta glucan it, which allows the estrogen to get cleaved and get reabsorbed back into the body.

And I'm sure that's influencing toxins and toxin reabsorption as well. Right. And so so it's we also will look at the gut microbiome to say, okay, how is the body getting rid of these hormones and xeno estrogens?

Yeah, I think people really struggle to understand how the gut is connected to hormonal health. So we you were you talk about that a little more to make that connection a little more understandable for people.

Sure, I will try. Right. So your covered we are covered with these trillions of bugs, right? Bacteria and viruses and healthy fungi. Right. And they cover our skin and our nasal passage way.

There's even certain, you know, bacteria in the gut in our in the breast tissue, in our our vaginal area. And and when things get out of balance with these bugs, when they get out of balance, that's when we call it dysbiosis.

So it's not necessarily an infection. So if you've got a stomach bug and you've got this this bacteria and it's an infection, and sometimes you might have to treat it or, you know, you're very, very sick.

But a dysbiosis just means an imbalance. So not necessarily as acute or as symptomatic as when somebody has an infection, but there is an imbalance. And this dysbiosis is sometimes hard to put your finger on.

You know, you can sometimes women or people will have symptoms in their digestive system when they have dysbiosis. So they might feel bloated, they might feel constipated, or they may have diarrhea, or they may just not digest food.

Well, but sometimes women have no symptoms. And we find dysbiosis. And that dysbiosis or imbalance in the gut microbiome can impact our body in so many different ways.

One way is because it's inflammatory. So we know that when there is a dysbiosis, it creates a local inflammation because it's out of balance. But that local inflammation can create a systemic inflammation, right?

Meaning that our whole body has a higher level of inflammation. And what we know about cancer is cancer likes to grow when there's inflammation, right?

When inflammation is high in the body, cancer likes to grow. And so that's one reason that dysbiosis or imbalance in the gut can influence our overall health.

And and then in addition, the imbalance, the dysbiosis can also influence how well we remove toxins from the body. So I just gave you that example of estrogen.

So what happens is we've got estrogen going through the digestive tract after it's done its job and it's going to get released in the stool and it's bound to this substance called glucose chronic acid in.

If there is this dysbiosis meaning imbalance in the in the gut bacteria, there may be an increase of this enzyme beta gujaratis and that then will get you know, cleave that bond and allow estrogens to get reabsorbed back into the body.

And so as I mentioned, we thought that all. Other toxins, not just estrogens, right, but other factors as. Well and other toxins as well. So that's very important that, you know, and if we're not having regular bowel movements, right.

Estrogen Metabolism, Gut Health, and Dysbiosis

If we're not having regular bowel movements and depending on the gut microbiome that's going to influence what we reabsorb into the body and how well we're able to eliminate those toxins from the body.

And so that could influence that could be one additional thing that influences how a toxin impacts a person and how it impacts one person different than somebody else.

Right. Because we always want to figure out, well, you know, you know, you always hear that, well, this person smoked till they were 99 and they didn't get cancer.

Right. So we are all individual and how and we all have sort of our weak points or Achilles heel, right. Where where we are. We need a little extra support.

And so important to pay attention to that gut microbiome, because that is how you eliminate toxins, how you eliminate estrogen after it's done its job.

And when the gut microbiome is out of balance, it can create more inflammation in the body. And it's been shown to create more insulin resistance. And we know that insulin resistance and pre-diabetes and high levels of insulin and blood sugar are associated with more cancer, especially breast cancer.

Right. So so there's all these different ways that it's all interrelated. So one of the things we always pay attention to is we say we get a good history from our patients and we try to figure out what's going on in their digestive system.

You know, how are things working? How is that microbiome? Did they have lots of antibiotic exposure in the past? How do we need to support the good microbes we always want to support, you know, the the good bacteria in the gut with prebiotics, right?

So prebiotics are things that feed the good bacteria, the probiotics and prebiotics are things like all of those different phytonutrients I was talking about before.

So when you eat a high fiber diet and when you have lots and lots of different plant foods in your diet, that that feeds the good bacteria. Right. So they know that there is for example, I had mentioned ellagic acid before, which is comes from pomegranate and that then will feed the good bacteria in the gut.

So when people have whole pomegranate seeds or a pomegranate powder that can feed the good bacteria or the egcg from your green tea right, that's been shown also to feed the good bacteria in the gut.

So when you have a major tea without added added sweeteners. Right. Or, or like this sulforaphane that comes from your cruciferous vegetables also feeds the good bacteria in the gut.

So prebiotics are really, really, really important for building a good, healthy microbiome in your gut. And then in addition, you know, sometimes we use well, we use probiotics or we'll use fermented foods to help build up the good bacteria as well.

So, you know, so that's I think does that help with showing the connection between the gut microbiome and cancer risk? I mean, I think it certainly does.

And I think in that it it brings forward the point that a healthy gut is tied to health and that it's very hard to be healthy if you don't have a healthy gut.

So with that in mind, what how does functional medicine help to identify these imbalances? How do you identify dysbiosis? How do you identify hormone imbalances?

Yeah. So, you know, I think the first thing is just getting a good history. So in functional medicine, we do the go to it model, but the first part of that is gather.

So we're gathering all this information from our patients because getting a very good, detailed history helps, you know, where that person needs to focus.

So for example, you know, I said earlier about the antibiotics, if somebody was on antibiotics for multiple years of their life, maybe they used antibiotics for acne treatment.

You know, that may be a sign that, okay, we've got to be focusing on the gut microbiome. So a good history gives us a ton of information. And that's, I would say, where we always start.

There are times where we will use some additional testing. So, you know, we are using some stool analysis where we will look at the level of bacteria in the gut, the level of diverse city, because we know that the more diverse your microbiome is, the healthier you are.

You know, we look for some bacteria that have been associated with increased inflammation or these signs of dysbiosis. So we often are doing stool testing to to try to get a better understanding.

And you can also do there are some other tests like organic acid testing that will look to give you a sense of does this person have imbalances in their microbiome?

Are they prone to yeast overgrowth or bacterial overgrowth? So there's there's a lot of interesting tests that we can look at as well in terms of hormone metabolism.

We can look at directly, we can measure how the body is metabolizing the hormones and and that can be really helpful to give us more information. And we also will look at genetic predispositions.

So I was talking earlier about those those low penetrance genes. Right, that lots of us have variations in. And we can do panels that evaluate what your balance, what your different genetic variations are and how that influences how you metabolize your hormones, how you metabolize toxins and that sort of thing.

So in that instance, you're not only talking about the genes that we typically associate with the development of key cancer, like BRCA1 or BRCA2, you're talking about genes that that help to influence how we deal with our environment.

And they they help to determine how big our bucket is to be really simplistic, right? Because some people have a big bucket and lots of tolerance. That's that person that smoked all 99 and eat bacon and eggs every day and lived a full, healthy life.

And. Whereas, other people are born with a much smaller bucket and start to develop diseases caused by environmental exposures, much younger. Absolutely 100%.

And you know, so when you talk about that bucket, I think that's a great analogy. You know, depending on the size of the bucket, that impacts how much toxins will influence you, but also how, you know, Europe.

So it's your exposure, your genetics, right. Which is the size of the bucket, but also the timing of the exposure, which we know is really interesting.

And your lifestyle because because you can influence your genetics. What's need about looking at these genes, these these gene and genetic variations is that there's a lot we can do in terms of our lifestyle that influence how they work.

So when we see somebody who has a harder time with produce, including iron, which is so important for detoxification, then we say to them, well, make sure you're eating your cruciferous vegetables every day, right?

Or if they're like, I just can't. I have a hard time digesting them. And then maybe that's where you say, okay, I'm going to add in this supplement. Like, I'm going to give this person some extra salt purifying with miraz and salt.

I'm going to actually support that part of their their their health. That's where a supplement might come into play. So let's shift gears a little bit.

And, you know, I think it's easy for people to understand how plastics might be adversely affecting your health, how chemicals might be adversely affecting your health.

But what about the role of stress? What's happening there? And how does stress directly affect our health? Yeah, you know, it's interesting. They I think it's important to point out that, like, stress isn't necessarily bad.

We are made to handle stress. And and actually, when when it's that acute stress, when we are running away from that tiger, our immune system actually is activated and is working increased or better in a sense, because if you were going to get if you were bitten by that tiger, you know, your immune system is ready to heal.

Right. The problem is with this chronic daily, unrelenting stress where we're not giving our body time to rest and renew and and and and sleep and, you know, work through it.

So if we're under chronic daily, regular stress, we know that's not good for the immune system.

Functional Medicine Testing for Hormones and Microbiome Imbalances

In fact, they've shown that when people are under chronic, regular daily stress without having the tools to manage it and without giving their body time to rest and and rejuvenate that, that they're actually have lower levels of this important part of the immune system called the natural killer cells.

So your natural killer cells are part of your immune system that are that are going around and finding abnormal cells in the body and gobbling them up.

So if you're under a lot of chronic regular daily stress and you're not doing anything about it, that's when the immune system doesn't work so well. And so it's really important to not just get people get all worried.

They're like, Oh, no, I'm having stress. It's not stress is not necessarily bad. It's just that we need to have the tools to help us manage that stress.

So, you know, really giving your body time to rest, giving your body enough time to get sleep, getting outside and getting into nature, going for moderate exercise, right.

And walking and getting into nature, doing meditation and breathwork and journaling and gratitude. Journaling all of these things, all of these tools are there.

So we support our body to handle all the stress that we're under and all the all the stress that our body is made to be under. Right. So that's really important to have those tools in place.

Yeah. I think that there are two things to say about that. Most people don't develop healthy stress management tools until they're forced to. So I feel like in in our society, the stress management tools are so often alcohol, pot, you know, things that that quickly take the edge off for people.

And I do believe that that has negatively contributed to where we are today. And the other the other thing is that while we are built for stress, we're not really built for the kinds of stressors that we have today in that we're not built for constant cell phone barrage of messages and emails and deadlines and and the overconsumption that we that we have too much food, too much light, too much movement, too much everything, too much oxygen either.

And so I think that while we we have to have stress, right. We our bodies are are made for that, like you said, because we are meant to be able to encounter the saber tooth tigers of life and be able to run away.

But we're not meant to encounter them with the frequency and duration that we that we encounter them now. Yeah. So we've got to turn it off, right. We've got to turn off the phone and turn off the TV and turn off the computer and turn off work.

I mean, it's so hard because because we can now work 24 seven if we don't turn it off. Right. So no, anything about that? I don't know. I don't know what I don't know to what you refer.

I don't know. So we have to be the ones to turn it off or we have to end. But you're right, you are right about our core skills in terms of stress management tools.

And, you know, listen, I'm not I'm not I don't I don't know if I can say that I'm happy I had breast cancer. Like, I don't I don't know. I haven't gotten to that point where we're like, oh, yeah, it was a gift.

But but there was a lot of things about it that were a gift. Absolutely. And one of the things that absolutely forced me to do was change the way that I handled stress.

And and I had to I knew that I was like it was that was the one thing that I could tell. I'm like, okay, you were not doing a good job at this and you've got to figure out how to do it better.

And not that it's easy, but it forced me to say, okay, you know, are you getting enough sleep? Are you saying no? Are you doing your meditation? Are you know, doing your breath work?

You know, what are you feeling inside? Pay attention to that feeling, you know, let's work through it. And not just like you said, okay, I'm just going to, you know, deal with it by, you know, a substance or ignoring it or, you know, avoidance, right.

So I am truly grateful that it that that having been, you know, had this disease at that age really forced me because it's hard. And I find with my patients, it is the hardest lifestyle modality for people to adjust.

You know, maybe it's just who comes to see me and my practice. But, you know, a lot of people can say we're like, okay, eat this, do this. They're like, okay, got it.

Okay, do this exercise. Okay, got it. Get your sleep. And I'm trying. You know, it's that's hard to meet with your you know, you have a good community and network.

Okay I'm going to do this group support do the stress management. Yeah. You know, I didn't have time for that one stress. I can't meditate. I can't sit still. It doesn't resonate with me.

I tried. It's not for me. It doesn't work. Yeah, you're right.

Stress, Immune Function, and Lifestyle Tools

But, you know, having grown up in an environment where, you know, was I to working parents and you know, what we saw on TV was the parent comes home and fixes a martini and has that at the end of the day and my parents did that and fix the martini and that at the end of the day.

And you know, like we we grew up that that was your reward at the end of the day was to have a drink or to have a you know, that that that was the way that we dealt with the stress of the day.

And I don't think that my family was an exception that it I yeah and and so many people you know I've been admittedly like I've been fired by patients who were like I'll do everything else you say.

But if you tell me that I have to give up alcohol, like our relationship is over. Yeah. And so people, people feel very strongly about their, their approaches and it's deeply built into them.

And it's because I think that we are really not raised with, with healthy, healthy stress mechanisms. That's that's very true. And the research the research connecting alcohol and breast cancer is very deep and it is consistent.

And we see that it's a linear relationship. As our alcohol intake increases, so does our risk. Yeah, yeah, it's a direct it's a direct relationship, without a doubt.

Yeah. And you know, I hate to be that bearer of bad news, but it's it's really impossible to heal as you continue to put that particular toxin in your body.

And and and like you said, why where where is it coming from? What is it covering up? What is it allowing you to avoid to dealing with? Right. Yeah. Yeah, absolutely.

So I want to talk about what functional medicine adds to the breast cancer treatment paradigm in that what kinds of things do you include while someone is going through conventional medical treatment?

Because I know that you're like me and that I don't say that functional medicine is in or I say it's in and. 100% right. So I mean, the what what we are focusing on is not just the treatment of that cancer.

Right. The cancer cells or whatever. It's treating the terrain, that whole body really, because you want to create a terrain where in functional medicine, we are working to create a terrain or soil where cancer is less likely to grow.

And so we are looking at all those things that help us identify what will be food to feed cancer and help it grow and what will help prevent cancer from growing.

So we look at everything from inflammatory markers. So we'll look at see reactive protein because it's a marker for inflammation. And as I mentioned earlier, if C-reactive protein is high, then cancer likes to grow.

So we are all we will measure what's C-reactive protein and then let's why is it high? We ask the question why? Why is it high? What do we need to do to bring it down?

Right. We will. We know that cancer likes to grow when when insulin is high, when blood sugar is high. So, you know, we will measure what your fasting insulin, what your fasting blood sugar, what your hemoglobin A1 see.

And if those aren't ideal, we work to get them ideal, right? So sometimes means that people have to cut way back on the refined carbohydrates and sugar and and get in more exercise and increase their lean muscle mass and all of those things so that that's because that's important for creating a terrain where cancer is less likely to grow.

We will look at markers that tell us how the body is methylated so, you know, homocysteine, for example, we want that to be ideal. Again, it can help influence and create a terrain where cancer is less likely to grow.

I look at things like the natural killer self function. You know, I think that's an important marker to look at because that's a marker of your immune system function and does that need support?

Does it need support with things like the Asian mushrooms or zinc or vitamin A, things that support the you know, that part of the immune system? I will also look at markers that look at things like oxidative stress.

We know that oxidative stress is is you know, when there's too many free radicals that are formed in the body and that creates a lot of disease and aging in the body.

And so, again, if we find those markers are high, we ask that question, why? What do we need to get under better balance? So the terrain in the body is more supportive for health and less likely to cause cancer to grow.

And then typically during chemotherapy or radiation, are there any recommendations that you make to people that those treatments to be more effective and less harmful?

Yeah, so, you know, I think that I think that focusing on good nutrition is really critical here because that helps with with people just feeling better, you know, avoiding like sometimes in those during those treatments, you might feel like, okay, I'm just going to run and grab some muffin or donut or something just to soothe my stomach.

But, but good nutrition really is critical because it helps us feel, feel better not doing as much exercise as you can. So moderate exercise. So, so often we feel okay, I'm just going to rest.

But we do know that women who are able to do some exercise so or that do some exercise so moderate exercise, you know, it doesn't have to be crazy intense if you're not up for it.

But getting outside and going for a walk really does help us feel better. Yeah, I know. For myself. Yeah, I know for myself and so many of my patients, really, the complementary treatments worked great.

Integrative Support During Treatment and Recurrence Prevention

So, you know, getting acupuncture, your treatment I found really helpful for side effects Reiki cranial sacral massage really, really helpful to help me feel better and do better.

And then there are times, you know, I'm also also from a dietary perspective looking at things like, you know, the fasting mimicking diet and, you know, some ketogenic protocols that can help people feel have less side effects from their treatment.

And sometimes do we do better? Yeah, we use that as well. Yeah. Especially because chemotherapy affects rapidly dividing cells and we have that. That is basically our entire GI tract.

So if we can fast during chemotherapy and kind of make those cells quiet and and shut them down, make them not metabolically active, then the chemotherapy does not have such an effect on them.

So it makes a huge difference. We also has a lot of our immune system in our gut. So if that is quiet while we're getting chemotherapy, that can also protect those cells.

So there's a lot of protection goes on while we while we fast during chemo. So the fast and minimally mimicking diet and the work of Valter Longo around that is really amazing and I think has made a huge difference to a lot of people and.

It's very powerful. Yeah. And I loved the you talked about exercise because there are so many studies showing the benefits of exercise during chemotherapy and that people maintain their energy and they sleep better and they have a better mood and a better outlook and better outcomes.

100%. Yeah. I also often recommend gratitude journaling for for people as well because we know that when you have feelings of gratitude, when you write down, you know, three things a day that you feel grateful for, those feelings of gratitude really do help with mood as well.

They can help with our anxiety around everything. They can help with depression. And they absolutely give us help us feel a better outlook on the whole and the whole situation.

Yeah. So let's fast forward past that and for the people that have completed treatment, what are the best things that they can do to prevent a recurrence?

The number one thing I work on with everybody is, you know, is balancing blood sugar and preventing spikes in blood sugar and insulin. So the number one thing is, you know, you want to make sure that each meal of your day has a good, healthy source of protein, a good healthy source of fiber and a good healthy source of fat.

So protein, fat and fiber, because those three things will help prevent the spikes in blood sugar and insulin that we know can trigger the growth of cancer.

So I really have people, you know, focus on food and the power of food, both to help us heal and feel rejuvenated and and to help prevent a recurrence.

And then and then we mentioned this earlier, avoiding too much alcohol. So at least five or less drinks a week, though, many times when women when women have had breast cancer, we're going even lower than that.

And then regular daily exercise and getting sufficient sleep. I would say those are at the top of my list. Yeah, I agree with you. And are there are. First, I wanted to ask you, do you have people wear a CGM, do you feel like that is a valuable tool for people?

Sometimes, yes. So I think a CGM or continuous glucose monitor can be a really valuable tool. What it does is it measures how much your blood increases after a meal.

And I think for a lot of people, that can be very helpful information. It's not it doesn't give us all the information. You know, there are some people who have significant insulin resistance and their CGM doesn't look that bad because their body is making so much insulin and keeping the blood sugar in a pretty normal range.

But the high insulin, if we were to test with either fasting insulin or a glucose tolerance test, looking at insulin is showing us that, you know, not all is well.

So I think there are times when the CGM doesn't give us all the information. And then on the other end, there are people who who who get so concerned and worried with their CGM results that it creates a very unhappy, unhealthy relationship with food.

And so so I think a CGM, to sum it all up, can be some good information, but it's not perfect. So there are times where it doesn't work for every patient.

All right, that's fair. And lastly, what labs should everyone know about them for long term maintenance purposes? Like what should people be checking and make sure that they know about themselves every year? Yes.

So definitely get your high sensitivity C-reactive protein, that's the marker of inflammation and you want it to be less than one. Definitely get your vitamin D level, your 25 hydroxy vitamin D level.

You know, people debate about what is optimal, but probably somewhere between 50 and 75 is is great place to be for vitamin D. I want to know your fasting blood sugar and your fasting insulin.

Ideally, I like fasting insulin around five and fasting blood sugar, definitely less than 100, maybe even less than 90 for most people. And then your hemoglobin A1C, hemoglobin A1 C tells us about your blood sugar, how it's been over the last three months.

So hemoglobin A1c a 5.5 is pretty good. You don't want it to get much, you know, you don't want it to get like 5.7 is starting to get a little too high for you.

No, definitely not greater than six. This means your blood sugar has been running too high. And I also like to look at homocysteine. Homocysteine? I love to be around eight.

And that gives us an idea of the amount of folate this person is taking in, as well as B12 and B6. And if you're not getting in enough, it'll start to go high.

So those are some of my basics. Oh, I also look at zinc and copper. I want zinc and copper to be around 1 to 1. If zinc is much lower than copper that I'm asking the question why I may be giving a little extra zinc because it's good for the immune system.

Great. Well, this has been amazing. As always. I love having you. I love your perspective. Your patients are so very lucky to have you. And I am lucky that I access to you and I get you to come on and talk about all the wonderful things that you're doing and and the care that you're taking of people and the difference that you're making in this world.

So thank you so much for being here today. I really appreciate you Oh your welcome, Jenn. It's really been a pleasure being with you as as it always is.

I will speak to you real soon. And for everyone who's at the summit, I hope you're enjoying it. I'll see you real soon. It's Dr. Jenn. Bye for now.

Elizabeth Boham, MD, MS, RD

Rediscover Breast Cancer Through A Functional Medicine Lens