Eat To Beat Breast Cancer

William Li, MD

Thank you so much. Dr. Jenn, it is a real pleasure to speak with a fellow physician who has dealt with real cancer patients and all those issues.

Jennifer Simmons, MD

Yes, for sure. I am so excited to dig into the research on how diets can help fight breast cancer. I know that you plan to share five new ways that food can enhance your body’s anti-cancer defenses. I am so excited to hear about that. I am especially excited to hear about the brown fat activation because all of this is fascinating. Start by taking us. What inspired you to look at food as a solution? Because, as physicians, we are not led there at all.

William Li, MD

Yes. It is such a great question people ask me. I will tell you that it goes back to the fact that I grew up, in an Asian family in America, in the town of Pittsburgh, Pennsylvania, where it is a very ethnic and culturally diverse world, and in a community where I loved exploring the foods from different cultures. When I was growing up, there were folk festivals, and I had friends from many different cultures. So food, as a natural part of the community, was something that I grew up with. 

Fast forward to when I was in college. I was a biochemist. Many people go on to pre-med to study the sciences. But I spent most of my time—a lot of my time, I should say—in the studio arts and history classes, understanding, these old cultures in the Mediterranean and Asia and how they influenced society. I became fascinated, particularly by the Mediterranean way of life. This is back in the 1980s, long before people talked about the Mediterranean diet. 

I did a gap year between college and medical school, and I embedded myself in Italy and Greece. I lived there for a year to be able to study. Perhaps not surprisingly, given what I told you about my childhood and my desire to study food and how it integrated with the culture and how that impacted their health. We were talking a long time ago. I was walking the walk long before I was talking about the Mediterranean diet, healthy foods, and healthy eating. But that experience before medical school always implanted in my brain that there were places and people around the world that think very differently about, or at least traditionally think very differently about, the role of diet on their health and their community and both physical health as well as emotional health, mental health, and mental wellness. 

When I went to medical school, here we were learning, as you and I both know, memorizing bacteria and viruses and myriad diseases and, digesting and regurgitating textbooks worth of material. I mean, this is just being in boot camp. Only people who have done it could even. You are nodding. You and I understand exactly what that experience is.

Jennifer Simmons, MD

Well, and the best medical student. The best resident was the one who could regurgitate it the best.

William Li, MD

Exactly.

Jennifer Simmons, MD

I originally thought there was no original thought there at all.

William Li, MD

It is 4,000 years of medical knowledge. We have to just master it. The thing that, as I was learning it, my professors would show was diabetes, and here’s cancer, here’s Alzheimer’s, here’s obesity, and here’s a thyroid disease. I am, Okay. I get it. I got it memorized. All of these diseases have treatments. But, you tell me about the disease. Tell me about health. What is health? They never got a straight answer that I felt was convincing from my medical school mentors and residency mentors. What was the definition of health? That always bugged me, and I connected it back to my earlier experiences during my gap year. Food and health are so interconnected, and so later on, I created the Angiogenesis Foundation because I trained with a surgeon who pioneered the field of angiogenesis, a guy named Dr. Judah Folkman at Children’s Hospital in Boston, who is very well-known to people in the surgical ecology world. I was taken under his wing and became so inspired.

I created The Angiogenesis Foundation, which led me to become involved with 44 FDA-approved new treatments for cancer, vision loss, diabetes, and wound healing. For you, surgical oncologists, that is where the overlap of what you and I are trained to do is where I have made big contributions. But I always thought we were treating the horse out of the barn. How could we turn the clock back and intervene for cancer, including breast cancer, long before we have this? The horses are out of the barn, and the 20 cars pile up on the highway. This is where food came in. I, having had lots of experience with developing drug therapies for cancer, know that these cancers started with drugs, antiangiogenic therapies, and now immunotherapies for diseases including breast cancer. I wondered: What is the role of food in the prevention and treatment of cancer? This is not a new question, but a very old one, but I had an unfair advantage because I was involved with drug development. About 15 years ago, I started throwing foods into the same lab system. We study drugs in biotech as well.

Jennifer Simmons, MD

They should be. I mean, where did the drugs come from? Most of them originate from our food system.

William Li, MD

Natural products. This was the eureka for me when, 15 years ago, I began to discover that about 50% of the foods that I was testing in drug systems could go head-to-head against drugs; they could be as powerful as or even more powerful in those systems and drugs. It gave me an entirely new view of how our diets could influence our health, whether we are sick or being treated with medicines. My gosh, food is a tool in the toolbox we had forgotten about because, before pharmaceuticals, we only had food, diet, and lifestyle. Now, maybe incantations, and leeches. 

But somehow, in the era of pharmaceuticals that started, more or less, in the 1940s, we just completely put out of mind in the medical community the role of the old tool in the toolbox, which is our food. I went back and dove into it, saying, Look, I want to be agnostic, whether it is a food or a drug, but I am interested in the food. Let us study how these things work. Let us figure out how they activate the hardwired health defense systems in our bodies that my medical school professors never taught me. Let us go figure this out. Let us define health. Let us figure out what our health defense is and let us figure out how foods activate them. For me, the orientation was to discover the benefits of adding foods to your system because there are already so many people who focus on what to cut out. I wanted to figure out what delicious things you could add to your body.

Jennifer Simmons, MD

Yes, it is brilliant. I think a large part of the reason you could not get an answer to what health is because that it is not a focus of medical school. We are not trained to recognize health. We would go so far as to say that I believe in our training. Health was equivalent to the absence of disease. But that is not about health at all.

William Li, MD

Yes.

Jennifer Simmons, MD

In our training, we got stuck in that place, and our training was so segregated. We just talk about the body as a collection of systems, and nowhere do we appreciate the fact that it is a system and that those separate things are acting collectively to form one functional being, and if one of those systems is off, the whole system is off. But that is not recognized at all. 

William Li, MD

Well, it is time for things to change, because I remember, and maybe you do as well. When I was in medical school, nutrition was something that was deemed below the medical school curriculum, and there were.

Jennifer Simmons, MD

There were other people to deal with that. Yes, exactly.

William Li, MD

Exactly. Now, I can tell you, particularly in oncology, for treating cancer, that the data is so overwhelming that the foods that we eat through rigorous studies, published in big major journals, and presented at major cancer meetings, have a huge difference. One of the things that we talked about a little bit before starting this was, What are the things that we should be eating when we have cancer? Because every patient I have ever had who is dealing with cancer has always asked me, Dr. Li, how bad is it? What is it? Treatment? How long do I have? the usual questions that every cancer patient naturally asks. Then, in my own clinical experience, the patient leaves my office then they pop their heads back in and say, One more thing, doc, what should I be eating? What can I do for myself? 

Jennifer Simmons, MD

Yes, absolutely. I think that we need to make a distinction between what I can eat during treatment and what I should eat during treatment. Because there are things that markedly improve how you do during treatment and beyond.

William Li, MD

I will tell you, by the way. Those things that you can eat that markedly improve your outcomes are easy foods to add to your diet. You do not have to reach. You do not have to go into anything crazy. This is not a diet. I even do not work to use the word diet. If you have cancer and you are getting the best possible treatment out there, you are still not optimizing; you are still leaving opportunities to improve your outcome if you do not open the refrigerator and make good choices in the pantry. 

Here is an example: Just about a little bit more than a year ago, one of my colleagues, Dr. Jennifer Wargo, at the Anderson dry-erase immunotherapy dry-erase whiteboard The Cancer Center, one of the biggest research cancer institutes in the world, published a paper in the Journal Science. This is one of the most difficult, prestigious, rigorous, and hard-core scientific journals, with only four major discoveries that can advance humankind. She published a study looking at melanoma and skin cancer that was very advanced and people were getting the latest treatment, which is immunotherapy. For people who are listening and who do not know about immunotherapy. Immunotherapy is not only one of the biggest advances in cancer research and cancer treatment, but it works, and it works well for some people. When I say work well, it can reverse your cancer. Think about a dry-erase board with writing on it—your markers.

Jennifer Simmons, MD

I love that imagery.

William Li, MD

Immunotherapy activates your body’s immune system, which normally wipes out cancer in your body. Immunotherapy is going to the dry-erase board with all this messy stuff that has written all over your body and just scrubbing it off and cleaning it off. You have a whiteboard again. That is how powerful immunotherapies are. However, before melanoma, it used to be that maybe 20% of people would get the response they want, which is having the immune system wipe out the cancer. That is a bummer because it means 80% of people are not getting the response you want, and this is a life-or-death situation. 

In the research that is started on your diet matters and what you eat among what you eat, the foods that help to nurture are a healthy gut microbiome and gut health. You have heard about this. Everyone has heard about gut health. This becomes a life-or-death situation for the cancer patient. Our gut has 39 trillion bacteria that mostly live in it. Where? In the last part of the gut. Before the tailpipe. But in the colon, and where in the colon? You are a surgeon. This is the conversation that surgeons talk about most.

Most people talk about the microbiome. They do not know where most of them live. It lives in the cecum. The cecum is this baggy, the vacuum cleaner bag part of the colon. It connects the small intestines to the large intestines. It is also where the appendix is. This baggy area is where most of your gut bacteria live. Because it is where the appendix is, there is now some conversation that typically asks whether the appendix might serve as air traffic control or a new ammo clip for restoring healthy gut bacteria when you have a problem. 

Anyway, the point is that gut bacteria in cancer patients do something important when they are healthy. First, it lowers inflammation. When we have good, healthy gut bacteria, they produce substances called short-chain fatty acids that lower inflammation throughout our body, regardless of whether it is breast cancer, melanoma, or a brain tumor. It is very important. You want that to happen, all covered; you need that to happen. Lower inflammation is number one. 

Number two is that our healthy gut bacteria talk to our immune system. Now, when you and I went to medical school, we were taught that your immune system lives in your lymph nodes, your spleen, and your bone marrow. 70% of our immune system lives in the walls of our gut. If you think about it, what that means is that it is a garden hose. If you were to take a big garden share and clip the garden hose and look at it, there is a tube in the middle. But the thick wall of the garden hose that you have just transacted inside there is where the immune system is a large part of the immune system. Now, we are beginning to learn where our immune system lives. It also lives in body fat, by the way, which is cool and very important for metabolism and using that to control inflammation as well.

But when good healthy gut bacteria talk to your immune system; they will think about the cancer patient getting treatment, whether it is chemotherapy, targeted therapy, or immunotherapy. The thing that we are now, we never thought about until just a few years ago, but now every modern oncologist must think about this. Those bacteria in the gut, the lower gut, and the colon start lowering inflammation and helping treatments work better. Making the patient’s body more receptive to treatment. The bacteria talk to your immune system, especially if you are on immunotherapy. You need your immune system to be able to follow instructions, which are to search out and destroy cancer in your immune cells when they are activated. It is ways. They follow ways as they get directions for where to go next.

If they are not able to respond or if there is a problem with the app and they cannot go to the tumor, you are not going to get the benefit of immunotherapy. We are now realizing that gut health is connected to immune health, which is connected to the response to immunotherapy. What my colleague Jennifer Wargo showed is that dietary fiber, which we find in lots of plant-based foods, can activate, feed our gut microbiome, and talk to our immune system, making it possible for our immune system to respond. In this study that was published in the journal Science, she found that for every six grams, there are 5 to 6 grams of dietary fiber that a patient with melanoma eats per day. There is a 30 percent reduction in mortality and death from cancer during treatment. Eating dietary fiber can help you respond and increase your chances of being one of those people who gets the beneficial outcome—the dry-erase effect that we are talking about.

 A 5 to 6 grams of dietary fiber. How do you get that? Well, it turns out the average, medium-sized pear has five grams of dietary fiber. You eat a pear or two a day while you are getting cancer treatment. You are their baby. It is not hard. The more you eat, the better it is. I think this is the thing that cancer patients are looking for: what is the evidence? What should we eat? How much should we eat? What are some things that we can do for ourselves? This is where, in the cancer world, patients and doctors need to be able to have this dialog, and they need to have trusted, spine-specked information. Food as medicine for cancer is important during treatment and also important for people who are at risk or who just want to avoid cancer. That same effect is beneficial—that dry erase. That is what you want every single day in your life.

Jennifer Simmons, MD

Yes, and to prevent a recurrence afterward.

William Li, MD

Exactly.

Jennifer Simmons, MD

If you have been through it once. You, for sure, do not want to go through it again. I am so glad you brought up the immune system and its role in all of it because cancer is a reflection that your immune system has become overwhelmed. Only by resetting the immune system, empowering the immune system, and bringing the immune system back online is it going to reverse this process and allow you to live cancer-free. But to do that, since 70% of our immune system is housed in the gut. It is impossible to bring your immune system back online unless you are paying attention to the gut master the nurturing of the gut, and master healing the gut. There has to be one there.

William Li, MD

100%. This is the only way. This is the most important missing piece that has been ignored for decades in cancer treatment. Although some old-school oncologists are not yet on the program, I would say that a growing number of us, especially the younger people who are going into oncology or surgical oncology, are beginning to recognize that data is out there. There is an opportunity to learn and to connect with our patients. But the patients now—if you are listening to this and you are a cancer patient—the time is now for you to go out there and find that information. If it is not discussed with you, you bring it to your oncologist. You have that conversation.

Jennifer Simmons, MD

Yes, that is where it’s going to come from. Because, I mean, I will tell you that I see thousands of women a year, and they are still being told that what they eat does not matter; they should not lose weight; they should eat ice cream and pizza. They are still getting bad information. While I do agree that the world is changing, it is not changing fast enough for my liking. I know that the movement and the change are going to come from the women who demand them.

William Li, MD

This is just one of the many other things in medicine that doctors in this case will respond to patients. I think that as younger doctors come into practice, they are going to be people who are naturally more sensitive to diet and lifestyle, to begin with. They can begin to talk the talk because they walk the walk. This was a big problem for us. I think in our generation, we went to medical school. The food that we had in the cafeteria was awful.

Jennifer Simmons, MD

Disgusting.

William Li, MD

Yes. We had bad role models.

Jennifer Simmons, MD

For sure. I remember the day when we got all the department heads and got an announcement, excited that we had a new partnership with Pepsi. I called my chief medical officer, and I said, Are you kidding me? I am trying to run a cancer program here. We cannot partner with Pepsi. He is; Why? They have bottled water? They did not see any connection there. Thankfully, things are changing. I wish they were changing faster. Yes, but let us give people the information that they need. Let us start with: What are the biggest myths when it comes to food and cancer?

William Li, MD

There are so many myths out there. I want to pick out a few of them that relate to breast cancer and show some surprises that can go along with them.

Jennifer Simmons, MD

Can I start with the first one, which is fruits, and ensure that it is not good for you? Please do not drink them.

William Li, MD

Well, okay. Let us back up for a second to say that when doctors tend to give old-school advice, it is all focused on macronutrients and proteins and getting enough fat to prevent weight loss. It is true, that cancer patients can indeed get compromised and lose muscle mass, and it is a problem. But before you get to that problem, the key is that you want to try to let your body be strong enough to help with treatments and beat the cancer. Then you do not get to that position.

Jennifer Simmons, MD

Is this a very end-stage issue? That is not happening early on in the cancer process.

William Li, MD

No, not at all. Absolutely. The thing that you want to do is avoid these ultra-processed nutritional supplements. By the way, this is even the stuff that you can find on the Internet that people talk about on social media—all these manufactured things. If you take a look at the ingredient label and it creeps you out because you cannot pronounce it and you do not know what it does, it is probably stuff to stay away from.  Yes. That is a hard pass. Soda, whether it is regular soda or diet soda, should be a pass. The reason is the diet soda because we are not talking about weight gain or weight loss. We are talking about artificial sweeteners that damage your gut microbiome. The thing we were just talking about is that your immune system requires and normally lowers inflammation. The last thing you want to do is slake your thirst with something that is going to damage that 39 trillion-member ecosystem, and that is going to help you get through your disease and get back to your health. So that is a pass, as are any of these ultra-processed foods with artificial preservatives, artificial coloring, artificial sweeteners, and artificial flavorings; they are everywhere. When you go out to eat, especially in drive-through places, a lot of that food is all manufactured stuff. Make it as cheap as possible. 

The author of the James Bond novels, Ian Fleming, had this great quote that he wrote about, and he said, One of the titles of the novels was, You Only Live Twice. The book opens with this quote that says, You only live twice: Once when you are born and Once when you look death in the face. I think that this is an opportunity to reexamine and make a fresh start, regardless of what your old dietary habits are. You are looking at a serious disease. You are looking at your mortality to face time, to have a fresh start to do something, and to let your body do the work—the heavy lifting for you. 

Avoiding ultra-processed foods, avoiding sodas, alcohol, smoking, and vaping—all of these things that trigger inflammation compromise your immune system. You do not want to do that. What do you want to do? You want to eat foods that help your gut health that get into your microbiomes. For a healthy defense system, you want to eat fiber-containing foods. I told you even a pear can do it. The broccoli does it. Kale is a great source of dietary fiber. Kiwi gives you fiber as well. There are so many foods that can provide dietary fiber. All you have to do is look up, on Google, fruits, and vegetables with dietary fiber. You have to be able to get a long list that you can take with you as a shopping list, number one.

Number two, your gut microbiome also loves polyphenols. They are called prebiotics because they are the fish food for your gut microbiome. If you have a pet dog, catfish, or bird, what are you doing? You are feeding it every day, and you are hoping that you are going to give it good food. You do not feed it. It is going to die if you feed it crap, it will not going to live very long. If you take the time to care for your pet, you are going to feed them good-quality food, and you are going to be very conscientious about it. That is what we need to do. That is what every cancer patient needs to think about: They have pets inside their gut, and the pet gut bacteria have an important function that helps our body do the dry erasing. The immune system is dry-erasing cancer. It is super simple to think about, and the things that can support our gut health are in the grocery store.

What foods with lots of polyphenols—green tea, coffee, colorful fruits, and vegetables—eating the rainbow should take on a completely different meaning. If you are worried about cancer in your gut, you want to eat those colorful rainbows. Not only do they brighten your mood on your plate, but they also help your gut bacteria improve. Now, those polyphenols, by the way, not only activate and help feed your healthy gut bacteria, but they can also activate your other health defense systems as well, your DNA, to help your DNA minimize the damage that can occur with chemotherapy. That is important to protect your DNA, by the way. Here is something interesting. We should be eating colorful fruits and vegetables and dietary fiber every day, no matter what. Whether you have cancer, you had cancer, or whether you want to avoid cancer, about which we are now talking.

Jennifer Simmons, MD

Everyone should if they want to avoid cancer.

William Li, MD

For eight billion people, this is a common goal. In a world that has so many differences, this is the one thing that I can guarantee unifies everyone. Yet we are all linking arms and not wanting to get cancer.

Jennifer Simmons, MD

For sure.

William Li, MD

The answer to cancer lies in the kitchen, in the pantry, in the grocery store, and in the farmer’s market. Do not wait until you have to go to the oncologist’s office. You and everyone can take charge right here and now to make those moves. How do some of these polyphenols activate our health defenses? Well, one of our five health effects is our circulation or angiogenesis. If we can eat foods that help our body keep blood vessels where they need to be and prevent blood vessels from growing towards cancer. Prevent cancer from hijacking blood vessels. We have another way of controlling and preventing cancer from growing. If we can eat foods that kill healthy and baby cancer cells, and stem cells that grow cancers, we can control recurrence that will come back, and then we will start if we can get our gut microbiome going. 

We talked about this already: protecting our DNA, and some foods directly boost our immune system and boost the immune cells that we need—the T cells, and dendritic cells—the things that pharmaceutical companies are spending billions of dollars trying to figure out how to deliver to patients. We can do it ourselves and with the choices that we make. Our body’s health defense systems are incredibly important to activate with food. This is empowerment at the level of the patient, the caregiver, the family, and the friend. These are things that are not done in the doctor’s office or the infusion clinic. These are things that you do yourself at home, for sure.

Jennifer Simmons, MD

That is where health happens. Health happens at home. It cannot happen unless you foster a healthy home and a healthy environment. With that in mind, are there foods that you think of that trigger cancer?

William Li, MD

Well, we do know that there are. I am a cancer researcher, we have looked deeply into this, and different foods and substances are well-known and recognized to trigger cancer in the lab, and it is correlated in population studies to be correlated with the development of cancer in large populations. One of the best studies that people should know about is that, even if you are not a researcher, you should just know how is food in medicine studied. Well, it’s studied in a lab. It is studied in the clinic. It is studied in real-world populations. The one that I want to point out now that we are a global population is a study called EPIC. It is the European Perspective Investigation into Cancer, it involves half a million people, over 14 countries all across Europe, and over 20 to 25 plus years.

They just track what people are eating and see what the connection is between patterns of eating across all European countries and the development of cancer. What they are finding out are some incredibly important connections between foods that you should avoid and foods that you should eat—foods to avoid to prevent cancer, and foods you should eat to be able to enhance your outcomes or lower your risk of developing cancer. 

What are some of the harmful ones? Alcohol and too much alcohol. There is nothing, they talk about the proverbial glass of red wine. It is the stuff that makes the red wine, red. It has nothing to do with the alcohol. Too much alcohol. Alcohol is a toxin. It is associated with an increased risk of all kinds of cancer, especially breast cancer. 

Processed meats are also associated with many types of cancer, including breast cancer. What are the processed meats? Again, this is where I think it is important to be specific. There is a whole history of processed meats, where you are curing the meat or drying the meat and, treating them in different ways. When we talk about processed meats, it is stuff that probably you and I grew up with, Dr. Jenn. In the school cafeteria, the sliced baloney, the deli sandwiches. 

Jennifer Simmons, MD

Salami.

William Li, MD

All have the stuff that you see on TV advertising that the lunch lady used to give us—maybe our moms packed into a bag, into our school lunch.

Jennifer Simmons, MD

Maybe your mom.

William Li, MD

Well, the idea is that it is so common that we have grown accustomed to this staple in our diet. Those factory-created, convenient sliced meat is cheap, tasty, salty, and manufactured. Those are the processed meats that the World Health Organization has identified as carcinogens. It is known to increase the risk of cancer, especially colorectal cancer, but other cancers as well, including breast cancer. Processed meats are a dangerous factor. 

I think that we are beginning to recognize that there are other chemicals out there, such as artificial colorings and flavorings, many of which are banned in Europe but still permitted in the United States. Other food additives that you cannot sell in Europe, in many European countries because they are connected to higher cancer risks, are still available in the United States. Anybody interested, just type into Google: food additives banned in Europe, cancer risk, and you will see this long list of foods then identify one of those things, the banned foods, and see if it is available in the U.S. Sometimes it is in sodas and food colorings for sodas.

Jennifer Simmons, MD

I never pronounce this, but carrot, tarragon, and gum.

William Li, MD

Well, yes. There is carrageenan and phantom gum. These are all food additives.

Jennifer Simmons, MD

Yes, but carrageenan, I think, is directly linked to cancer. Not allowed to be used in Europe and yet it is still there; I see it all the time on labels here.

William Li, MD

Yes, exactly. By the way, if you go to a bakery, or a commercial bakery, they are using all of these additives as part of the prepackaged ingredients that they use. This whole idea of trying to live a clean life becomes the most important thing that you can do yourself, if you have been diagnosed with cancer is to have a reset and say, I want to make sure everything that I have in my kitchen, everything I put in my body, the temple of my body to improve my health defenses, has got to be good. 

Now, that said, there are a lot of things that should be avoided and cut down. Cutting out red meat, including excessive red meat, is also something that has been correlated with a higher risk of some types of cancer. Those are some of, I would say, the clearest offenders. On the other hand, much about food and health is about what?

Jennifer Simmons, MD

Can I ask about sugar?

William Li, MD

Sugar is also very confusing for most people because the easy mantra is to cut down or cut out all sugar because sugar feeds cancer. As a cancer researcher and as a medical doctor, I can tell you that is both true and not as worrisome as a lot of people think. First, our body needs sugar. Our brain especially needs sugar. If you do not have sugar, your body’s going to make it. All. If you cut out all sugar from your life, you are still getting sugar from eating the foods that are good for you. Vegetables contain, fructose. That does not feed the cancer. This is where the other stuff is important.

I want to say, but on the other hand, you do not want to have added sugar. You have nine teaspoons of cane sugar in a glass of soda. The red can or the blue can. It does not matter which soda you choose. If I gave you a whole empty glass for your dinner table and I just started a loaded nine teaspoons full of sugar, and I said, Here, Dr. Jenn, eat this. Pour it down your throat. You go, that is disgusting. I am not going to do that. Yet that is what we do when we drink a can of soda. That is not only bad for our metabolism; it overwhelms our ability to process. Here are people who are drinking, a six-pack every day or multiple six-packs a day. You can see what they are doing. They are overwhelming their system. 

By the way, excess sugar also poisons our gut bacteria, which then increases inflammation and lowers our immunity. You say, well, what about diet soda? Diet soda does even worse because the data now shows that the artificial sweeteners in many of those new sodas kill and assassinate our gut microbiome. When you change that ecosystem of healthy gut bacteria, all of a sudden your inflammation levels go up, and it wrecks your metabolism, which then causes body fat to grow, which causes inflammation to be terrible. 

I think that sugar itself, to answer your question. It is very important for us, especially as doctors, to frame our answers. To say sugar itself is bad but our body needs sugar—the kind of sugar that our body makes us healthy for us for energy. The sugar we get from plant-based foods is important. Because, not only do we use that sugar for our metabolism, but that energy, so we can think in our hearts and beats and have enough muscle strength. But we are also benefiting from the other nutrients—the micronutrients, the bioactive, and the polyphenols—found in these foods as well. But the candy bar, the soda, the cotton candy, all that other stuff that we.

Jennifer Simmons, MD

Table sugar.

William Li, MD

The table sugar.

Jennifer Simmons, MD

Syrup, not so much.

William Li, MD

Yes. Not so much. That is overwhelming. Flooding our bodies. The source and the amount make the difference. Now, I do think it is important, and I do not know if you have explained this to your viewers, but where did this myth of our concept of sugar-feeding cancer come from? Now, I looked at this myself as a researcher. I am telling you, I was curious, too, because when I heard that sugar feeds cancer. I put down the mints that somebody offered me at a medical conference. I am, that is candy. I am not going to have that. But then I looked into it, and I realized that there is an origin story for every urban legend and every myth that is out there that gets propagated by the Internet or word of mouth. 

There is usually an origin story. This origin story started in the 1980s when a special scan that we use in oncology for cancer patients called the PET scan was developed. The PET scan is different than an X-ray and different than a CAT scan. A PET scan detects the metabolism and energy of a tumor. You do not get a lot of detail, but you can see the tumor lighting up. It uses an infrared light to take a look at what is lighting up. If you look at a fireplace with an infrared light boom, where the fire is, it’s glowing. That is what happens when we are using a PET scan on cancer patients. 

We are looking for areas where a tumor might be lurking or where we know a tumor is lurking to light up. That gives us a lot of information as doctors that we can use to identify where we might want to remove the tumor, where we might want to treat or inject the tumor, and also to follow the treatment down the line. Now, what is it that we use to light up the tumor? We give them an injection. The injection we give them is radioactive sugar. For those of you who are into the techie, biohacking stuff, it is called FDA. Fluorodeoxyglucose is a radiolabeled form of glucose. You inject it, and it goes throughout the body. The tumors, because they are so metabolically active, immediately up the sugar.

 Does it feed the cancer? It has a high uptake. But then it gets washed out very quickly. But at that moment, you can do the scan. That thing lights up fireworks, so you can see it. But that is different than saying that. That is an injection into the vein. That is different than saying that eating a strawberry is going to do the same thing. It is very important to realize the origin story has to do with this injection using radioactive sugar to be able to light up cancers. There is truth in it. That is where a well-intentioned person starts to do the interpretation. But I think that saying you should not eat any food containing sugar, especially natural sugars, is an overstatement, and it can make this confusing.

Jennifer Simmons, MD

Yes, but I do think that we need to be clear about the fact that what you are talking about are naturally occurring sugars that are part of whole food. You are talking about eating fruit, and you are talking about eating vegetables, and that is one thing. But I do not want to dissociate the sugar cancer thing entirely from that. 

Processed sugar is not good for you. If you have a lot of processed sugar in your diet, you will not be metabolically healthy. It is those people who lack metabolic health who have more of a cancer progression because tumors certainly are more metabolically active than normal tissue. You can change your diet to benefit normal tissue. I do not want to starve cancer, but I want to give it less opportunity to grow by establishing your metabolic health.

William Li, MD

Well, let us dive into that a little bit more, because I am not saying that people should eat sugar. What I am saying is that there is a different explanation for sugar-feeding cancer. I will tell you what added sugar can do. You are putting a lot of calories into your body. You are overwhelming your metabolism. When you overload the metabolism. That means many things. But one thing it means is that we are growing. We are using the sugar, and we are storing that energy into body fat, and we are using the fat cells in our body because the trigger has got to go somewhere. It gets stored when the energy gets stored in fat, and we have a lot of fat naturally in our body that can be healthy. 

We need to store that energy. It is the gas tank in our car. When we are there, we are running on empty. We go to the gas station to fill up. But sugar emptys out, added sugar is a lot of empty calories that you just load into your fat cells the more you grow your fat cells. Not only can you see that in the shape of your body, but more importantly, the fat cell accumulation, the growth of fat mass effect that you cannot see, is the most dangerous kind. It is called visceral fat, and when you load up on lots of sugar, added sugar, and you are growing, you are storing that in your fuel tanks. That fuel tank, which is your body fat, is growing in the middle, inside the tube of your body, visceral, which means gut. It is all the stuff that is around your organs and that grows. 

You could be a skinny person, and this could be happening to you. Yes, that increased visceral fat was driven by excess sugar consumption. The excess fat outstrips its blood supply and becomes inflammatory. When you have more inflammation, you have not only the cancer being inflammatory; now you are feeding the fat cells. Your fat cells become inflammatory, creating more inflammation in your body. That is another different connection between how sugars are flaming the fuel through inflammation by wrecking your metabolism and growing body fat. 

What I am trying to say is that research is showing that yes. Added sugar is not good for cancer and, frankly, for preventing cancer. You want to cut down or cut out your sugar anyway, or not cut it out, but lower dramatically your added sugar. But the explanation is not simply that, you know, you are feeding the tiger at the zoo. It is not that.

Jennifer Simmons, MD

We do not want to create fear around real food because real food comes with a lot of nutrients, polyphenols, and all the other things that you talked about that are beneficial to our health and to our gut microbiome. But when we isolate that out, when we highly process it, when we are just taking in the sugar without the fiber or the nutrient, it has very different implications for our health.

William Li, MD

That is right. Exactly. To keep things simple, because we just talk about a lot of complicated things. If you eat whole foods, mostly plant-based, use healthy oils like extra virgin olive oil or avocado oil, and stay away from ultra-processed foods that contain artificial things like chemicals, coloring, preservatives, etc., things you cannot pronounce. You are going to be doing pretty well. If you use traditional recipes to prepare the food, you are more likely to get something that tastes great. It is also good for your health defenses, which helps your body naturally fight cancer and helps the treatment that you are having more of, so you can enjoy your food while it is fighting cancer as opposed to depriving yourself of tasty food.

 That is what I want people to focus on eating whole foods that you have prepared and using recipes that you enjoy. I suppose one additional thing, because we talked about, growing body fat metabolism. Another thing that cancer patients should just realize is that the choices you make—you do need energy, you do need nutrition—you also do not want to overeat because overeating and overwhelming your metabolism is going to lead to more inflammation in your body. Eating modestly is fine; honestly, people do not realize this, but they skip meals now and then, which I am sure you and I did frequently in medical school and training. You are laughing.

Jennifer Simmons, MD

I know. I was. I was preparing for my intermittent fasting later in life.

William Li, MD

Exactly. It is okay. It might even be beneficial if you take a look at some of the studies on intermittent fasting and cancer. You can see that there seems to be some benefit to not overloading your body with calories. That is probably pretty important. That is as important as putting those good whole foods in your system as well as not overloading your system.

Jennifer Simmons, MD

Yes. I want to finish by talking about what you think are the most astounding new advances that you have seen in cancer research that everyone here needs to know about.

William Li, MD

Okay, I am fresh out of the lab with some smoking-hot experience. What should you guys know about it? We started this conversation by talking a little bit about gut health and how your gut health can be important for the response of your immune system, which can help dry-erase the cancer in your body. Well, we now can identify healthy bacteria that seem to be important for having a better outcome from cancer. Early days yet. But it is exciting enough for people to understand, which underscores how researchers, like myself are beginning to pile on this evidence that we must have good, healthy guts. 

There was a major cancer conference that took place just in May of this year, in the spring. It is called the American Society for Clinical Oncology. We call it ASCO. For those of us who are in the know, it is a big conference with thousands of people coming together—30,000 people—to talk about the latest cancer discoveries. That session about gut health and cancer five years ago would have been an almost empty room. There might have been, five or ten people sitting in it. This past spring, it was a standing room only with easily over a thousand people that came in. 

Guess what was presented there? One bacteria after another. Bacteria from the gut are correlated with better cancer treatment outcomes. More ly to survive, more ly to respond, less side effects. We are also beginning to identify bacteria that are harmful to cancer as well. Stepping out to deliver fresh information to you, and this is going to change. But so far, we have identified in the Medical Community Medical Research Committee nine bacteria that can be from the gut that are associated with how well you are going to do with immunotherapy for cancer. Eight of them you want to have, because the more you have, the better you are going to be. One of them is called akkermansia muciniphila, you can grow it yourself in your gut by drinking pomegranates or eating pomegranates, drinking pomegranate juice, cranberry juice, or concord grape juice or cranberries. 

Here is a little word of caution. Cranberry juice; commercials are very bitter, so they put a ton of added sugar into it. Somebody asked me yesterday during office hours to teach an online course. I had people from all around the world last night and their office hours. They are saying; that Thanksgiving is coming up. I am going to make some cranberry sauce. How do I avoid adding a ton of added sugar? 

I like to cook. I told them; This is how I do it. I take whole cranberries, and I wash them well. I cook them down, and I will add a little bit of maple syrup, which is a natural sweetener. The stuff in the maple syrup takes the edge off the bitterness. I use orange zest; get an organic orange so that you have the zest, and now you brighten the flavor. It has plenty of polyphenols. It also makes the bitterness makes it more brighter and more appealing to your taste buds, and then squeeze half an orange into it. Now you have natural sugars plus dietary fiber from it. You have not put a single teaspoonful of white cane sugar into that cranberry sauce. 

Be very careful about these commercial juices that you buy. Read the instructions because many of them put sugar after water before cranberries. But even pomegranate juice is very sweet apropos what we were talking about before of not overloading your metabolism, I tell people if you want to grow akkermansia, just have the evidence show you only need one eight-ounce glass. That is a couple of shot glasses of pomegranate juice if you are.

Jennifer Simmons, MD

Using pomegranate, put it in our palate.

William Li, MD

Exactly. Now you have seeds, and they are delicious cranberries. You can have it dried as well. Now you are getting the skin, which also has dietary fiber, which also helps. Again, there are bacteria that we are beginning to identify that are beneficial for us to be able to get a better response. That is one thing that I think people need to know. We are also beginning, and this is the beginning of a new era. A second thing that people need to know is that we are beginning to be able to identify whether you have those bacteria in your poop or your gut. 

Although oncologists are just starting to think about it now, in 10 years, I guarantee you we are going to be doing this routinely in every patient with cancer, which is due to a fecal microbiome test, where you do a little swab of poop on a Q-Tip, put it into a little tube, and send it off in the mail to a lab. They see whether you have these good bacteria or whether you have bad bacteria that can help, you know where you are standing. 

Do you need any more fiber, or do you need to cut down on your bacteria? There is nothing more empowering than knowing where you stand. That is something that you might want to do. People should start thinking about it as well and bring it to their doctor. Can I get my gut microbiome tested? Then I would say that the other thing is to just recognize that.

Jennifer Simmons, MD

I am looking forward to that time because I will be able to retire. When the medical oncologist starts to do the work. I am going to retire.

William Li, MD

All transformations occur with one person at a time, one patient at a time. Unlike you. I am very impatient for change. But because I have been involved as a changemaker, I know that there are different pressure points to get things done. This discussion we are having on this podcast is so important because it allows us to get the message out so that people can bring the conversation to their doctor, who may be so busy they cannot keep up with it. 

Now the patient is going to, you, the listener, prompt your doctor to look into it further, not only to help you but to help other patients. We are all doing everyone a favor by creating the ripple effect. By the way, that doctor, that oncologist, is going to be there to help himself or herself, their family members, their community, and their colleagues as well.

Very importantly, what we are talking about, Dr. Jenn is it is a spread the word message; about gut health, strong immunity, good health defenses, whole foods, and avoiding ultraprocessed foods, and added sugars. There are some take-home points here that are quite practical. Whether you want to prevent cancer, whether you want to prevent it from coming back, or whether you want to tip the odds in your favor to respond to cancer treatment.

Jennifer Simmons, MD

I am glad that we are moving from our time of training, which is to do as I say, not as I do, to doing as I do. We are now walking our talk, and the reason people are listening to us is because they see that we are walking our talk. Yes. I remember, the days when your cardiologist would be 40 pounds overweight, smoking a cigarette, and telling you to eat less and move more.

William Li, MD

Right.

Jennifer Simmons, MD

I am glad that those days are behind us. I am glad that we are now living in an exemplary way so that our patients are inspired to live in an exemplary way and certainly to pay it forward because we know that when we help that one woman, her family gets healthier. Her friends get healthier, and her community gets healthier. That is what we need. We need to spread in that way. 

Will you leave us with, is there one food that you think we should all be eating or drinking?

William Li, MD

I will give you my personal preference, but I think that the data and all the research support the idea that green tea is beneficial in so many ways. It is hydrating; it provides the polyphenols that our body’s defense systems need; it improves our immune system; it lowers inflammation; and it helps our body starve cancer naturally. Green tea also helps to lower our blood pressure, which is good for cardiovascular health as well. Believe it or not, there is fiber that we swallow. When you brew tea leaves, some of that fiber comes up, and we swallow it. If you want to drink a lot of matcha, which is a special Japanese green tea that is a whole leaf with all the fiber and all the polyphenols ground up, you can sip that and drink that.

My great uncle, by the way, lived to 104 years old, completely mentally intact and independent, and he attributed his longevity to drinking green tea all day long, his entire life. He lived at the base of a tea mountain, and he would get up in the morning, walk up, and just sip tea all day long. People go. Some people will say, I do not know how I would drink 3 to 4 cups of green tea a day, which is what most of the evidence is circling. You want three or four cups of green tea for your ultimate benefit. But I would tell you, in Asia, they drink a lot more than in Japan, China, Vietnam, and Thailand. 

The reason is to think about it. When you go to one of those Chinese restaurants or Vietnamese restaurants, somebody is pouring and refilling your tea for the entire meal. What happens in Asia is that they use whole-leaf tea and just brew a pot or brew cup, and they just keep filling it up with hot water and carry it around with them. Do you know how people these days carry a thermos and a water bottle? Yes. They are just swimming in it. 

If you want to do one thing that could make a big difference in your life, try having a water bottle filled with green tea or cold iced tea. All fine. Do not add sugar to it. Do not buy the commercial versions of these teas. Make it yourself. That is even tea. It is best to have a whole-food version of it. When you brew yourself you are going to be doing yourself a world of benefit. You can also cook with tea, by the way. There are lots of recipes now. People go, yes because I like to cook. I do not know how to cook with tea. Type, a green tea, recipe, video, search, and just watch somebody else show you with passion and with joy. What an amazing meal that you can make.

Jennifer Simmons, MD

Yes, amazing. This has been an amazing talk. We covered so many things. I love that your research is finding that food is every bit as successful at reversing disease and herbs as the pharmaceuticals that are being worked on. We talked about some of the myths about food and cancer. We talked about how important it was to have a diet rich in fiber and that fiber comes from your whole plants, your whole vegetables, and your whole fruits. Not be afraid of sugar and fruit because they are bound to have so much goodness and have such health benefits for us. 

We talked about the foods to avoid being sure, avoid processed sugar, alcohol, processed meat colorings, flavorings, and food additives, and go easy on red meat, and then we finished up by talking about the breakthroughs of the bacteria that are associated with better outcomes. You said there was one that was associated with a worse outcome. We are going to continue to follow this story because we want to know. But the thing is, you cannot control those individual bacteria without taking control of your diet. 

That is what it comes down to at the end of the day: having a rich, diverse diet filled with lots of plants, lots of colorful plants, and lots of polyphenols that you can enhance the strength of your microbiome, enhance the strength of your immune system, and have the health that you want. Make sure you are drinking your four cups of green tea every day. Thank you so much, Dr. Li, for being here. 

William Li, MD

Thank you. 

Jennifer Simmons, MD

I loved talking to you. I could listen to you forever, but we are out of time, so it is Dr. Jenn. Bye for now.