Eat Right: A Culinary Approach to Breast Cancer

Monisha Bhanote, MD, ABOIM, FCAP

Thank you so much, Dr. Jenn Simmons. I’m so excited to be here and talk to everyone about breast cancer and what I know about it.

Jennifer Simmons, MD

Yes, because you do have vast experience in both breast pathology and taking care of people with breast cancer. But what I’m curious about, and I’m sure everyone’s curious about, is: how a quintuple board-certified physician goes and makes that shift to integrative medicine. How did you find your love then, and what are you doing right now? Like, how did you arrive at that?

Monisha Bhanote, MD, ABOIM, FCAP

Yes, thank you so much for that question. Here’s the thing. I’ve been in pathology for a long time, and I have been looking at so many human cells under the microscope with people who are experiencing inflammatory diseases, from some colitis and reflux to more cancer-like conditions. Looking at them, we have the diagnosis, but why are our people getting better? Why are the treatments we are applying that all of us who went to medical school do? All right, here’s the diagnosis. Here is the treatment. But why aren’t people getting better?

Jennifer Simmons, MD

Where was the focus of your practice initially? What did you initially do with your training?

Monisha Bhanote, MD, ABOIM, FCAP

Yes. I did internal medicine, which was decades ago. I found that at that time, that was deeply unsatisfying, both for me and for my patients, because they weren’t getting better. I was just seeing my same progress notes, not making progress with them. Then I dived into pathology, and I trained at NYU Winthrop Hospital. I got a lot of my training in New York. I trained at Cornell for psychopathology, and I also trained at the University of Rochester for breast, bone, and soft tissue cancer.

Jennifer Simmons, MD

Why was that important to you? Why was learning about pathology important to you in your quest to help people get better?

Monisha Bhanote, MD, ABOIM, FCAP

I believe that learning pathology and seeing something more internal to me. What’s fascinating is the human body inside and how everybody’s human body is so different. Yet we’re born with these types of cells. Whether they’re breast cells, lung cells, gastric cells, or all these different cells, we were born with them. Yet why, over time, do some individual cells become damaged while others remain healthy? I wanted to see what the pathogenesis behind all of these diseases was. That’s where pathology came into play. Looking at what I call angry cells and going, all right, I heard these cells so angry, and I will tell you, there’s a spectrum of angry cells, especially in breast cancer. When you have over 30 different types of breast cancer, why are some of them so angry? What’s going on here? That’s what’s fascinating.

Jennifer Simmons, MD

Do they have to be angry or can they just be unhappy?

Monisha Bhanote, MD, ABOIM, FCAP

No, they’re pretty angry. There are a few who are a little unhappy. Maybe those could be the ones that are, like, the typical ones that are just a little bit unhappy. But yes, the cancerous ones are totally angry.

Jennifer Simmons, MD

You learn more about the pathology by seeing what it looks like on a cellular level. How does that motivate you to make this holistic shift? 

Monisha Bhanote, MD, ABOIM, FCAP

Yes, seeing all this and then also being on what we call tumor boards, where we review every person’s cancer diagnosis, there’s an oncologist in the room, there’s a surgeon in the room, and there’s a radiologist in the room. There’s a pathologist in the room. Now, if you’re lucky, there’s also a psychologist in the room. But with these discussions around, all right, what’s the next treatment? Are we cutting it or irradiating it, or are we giving drugs to it? What’s going on? I found that the patient was lost in this space, and we forgot what was going on with the patient. We’re just so hyper-focused on this tumor and this diagnosis. The unfortunate part is that I didn’t see people improving. I saw all these breast cancers coming back ten years later and people developing new cancers ten years later. Why is this still happening? What is the missing link there? The missing link for me was lifestyle. Lifestyle plays a huge component in the development of any disease. That’s what led me to investigate. Well, what are the lifestyle parameters? led me to the Andrew Weil Center for Integrative Medicine.

Jennifer Simmons, MD

But that’s a big jump because we’re not trained to think that way. I know that having practiced breast cancer surgery for 20 years, I wasn’t thinking about lifestyle until I had my diagnosis. What is it that gave you that perspective? That enlightenment? We have very similar training. People would talk a little bit about diet and exercise, but we never knew what that meant, and we thought that that was like dressing.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. For me, I wouldn’t say it was my health journey per se, but for some individuals it is. For me, it was seeing what was going on with my friends and my colleagues, and how come people my age now, a decade ago, were on medications at that time. Why are my colleagues mentally just drained, and what’s going on in their bodies that’s not going on in my body? What am I doing differently than what they are doing? Why can I manage stress better? Like, bring on the work and give me piles of slides to look at? I see it as a meditative approach to just looking at these beautiful, sometimes angry, cells under a microscope. All right. Why is it that I can handle this differently? So it took me down this path. What is going on with my colleagues? What is happening, my friends and family, and how can I help? Helping them, in turn, turned into me helping a lot more people.

Jennifer Simmons, MD

True.

Monisha Bhanote, MD, ABOIM, FCAP

Everything that I’m doing now and finding that lifestyle are the keys. But I also love food. I’m a total foodie, and I’m not going to give up food, and nobody’s going to give up food. But what food was I eating to keep my energy up? What food was I eating? That’s different than, say, my colleagues. looking at how I was addressing my gut microbiome, which we weren’t even talking about ten years ago, but thinking about how we are addressing our microbiome, how are we addressing our mind? There were a few things that I was internally doing without realizing that that was the key to health.

Jennifer Simmons, MD

That’s a tremendous realization. Then you went and did the training, integrative medicine training. What made you gravitate towards the breast cancer population in particular?

Monisha Bhanote, MD, ABOIM, FCAP

Yes. I have been diagnosed with over a million cancers, so I’ve seen them all. I’ve seen a lot of cancer, and I was fascinated by the breast part of it, for one, because when you think of the breast, it’s an organ that’s external to us. It’s not one of the internal organs. But how can this thing that makes us women be so influenced by so much? Why is one in eight women having breast cancer? I mean, the youngest person I diagnosed was 18. Her genetics were normal. Genetics are normal. when people are like, “Oh, my family doesn’t have cancer or I don’t have the gene, and they stop worrying about it,” and I’m like, “Well, 95% of cancer is not your genetics; 95% of cancer is your lifestyle.” That’s where I’m at; I can make an impact because people need to know this. One of the worst things is for a person to come to me. Many of the cancer patients that come to me are like, Why didn’t anybody tell me this? Why didn’t anybody tell me that? What I do every day, from the food I put in my body to how I move my body to how I sleep to how I manage stress, is going to impact the development of chronic disease. What can anybody tell?

Jennifer Simmons, MD

Yes, and I’m sure your answer was the same that I’ve been giving, and it’s that they simply don’t know because this is not what we’re taught in medical school.

Monisha Bhanote, MD, ABOIM, FCAP

I believe it’s a combination of two things. One, we aren’t taught it, but two, depending on where you are trained, where you’re working, and what country you live in, our healthcare system is built exactly the way it was meant to be built. It is built to have you come to the hospital when you get sick. It was built so you get medications that you have to stay on and pay lots and lots of money for so you’d think you’re getting better? That is our healthcare system. We haven’t been in a place where we are focused on prevention. Imagine if we did that and what world we could live in. But sometimes money is more powerful than people realize. That’s where our focus has gone. Bringing the focus back to the people, bringing the focus back to what can transform the health of not just the U.S. but our entire planet, and how we can support people in this. That comes back to the basics that people are missing because they think they go to the doctor, and the doctor is going to give me a pill, and that pill is going to make me better. That pill addresses a symptom. That pill is not preventing your disease from further progressing. It may be slowing it down, but your disease will progress. That pill will not reverse your disease. Only you can do that.

Jennifer Simmons, MD

You embody food as medicine. What does that mean to you?

Monisha Bhanote, MD, ABOIM, FCAP

I see food as our fuel. It is our life source. It is what gives us our energy. But it’s interesting because if you think about food, and we have to think about ourselves, we are 50% humans and 50% microbiota. What I mean by that is that we’re only half-human. We have almost a 1 to 1.

Jennifer Simmons, MD

It’s less than that.

Monisha Bhanote, MD, ABOIM, FCAP

Maybe.

Jennifer Simmons, MD

Just from a genetic standpoint alone, we are 10% human and 90% microbiome. Our microbiome may not make up the majority of the volume in our tissues. But it makes up the overwhelming majority of our genetic material.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. 

Jennifer Simmons, MD

Which is crazy.

Monisha Bhanote, MD, ABOIM, FCAP

But if you think about it, what you’re doing is feeding your microbiome. You can either feed a microbiome that is going to support you with anti-cancer nutrients and oxidant-free radical-fighting metabolites, or you can feed it something that’s going to contribute to disease.

Jennifer Simmons, MD

Can you talk a little bit more about the microbiome for people who don’t understand what that is and what it means?

Monisha Bhanote, MD, ABOIM, FCAP

Yes. When we think of the microbiome, that’s a collection of our genomes of microbiota. Microbiota, you can think of them as your bacteria, your protozoa, your fungi, all these different organisms, and now these terms are used interchangeably: microbiome and microbiota. But the microbiota is the organism that is responsible for helping with digestion and metabolism and your immune response. I mean, 90% of your immune response lives in your gut. Your gut is not healthy. Can you imagine how sick you are all the time? People are starting to go. “Oh, my God, why am I sick?” And they started to connect that. But so are your microbiota, these organisms that help you break down your food but also help you build up the neurotransmitters, vitamins, and minerals that your cells need to function.

Jennifer Simmons, MD

What do you think is the number one thing that people can do when they’re on a breast cancer journey is to improve their health and start to heal? What’s that number one thing for people?

Monisha Bhanote, MD, ABOIM, FCAP

Is to address their microbiome. Number one, you cannot address any disease without addressing your microbiome. I have found that most individuals—actually all individuals I’m seeing who are dealing with any chronic disease or on the verge of chronic disease and have symptoms—have something we call dysbiosis, which is an imbalance in their microbiome. Ideally, we want to be in a state of normal meiosis, where we’re maintaining the homeostasis between this relationship between our body and our gut. We have a symbiotic relationship. We want to get into normal biosis, but we’re mostly in dysbiosis, and that is influenced by many factors that we have control over. We would want to control those whenever possible.

Jennifer Simmons, MD

First of all, how do you cope if you have dysbiosis?

Monisha Bhanote, MD, ABOIM, FCAP

Well, you can look at it from two perspectives: one, symptomatology, and two, testing. If you’re experiencing any symptoms, they don’t need to be just gut symptoms; yes, we have the bloating and the indigestion, and maybe the constipation and diarrhea, but also look at other symptoms that are connected to your gut. It might be skin issues like eczema or acne; it might be headaches; it might be anxiety or depression; it might be respiratory issues, where maybe something is going on in your lungs. We have to think about this: the gut sends and creates these chemical metabolites throughout our body, through the blood supply. So any symptom can be traced back to how strong or healthy my gut is. In Ayurveda, we believe that a lot of disease stems from the gut. a 5000-year-old practice of Ayurveda we’re looking at how somebody’s gut feels and how we can make sure that we are addressing that so they are not developing diseases. I see a lot of women after breast cancer treatment, and they’ve had chemotherapy. Chemotherapy may be indicated, and in some situations, many situations. But at the same time, chemotherapy will destroy your gut. When your gut is further destroyed, what happens now? You’re developing an autoimmune disease. How many patients have we had who had breast cancer and then, a year later, developed Hashimoto’s Thyroiditis?

Jennifer Simmons, MD

Vice versa.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. Because it’s the gut, it comes down to the gut. 

Jennifer Simmons, MD

What are you using to test to see if people’s guts are healthy?

Monisha Bhanote, MD, ABOIM, FCAP

We want to look at at least five factors in the gut. We want to look at it from the point of view of: You may have a maldigestion. This means you may be eating the best diet, but maybe you’re not able to break down those nutrients because you had your gallbladder out and you don’t have those enzymes, or there’s something else going on where you’re not able to break down the nutrients. We have to look at it from an inflammation perspective. Maybe there’s something in your gut lining that has been damaged, and we can create a more protective barrier there. Toxic metabolites don’t enter the gut and go into the bloodstream. We have to look at it from an infectious pathogenic point of view, meaning are there infections that we may have picked up that are inhibiting our body from doing what it needs to do? We have to look at it from a metabolism perspective, meaning are we creating the chemical reactions that our body needs to be anti-cancer? Meaning we are creating short-chain fatty acids like butyrate, or one of the short-chain fatty acids that has anti-cancer properties. Guess what? People do not have short-chain fatty acids because they’re not eating the right foods. And then lastly, we need to look at that balance in that gut microbiome, looking at the commensal bacteria and identifying, if we have overgrowth or maybe we have something called a microbiome deficiency because we’ve taken years of antibiotics or we’ve taken so many chemotherapy that now we’ve wiped out the microbiome. It’s a complex strategy, but one that proves to be truly beneficial, meaning you’re building your body from the inside out.

Jennifer Simmons, MD

Is there a test in particular that you use to look at malnutrition, inflammation, infection, metabolism, and microbiome balance?

Monisha Bhanote, MD, ABOIM, FCAP

Yes. There are several different tests on the market right now, and I will use a variety of them depending on where my patients are located.

Jennifer Simmons, MD

Is this something that people can do independently, or do they need to work with a practitioner like you?

Monisha Bhanote, MD, ABOIM, FCAP

Yes. I have had patients who have tried to do this both independently and with health coaches or with friends. The results have not been, let’s say, the best that they could be because there’s something different when you’re working with a doctor and the way a doctor understands the human body on a different level than just these external lab results. I mean, as a pathologist, I’ve run medical laboratories. I’m the one who validates these tests. My depth of scope for laboratory testing is that I’m going to make sure that we’re not just going, Oh, this is high, this is low. But we’re looking at it from a whole perspective because you can also create imbalance by overdoing something. It’s a very finite way of doing things. I highly suggest working with either an integrative or functional medical doctor.

Jennifer Simmons, MD

It’s so funny that you mentioned overdoing because I see people all the time. We have this mentality that if something is good, more is better. So I see people all the time on super high doses of probiotics that they just take daily for no reason at all because they think it’s good for them. You look at their gut test, and they have like so much organism overgrowth, so this is one area where it is beneficial to have someone familiar with this space to be advising you. Let’s start a little deeper into the microbiome and what affects the microbiome, this is important for people to know because we’re encountering a lot of things on our end in the course of our normal daily lives that we have no idea what impact they have on the microbiome. We talked about the kinds of things that damage the gut. We talked about antibiotics, we talked about chemotherapy, and other things that people will usually encounter that will have a detrimental effect on their gut health.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. Let’s put it from the perspective of what can influence your microbiota and what can influence your microbiome because that can.

Jennifer Simmons, MD

That would be both positive and negative.

Monisha Bhanote, MD, ABOIM, FCAP

 Yes. So, I want people to understand that there is like you said, a little bit too much or a little bit too little. What’s going to influence the microbiome? Without a doubt, Diet. I mean, that’s been established. There’s no question about that. Medications: Not just antibiotics, but other medications can influence the microbiome. Your ingestion of prebiotics and probiotics can influence that, sometimes in a good way and sometimes in a not-so-good way. If you’re drinking a lot of alcohol, if you’re smoking, the state of your immune system, your hygiene, if you’ve been exposed to infections, and let’s not forget stress. We want to make friends with our gut microbiome. We don’t want them to be our enemy. We don’t want them to be like what I call enemy intruders. Now they’re like, “Oh, let’s go make some angry cells.” We want that happy gut microbiome, which goes, okay, let’s go keep these cells healthy and happy. Those are just a few of the things that will influence your microbiome.

Jennifer Simmons, MD

We talk about stress and, in particular, a couple of stressors that are probably helpful to your microbiome. Talk about why. Because things like fasting are stressful,  yet they’re very helpful for microbiome health.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. Fasting for some individuals may be a good stressor, but you have to see where that individual is coming from. We also have individuals who are putting food on top of food. Imagine the stress that that is causing. I like to focus on your dietary intake. Yes, I do intermittent fasting, but I like to take it from the perspective of what my body needs to function. Most people are not getting those ingredients, like vitamins, minerals, antioxidants, phytonutrients, omegas, or any of this stuff. They’re just missing the pieces. They’re running on empty, and it doesn’t catch up. I mean, now I’m seeing it catch up to people in their twenties and thirties, but like from a cancer perspective and the way cancer develops, it catches up to them around their forties. I mean, we’re seeing this boom of cancer. I suspect that from what’s happened in the last couple of years, we’re going to have a bigger boom because we’ve changed our lifestyles. Some have taken advantage of it and created an even better lifestyle, but a majority have not.

Jennifer Simmons, MD

Yes, it’s going to be a combination of things. It’s the stress of the last few years. I agree that it is the vast majority of people who didn’t use these last three years to improve their health, and in fact, their health has worsened. I also think that we had a decrease in screening. So the people who didn’t get picked up in that window are now going to present.

Monisha Bhanote, MD, ABOIM, FCAP

They’ll present with a more advanced disease, too.

Jennifer Simmons, MD

Yes. If that’s what they were destined for, I also think that we are picking up an entire group of cancers that probably wouldn’t progress to be clinically relevant. I say that coming from a place where, if you look at the annual statistics of the number of women that die of breast cancer, it doesn’t matter how many women we diagnose; the same amount of women die every year of breast cancer. It’s been just a steady number. So I have to think that there is some inherent disease that we’re just not able to influence adequately and that’s the last aggressive disease we’re doing better with. We’re able to reverse that. But there is this subset of breast cancers that, up until now, we haven’t been able to positively influence. But I also believe that it’s due to a complete lack of awareness of what the patient can do to influence their future. Because nowhere in the current paradigm are they asking the questions that you’re asking. Nowhere in the current paradigm are they asking, Why did these cells get angry? Because breast cancer is a normal response to an abnormal environment, It’s not. 

Monisha Bhanote, MD, ABOIM, FCAP

Yes, we’re making cancer cells every day. Why do some people fight them off? Some people progress into the masses and even become metastatic. that comes back to our lifestyle. But the one thing I do want people to keep in mind if they have breast cancer is to realize that your journey and your response to anything are going to be very different than somebody else’s. What I mean by that is that there are 30 different types of breast cancer. If you’re comparing yours to someone that you’re in a group with and you’re like, Well, why did they only need surgery and why are they doing much better? Now I need to be on this for ten years, and I’m not going to take it because they didn’t take it. You have to look at, first of all, what your cancer is. Like if somebody came to me and was like, “Oh, I had a low-grade tubular, invasive ductal carcinoma,” and I’m like, Okay, yes, it’s out. We’re all in good shape. But somebody comes to me and they’re like, Well, I had an invasive micropapillary. I’m like, That one scares me. I’m like, micropapillary is tricky. It likes to go everywhere; it goes to the lymph nodes. It’s just one of those that weasel its way into the body. Looking at it, if you developed it, what are we dealing with? Because everybody’s tumor is completely different. The state of the angriness of their cells is a spectrum. Some are worse than others.   In conventional care, we’re looking at it as a stage of your tumor. At this stage, this is what we do, and this is what the guidelines say to do. We have to look at the whole person.

Jennifer Simmons, MD

That we have not specialized enough in the area of breast cancer. I still think that we are operating in a pretty archaic way in that tumor size is pretty meaningless. It’s a function of at what point you found the cancer. It’s about biology. Biology is a reflection of what you’re talking about—pathology. In addition to people having unique pathologies,  their why is unique, and what got them there is unique. That’s the part that needs to be identified and explored more. That’s not happening at all in the conventional system.

Monisha Bhanote, MD, ABOIM, FCAP

I would tend to agree. I know when any of my cancer patients, especially my breast cancer patients, have this discussion with me, I’m like, “Can you tell me a little bit about what was going on in your life six months to 18 months before the diagnosis?” Without fail, there is some perceived traumatic event. T Yes, and they don’t recognize it, and their physician doesn’t recognize it. But without recognizing that, it’s going to be challenging to address the future of that individual. You have to recognize that. You have to address it. You have to figure out coping tools to manage it.

Jennifer Simmons, MD

That stressor is the straw that breaks the camel’s back. I mean, that alone probably didn’t cause breast cancer, but it was the thing that pushed you over the edge. We know from studies that of women who present with early breast cancer, 30% of them will have trauma in their background. But when we look at the metastatic population, 80% of them will have trauma in their background. If you’re not talking to your patients about trauma, you’re not serving them fully.

Monisha Bhanote, MD, ABOIM, FCAP

The missing link is: what can the individual do? How can we empower them whether it’s from that gut microbiome perspective and guide them in how to have a more diverse microbiome, how can we manage stress, and what should we be doing regularly? What are the tools that I want to incorporate into my daily lifestyle, or, as I call them, rituals? Like, what are some rituals, and maybe their anti-cancer rituals? Like, this is what I’m doing to take care of my body right now, and what are these things? They’re going to vary from individual to individual. I have people who are like, “You’re not going to get me to meditate. I’m like, You don’t get to meditate.” Guess what? There are other things you can do to manage stress. Let’s talk about what you like to do.

Jennifer Simmons, MD

I love what you said about empowering patients, and the first thing you mentioned is strengthening your microbiome. What kinds of things are people doing to strengthen their microbiome?

Monisha Bhanote, MD, ABOIM, FCAP

Okay, so we want to make sure we’re incorporating a lot of fiber-rich foods. These are going to be your things, like fruits, vegetables, legumes, and whole grains. They’re going to promote microbiome diversity. Guess what does not fiber are three things that do not fight dairy sugar meat, which is what most people are eating okay at least a couple times a day. Because when I go through how many times a day you have breakfast, lunch, and dinner, are you having any of these things? It’s pretty much all day, every day. We know that from a large study in the UK, over a million women were evaluated, and the ones who were eating meat were predominant, and we’re talking about things like just half a hotdog or not even that much. But having things like kebabs and sausages, hot dogs, chicken, and bacon increases their risk of breast cancer. Well, that’s because your microbiome gets changed based on the food that you eat. focus on fiber. Rich food is number one. The other thing you can do is say that we’ve already touched upon prebiotics and probiotics. I tell my patients that they should be having some probiotic-rich foods with each meal. If you were eating three meals a day—breakfast, lunch, and dinner—I want you to have something that has probiotic-rich foods in it. That might look like non-dairy yogurt or coffee here. That might look like sauerkraut or kimchi. Yes, you can even replace your glass of wine in the evening with some kombucha. All right. then probiotic-rich foods. If we think about the spectrum of what the microbiome needs, it needs prebiotics, probiotics, and postbiotics. Prebiotics you can have with your food is going to be things like asparagus, leeks, onions, bananas, and garlic. Some of these things are prebiotics; they help feed the probiotics, which are your microbiome’s gut bacteria. What that is, and now the postbiotics, which are those things like short-chain fatty acids like butyrate that I mentioned that are anti-cancer. You can’t take those. Those are metabolite products from your probiotics. You have to eat this chain for all of this to happen. fiber, prebiotics, probiotics, and other things to think about. One of the things I didn’t mention is that I’m also trained in culinary medicine, which involves taking food.

Jennifer Simmons, MD

I know that’s where we were going next.

Monisha Bhanote, MD, ABOIM, FCAP

Which is taking food and looking at the individuals, like, what is their dietary pattern? What do they like to eat? What is their ethnic background? What is their cooking style? Are they in the kitchen, or are they not in the kitchen? Like taking a look at all of this and incorporating that. We want to look at some of these anti-inflammatory spices that you can include in your foods. People are doing turmeric latte, but what if we were regularly eating turmeric? Like I have it in almost every meal every day because that’s part of my culture. That’s what I grew up with.

Jennifer Simmons, MD

I put it in my coffee.

Monisha Bhanote, MD, ABOIM, FCAP

Oh, there you go. We got to get creative, and that’s where I take it. I call it a functional culinary medicine approach, where I’m like, literally looking at all these little superfoods, like mushroom powder or turmeric, and how can I incorporate them into something I’m already doing? So a mushroom latte is a way to do it. I do ashwagandha curry to manage stress. getting creative with your food. Then, besides the herbs, I would also mention omegas. That’s another key thing that omega-3-rich foods do. I’m a big fan of a mini avocado a day. lots of nuts and seeds. More seeds and nuts are needed to get that anti-inflammatory benefit into the body. Dark, leafy greens. We cannot forget about dark leafy greens. Let’s all upgrade our iceberg salads to dark leafy greens. Let’s do a little bit of an upgrade here.

Jennifer Simmons, MD

What are you talking about? They’re talking about arugula? What is your go-to base for your salad every day?

Monisha Bhanote, MD, ABOIM, FCAP

Here’s the thing. Diversity. It’s not eating arugula every day. It’s not eating kale every day. Not eating spinach every day. It’s about having a variety. Now, thank God some of the stores have caught on to this, and they do a mix of dark, leafy greens for you to make your life easier. Keeping that variety, because we don’t want to overdo something. It goes back to that, like a little bit too much. Now, all of a sudden, you’re like, I’ve got oxalate, and you’re fighting this, and you’re fighting that. everything in moderation.

Jennifer Simmons, MD

Have you seen that? Because,  in my practice, I do not see it. I have people eating a ton of leafy greens.

Monisha Bhanote, MD, ABOIM, FCAP

I have seen it in individuals who have chosen spinach as their only leafy green. I have not seen it in the ones who are doing the diverse, but in the ones who are doing just spinach. Spinach in their smoothies, spinach, and sauteed spinach salad. I have seen it in their bloodwork.

Jennifer Simmons, MD

Wow. Have you seen oxalate stones? Like, have you seen clinical manifestations? Yes, you have.

Monisha Bhanote, MD, ABOIM, FCAP

Yes, I have one person right now.

Jennifer Simmons, MD

That’s a lot of spinach.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. Because she was like, in her head, if you people do the easiest thing, first of all, and they do what they’re used to. They’re used to going and seeing spinach. They’re like, Oh, more is better.

Jennifer Simmons, MD

Like probiotics.

Monisha Bhanote, MD, ABOIM, FCAP

Yes, exactly. Diversity. Moderation. about even sprouts. I love broccoli sprouts and mixed different sprouted greens, which are a little bit lighter. We also want to think about somebody’s digestion. From an Ayurvedic perspective, some people just have great metabolism and digestion. Those are usually for individuals. They get these cooling salads. It’s dark, leafy green. You give this to somebody who is a doctor, dosha, who is very airy and doesn’t have the best digestion, and those salads will put them into overdrive. All of a sudden, they have constipation. This is what I’m saying: working with somebody who understands the body and individuality is a bonus.

Jennifer Simmons, MD

Now, if you have someone who loves your practice of culinary medicine, and I do think that food is the key and food is the number one game changer for people on a breast cancer journey, without question, if you have someone who comes to you and says they can’t eat raw vegetables, is that a permanent thing, or is that someone who you’re going to work with to help improve their digestion so that they can start to tolerate some raw vegetables?

Monisha Bhanote, MD, ABOIM, FCAP

When you can’t tolerate something, whether that is raw vegetables, beans, legumes, or that stuff, it’s because your microbiome doesn’t have the ingredients it needs to metabolize these foods. It doesn’t have the ingredients it needs to break them down. Or maybe you don’t have the enzymes needed to break down these foods. We work on this, and it takes time. Anyone who thinks they’re going to fix their gut microbiome in three months is in for a surprise. It takes at least a year to shift those 40 years of existence with this microbiome. I have some patients with it, but it is possible, and I look at it from the perspective of what are the diseases that I currently have and what are the ones that I could have. Because they do fall within my family spectrum. taking that and looking at what dietary changes I can make to address this.

Jennifer Simmons, MD

What I do with those folks is, first of all, make sure that they have adequate stomach acid because, as we age, we naturally make less stomach acid. Acid is what is primarily needed to break down food. We villainize stomach acid, just like we villainize things that are inherently part of us and necessary. Some so many people make extended use of acid blockers and things like that. I check for acid, and I supplement people with acid if they need it. The other thing that I check is the radical enzymes to make sure that they have the enzymes necessary, and I often supplement them along the way. Do you do that in your practice as well?

Monisha Bhanote, MD, ABOIM, FCAP

Yes, when indicated, based on their testing, I will supplement, or I will, depending on the level of the results. I may do it with certain foods, and if the levels are bad and they need an even bigger boost, then we’ll do it with supplementation. One of the things I didn’t mention, which I think is important for optimizing your gut microbiome and digestion, is mindful eating.

Jennifer Simmons, MD

Can you talk about what that means?

Monisha Bhanote, MD, ABOIM, FCAP

Yes, I talk quite a bit about it in my book, The Anatomy of Well-Being. This means taking time to sit down and eat your food. Forget the TV dinners when you’re sitting in front of a TV and you’re just inhaling food; the part of digestion starts with you seeing the food. That’s actually when you smell the food and your salivary glands in your mouth start releasing enzymes to start this digestive process, which is going to extend from your mouth down your esophagus to your stomach, and having these enzymes coming from your pancreas, the bile coming in, that whole process. stopping and observing what’s going on, what’s the food I have in front of me, and taking a moment to recognize that that food is as nutritious as I can make it today. Can I do anything to even step it up a notch? We often say thanks at the beginning of our meal. We were also thankful at the end of our meal. The food was nourishing for us. But in this process of mindful eating, you’re stopping and chewing your food.

We start with chewing our food, savoring each bite, losing those distractions, and then also taking a moment to pause and recognize: did I give my body what it needed? How did my body respond to this? Few individuals I find don’t recognize if the food they’re eating impacts how they feel. Meaning, are they feeling lethargic an hour later? Are they feeling energized? Are they feeling bloated? Take a moment to recognize that the food you’re eating is impacting your mood. It’s impacting your focus. It’s impacting your body’s ability to continue throughout the day. Being mindful, intentional, and slowing down is a key component of digestion as well.

Jennifer Simmons, MD

Yes, I love that. Eating in a way that you can be nourished because if you’re eating on the run or just not eating with intention, it’s going to have completely different implications than if you’re sitting there and you’re being mindful and focused on your food and the experience and making sure to choose since most people like to wolf down their food. That’s an incredibly important point.

Monisha Bhanote, MD, ABOIM, FCAP

To increase the nutrient absorption of your food.

Jennifer Simmons, MD

Yes, it’s amazing. I want to just dial down into breast cancer for our last couple of minutes. Are there foods that you think are particularly important for people on a breast cancer journey? We talk a little bit about what eating looks like when you’re actively dealing with their diagnosis, and then what your food should look like after preventing recurrence.

Monisha Bhanote, MD, ABOIM, FCAP

Why don’t we talk about three foods to avoid first and then three foods to incorporate? That would be helpful. Because it’s not just about what we add and what we want to avoid right now. Dairy.

Jennifer Simmons, MD

Can you say why?

Monisha Bhanote, MD, ABOIM, FCAP

Is dairy just not necessary? When we think of dairy, this is both in estrogen-positive and estrogen-negative tumors. It doesn’t matter. Dairy has a component called insulin-like growth factor and other growth factors that increase your risk for cancer. There was a study done that looked at about 2000 women and found that those who consumed the most American cheddar and cream cheeses had a 53% increase in breast cancer. That’s a high. Now, think about all those late nights when you’re having cheese, crackers, and wine as a meal. I remember I’ve done it well—not the wine, but I’ve had the cheese and crackers as well, like coming home from work exhausted with comfort food. Dairy would be one to avoid the next one, which I mentioned.

Jennifer Simmons, MD

I still do that sometimes with almond cheese.

Monisha Bhanote, MD, ABOIM, FCAP

Almond cheese, go for it.

Jennifer Simmons, MD

Almond cheese on seeded crackers.

Monisha Bhanote, MD, ABOIM, FCAP

I love it. That’s a good one. The other one that I previously mentioned was the study on processed meat consumption. over seven years of more than a quarter million women. eating bacon and sausages, burgers, and chicken nuggets. This was a huge study. They found that there was an overall increased risk of cancer. That risk was associated with something we call Heme Iron, which is a specific type of iron in animal products. It was also associated with heterocyclic amines. Those are found in meat. 

Jennifer Simmons, MD

Those are made worse when you cook them. 

Monisha Bhanote, MD, ABOIM, FCAP

Next up is barbecuing. Yes, HCA and heterocyclic amines are becoming even worse, like they are inherent in animal-based products. But once you stick them on the grill, we’re increasing them. So with that, the third thing, which I know, I can’t remember what decade this is, but it’s one decade since grilled chicken became the favorite of people. Oh, it’s so lean protein. I’m eating my grilled chicken. I’m going to stay slim. Well, guess what? Grilled chicken has carcinogens. A carcinogen is a cancer-causing agent with a very long name. Let’s just call it Pit for short, which is a type of heterocyclic amine. So this is what they found, and it’s found mostly in grilled chicken and then other barbecued meats. Even a small amount of this can cause breast cancer to become more invasive. Therefore becoming more metastatic and worsening disease. You have to realize that, like the food we eat, it’s not just the food when we think about it; it’s the metabolites that are influencing our gut. The metabolites influence our internal systems. Those are the three menaces. What does it mean?

Jennifer Simmons, MD

I’m going to say I’m going to be the devil’s advocate and remember that this is coming from someone who is completely plant-based. But if you’re not going to eat dairy, meat, or chicken, where are you getting your protein from, and is it adequate?

Monisha Bhanote, MD, ABOIM, FCAP

I am also plant-based, so I do not have a problem getting protein. I get my protein from beans, legumes, nuts, seeds, and soy. Then, when we go on to one of the foods I do want you to eat, it’s going to be soy. I am not talking about soy, like hotdogs or chicken nuggets.

Jennifer Simmons, MD

You’re not talking about soy protein isolate.

Monisha Bhanote, MD, ABOIM, FCAP

No, I’m talking about your isoflavones. Those are found in non-GMO tofu. Organic tofu. It’s found in soy milk, soy nuts, and edamame. that I want you to contribute. Even one to three servings a day. An easy way to incorporate that is, at the moment, an easy way to incorporate that. Soy milk into your smoothie that they found.

Jennifer Simmons, MD

If it says organic, is that safe enough? Does that mean that it’s non-GMO? As long as it says organic.

Monisha Bhanote, MD, ABOIM, FCAP

Organic, yes.

Jennifer Simmons, MD

The other thing people need to be careful about with soy milk is to make sure that it’s unsweetened and that it doesn’t have a lot of gums and additives.

Monisha Bhanote, MD, ABOIM, FCAP

What happens to soy is that soy isoflavones work as antioxidants. Sit down and regulate this. It’s the Cox-mediated inflammation pathway. that is beneficial in cancer prevention specifically for breast cancer. The research has shown that individuals who had soy intake were inversely associated with their breast cancer mortality and recurrence, and this was beneficial both for estrogen receptor positive and negative tumors and both for users and non-users of Tamoxifen. Soy is going to be one of those that you want to include. At the end of the day, I’m a big fan of the tofu I make. As somebody who does eat a lot of salads, one of the things I was missing in my salads was croutons because I also went gluten-free and I could not find any gluten-free croutons that were worth it. Now I cut tofu into cubes the size of flavor like croutons. But now I’m getting my tofu croutons into my salad.

Jennifer Simmons, MD

That’s awesome. I love that. It sounds delicious.

Monisha Bhanote, MD, ABOIM, FCAP

Yes, but just think a little bit more intentionally.

Jennifer Simmons, MD

Love it. I do that with pumfu.

Monisha Bhanote, MD, ABOIM, FCAP

With what?

Jennifer Simmons, MD

Hum, have you had a pumfu?

Monisha Bhanote, MD, ABOIM, FCAP

What’s that?

Jennifer Simmons, MD

It’s pumpkin seeds that are prepared, just like tofu. For people, it’s a little firmer than tofu but has the same profile, it’s high, and it doesn’t have much flavor like tofu. You can make it any flavor you want. I love it.

Monisha Bhanote, MD, ABOIM, FCAP

Yes, that sounds good. I’ve also seen it done with chickpeas. Chickpeas are another little weight. I like cubits. You’re getting this protein. Yes. It’s a plant-based protein.

Jennifer Simmons, MD

Yes. But at the same time, you’re getting a lot of fiber, especially for women. Because so many women struggle with the breakdown products of their hormones, fiber is one way of ensuring that that process is happening. It’s these low-fiber diets that women struggle with so much.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. Let’s talk next about my number two fiber. Where are you going to get fiber from? Cruciferous vegetables. It doesn’t just need to be broccoli.? We can be a little bit more. When I talk to my patients about mushrooms, I’m like you can have it. Maybe I should add mushrooms. That’s number three. But when I talk about mushrooms, I’m like, people are used to eating the white button, the Khameini, and the Portabella. I’m like, upgrade from your Toyota and Ford to a Tesla mushroom or a Maserati mushroom and start having the Asian shiitake, maitake, or even a lion’s mane. So I guess we can put mushrooms as number three because they do have anti-cancer-promoting abilities that are very powerful. Another food to consider would then be mushrooms. Quite a bit of research has shown that they can be beneficial. The key with mushrooms is to eat them cooked. Never eat them raw.

Jennifer Simmons, MD

Yes.

Monisha Bhanote, MD, ABOIM, FCAP

There is an ingredient in there that is toxic and gets cooked off once we cook it. I know one of my biggest pet peeves is in New York City salad bars. I trained in New York City. You go into all these little bodegas in the city.

Jennifer Simmons, MD

They have raw mushrooms.

Monisha Bhanote, MD, ABOIM, FCAP

Everywhere. Yes, hospitals, raw mushrooms everywhere. People. Let’s stop serving raw. Well.

Jennifer Simmons, MD

I don’t think hospitals are the place for healthy food. I mean, my days as a surgeon.

Monisha Bhanote, MD, ABOIM, FCAP

Yes, some changes are coming down the pipeline and culinary medicine there, but we still have a long way to go. But then back to fiber. That’s where we want to have our cruciferous vegetables. Yes, broccoli’s in there, but also think purple, purple cauliflower, purple cabbage, kale, Brussels sprouts, and broccoli sprouts. I’m a big fan of growing sprouts every day.

Jennifer Simmons, MD

And they’re so easy to grow. You can just buy a grow kit and grow them on your countertop in two weeks. You can have your supply of broccoli sprouts, whatever you want. Amazing.

Monisha Bhanote, MD, ABOIM, FCAP

I gave you three foods: mushrooms, and cruciferous vegetables.

Jennifer Simmons, MD

And soy.

Monisha Bhanote, MD, ABOIM, FCAP

I’ve got more than that. Let’s see a bonus. Start drinking some good-quality green tea if you like. Let’s upgrade, yes I like you to have the water stay hydrated for sure, but let’s upgrade our beverage to some green tea. They found that green tea consumption of more than three cups a day can reduce the risk of breast cancer recurrence. 

Every patient who has been diagnosed with breast cancer needs to find a green tea that they enjoy.

Jennifer Simmons, MD

Yes, I couldn’t agree more. I love green tea. Any other go-tos?

Monisha Bhanote, MD, ABOIM, FCAP

Any other go-tos? Let’s see. Well, I already mentioned omega, so eat an avocado a day to decrease that inflammation. That’s where the nuts and seeds come in. Let’s not forget fiber, because I know a lot of people who like to eat beans, maybe once a week. I want you to eat them daily if not one to two times a day. The fiber in the beans is a prebiotic type of fiber. It’s also a resistant starch that the gut loves. Having that can be great for your gut microbiome.

Jennifer Simmons, MD

Last but not least, can we talk about supplements? Are there ones that you think everyone should be on and that everyone needs? You take supplements individually for everyone. Like, how do you feel about that area?

Monisha Bhanote, MD, ABOIM, FCAP

My practice is heavily nutrition and supplement-based, and everyone needs supplements. They just don’t know which ones they need. I’m a big proponent of tests, don’t guess. We want to test, just as if we’re using medications. We don’t want to be guessing. We want to test, monitor, adjust, modify, and make it precise. This is what my body needs. For the individuals who have been on the same multivitamin from Costco for the last five years, I guarantee your body needs something else. We want to keep adjusting it because, as we age, we have changes in aging. Is there a way to do that? I have everybody on. I have most people on a very high-quality multivitamin, a high-quality omega, and a high-quality vitamin D. Then everything after that becomes super personalized based on their deficiencies, whether many people have magnesium deficiency, the gut, or whether one individual needs digestive enzymes. Does one need probiotics? Does one need short-chain fatty acids for a short amount of time? Does somebody need antimicrobials? It’s going to depend. That’s where testing comes in before diving into the supplementation game.

Jennifer Simmons, MD

What tests do you generally use for that?

Monisha Bhanote, MD, ABOIM, FCAP

Once again, I’ve got a huge panel, and when I sit down with my patients at the first appointment, that initial consultation is when we’re going over their whole existence for 90 minutes. what potential factors, including their DNA, may influence this. Based on that, I decided on the spectrum of what testing we’re going to do.

Jennifer Simmons, MD

That’s awesome. I just want to go over what we talked about today. We started by talking about what this healthcare system is built for. It’s built for sickness and hospitalization, and prescriptive medicine dependence and food are our fuel. It’s our life source. It’s a way of avoiding this paradigm. We talked a lot about dysbiosis, which is an imbalance in the microbiome. We talked about the symptoms of dysbiosis. Some of them were gut symptoms, but others could be skin headaches, anxiety, or depression. We talked about some of the things that damage the microbiome, like antibiotics and chemotherapy. But that diet is the number one influence on the microbiome, along with other things like medications, prebiotics, alcohol, smoking, hygiene, and infection. We talked about how to empower our patients. We do that by helping them to strengthen their microbiome, helping them to manage stress, and having anti-cancer rituals, whatever that is for them. We talked about culinary medicine, and we talked about three foods to avoid: dairy, processed meats, and grilled meats, in particular chicken. Then we talked about how you were going to list the things that everyone should be doing. They should be consuming soy, ideally every day, because soy does decrease the risk of breast cancer recurrence. Soy isoflavones are highly beneficial in both cancer treatment and cancer prevention. We talked about making sure to consume fiber and making sure to get in your cruciferous vegetables that have been consumed every day. We talked about the importance of mushrooms when upgrading your mushrooms. We talked about the importance of green tea. Your water. consumption is vital. However, adding green tea to your daily routine will decrease the likelihood of cancer recurrence. We talked about the benefits of omegas and adding avocado, seeds, and nuts to your diet. Lastly, we talked about supplements and that everyone should be on a good quality multivitamin taking in Omega and vitamin D, and then depending on your testing and your individual needs, maybe you need magnesium, maybe some enzymes, maybe some probiotics, and that it’s going to be beneficial if you have a practitioner that you can work with to help you manage the breast cancer that you have. We are all individuals, and we want to help you restore your health by looking at why your cancer developed, intervening on that level, restoring your health, and preventing your risk of recurrence.

Monisha Bhanote, MD, ABOIM, FCAP

Yes. That’s it, and you just remind me of one thing that I cannot do, which is important for our breast cancer community, which is that individuals with low vitamin D levels increase their risk of breast cancer. Vitamin D and the correlation between breast cancer are also important avenues to investigate with your physician if you have not had that tested.

Jennifer Simmons, MD

Yes, and everyone should know their vitamin D level without question. If your doctor is not measuring it, make them measure it. I like to keep my patients between 60 and 100 nanograms per deciliter. What is your range?

Monisha Bhanote, MD, ABOIM, FCAP

For most individuals, I keep them between 50 and 60. For my cancer patients, I like to keep them at around 60, depending on their level of obesity, because I want to be cautious of where they hold on to fat-soluble vitamins. It’s going to depend on the individual.

Jennifer Simmons, MD

Yes, but vitamin D is one of those things that we do not store well, which is why you have to dose vitamin D probably every day at the most, every other day. Those once-a-week doses are not effective at all for people. If there’s one thing that you want people to take away from our talk today, would that be okay?

Monisha Bhanote, MD, ABOIM, FCAP

One thing for everyone to understand is that self-care is self-care. Everything that you do and that you’re intentional with in your life is the self-care that you need to keep yourself happy and not angry. Hashtag self-care.

Jennifer Simmons, MD

I love that doctor burnout. Where can people find you?

Monisha Bhanote, MD, ABOIM, FCAP

I am on all media platforms, including Instagram, Facebook, and YouTube, at Doctor Burnout. My name and my website are doctorbhanote.com. Pretty easy to find.

Jennifer Simmons, MD

We didn’t talk about your book, The Anatomy of Well-Being. Where can people get that?

Monisha Bhanote, MD, ABOIM, FCAP

Yes. The Anatomy of Well-Being helps individuals create these intentional lifestyle practices to revitalize their health and goes into the holistic approach from mindset to nutrition to sleeping to movement and personalizing it. The book is available on Amazon and Barnes & Noble.

Jennifer Simmons, MD

My wonderful Dr. Bhanote, thank you so much for being here today. It was a pleasure to talk to you about all of this. I love that you practice functional culinary medicine. I’m fascinated by that. We know the importance of food. We’ve known for thousands and thousands of years the importance of food and its influence on our health. I applaud you for who you are and what you’re doing. It’s beautiful. Wonderful. Your patients are so lucky to have you.

Monisha Bhanote, MD, ABOIM, FCAP

Thank you so much for our conversation today, Dr. Jenn.

Jennifer Simmons, MD

It’s Dr. Jenn. Bye for now.