How Not To Die Of Breast Cancer

Michael Greger, MD, FACLM

Thank you so much. I’m so honored to be here.

Jennifer Simmons, MD

Wow. I can’t tell you how much that means. So obviously, I know who you are and the giant that you are. But can you give a little background as to kind of what drove you into this space because you started off a regular doctor like the rest of us?

Michael Greger, MD, FACLM

Yeah. You know, it was actually all my, it was all going back to my grandma. I was just a little kid when my grandma was diagnosed with end-stage heart disease and sent home in a wheelchair to die essentially. She already had so many bypass surgeries, basically ran out of plumbing at some point, confined to a wheelchair crushing chest pain. Her life was over at age 65. Then she heard about this guy Nathan Pritikin, one of the early lifestyle medicine pioneers. And what happened next is detailed in Pritikin’s biography. Frances Greger, my grandma, they wheeled her in and she walked out, though she was given her medical death sentence at age 65, thanks to a healthy diet, she was able to enjoy another 31 years on this planet until age 96. They continue to enjoy her six grandkids, including me. That’s why I went into medicine. That’s why I chose to practice lifestyle medicine. Why I started the website NutritionFacts.org. Why I wrote the book How Not to Die, and why all the proceeds from all my books are donated directly to the charity. I just want to do for everyone’s family what Pritikin did for my family.

Jennifer Simmons, MD

Yeah, it’s funny. I had a very similar experience at 11. My grandmother came to visit me at summer camp and brought an article with me and she said, it’s too late for me, but it’s not too late for you. And the article was about Dean Ornish. And so I didn’t appreciate who that was or what it meant then, but I became a vegetarian then, and it just grew from there.

Michael Greger, MD, FACLM

Wow.

Jennifer Simmons, MD

So vegans get a pretty bad rap. Most people think of it as a philosophical thing. And there are a lot of things that are vegan that are not healthy. Right. There’s the impossible burger meat. And I’m not picking on the impossible burger, twizzlers, or vegan, right? So, there’s a lot of junk food that’s vegan. So can you kind of break it down for us? Tell us the meaning behind it. Why is it meaningful to be plant-based? What’s happening and why is this such an important tool?

Michael Greger, MD, FACLM

Yeah, I’m glad you mentioned plant-based. I mean, that’s really the critical thing. You know, as a physician, right? As physicians, when someone tells us the vegan, that just tells us what they don’t eat. Right. Do they actually eat their vegetables right? I mean, we all know these college vegans who are like for the environment or whatever or, you know, living off of French fries and beer. I mean, it’s just like that.

Jennifer Simmons, MD

That’s true.

Michael Greger, MD, FACLM

Again, that is vegan but not healthy by any stretch of the imagination. So that’s why I like the term whole food plant-based. I’m suggesting that your diet is really centered around the healthiest foods on the planet. These are whole plant foods. And that’s what really the best available balance of evidence suggests is that the healthiest diet is one that minimizes the intake of meat, eggs, dairy, and junk, maximizes the intake of fruits and vegetables and whole grains and legumes, beans, green beans, chickpeas, lentils, nuts and seeds, herbs and spices, mushrooms. Basically, real food that grows out of the ground. These are our healthiest choices. But look, doesn’t matter what you eat on your birthdays, your holidays, or special occasions, it’s really the day-to-day stuff that adds up on a day-to-day basis. We really should try to eat healthy, not just in general to live a long and healthy lives but specifically for breast cancer. The American Institute for Cancer Research is kind of the most kind of prestigious body that looks at diet in cancer. Found that women just doing three things, limiting alcohol, maintaining a normal BMI, not being overweight, and eating a diet centered from plant foods or reducing meat. Eating lots of fruits and vegetables reduces breast cancer risk by 62%. Cutting more, your risk more than half by just those three simple steps.

Jennifer Simmons, MD

Yeah. And we can we can get into all of those things. Certainly limiting alcohol. I mean, I always tell people like don’t shoot the messenger when I say this, but we know that there’s no safe amount of alcohol for women. The bottom line is that the alcohol is broken down by the liver and the female liver. We are not equal. It just does not function as well as the male liver. And so alcohol has significant deleterious health effects on women that it still has them on men, yeah, I don’t want to pretend that alcohol is in any way good for men, but men will tolerate more alcohol than women, right?

Michael Greger, MD, FACLM

Yeah. What’s surprising is for the Harvard Nurses Health Study, for example, which followed 100,000 women for decades, found that even light drinking, which they define as less than a single drink a day. So like a drink every other day, still associated with increased breast cancer risk. We know alcohol is a breast carcinogen. It causes breast cancer in women. And so we should really minimize our intake of alcohol as much as possible.

Jennifer Simmons, MD

What do you think is happening in places like Marin County, California, where there is an increased incidence of breast cancer? Do you think that that is due to more alcohol consumption because they’re living in wine country? Or do you think it has to do more with pesticides, and herbicides that are used to treat the crops, and people are just exposed through it to it, through their food, through their groundwater? What do you think is happening there?

Michael Greger, MD, FACLM

Oh, I don’t know if there’s some kind of surveillance us they’re just looking for it more. I’m not familiar with the Marin County in terms of what’s been happening with breast cancer rates there, all the things you mentioned could certainly play a role. But of course, just because you live in wine country doesn’t mean you actually have to drink this stuff. But, um, yeah, so, but there’s certainly a number of factors, but, you know, you’ve got to tease them out to find out where exactly it is.

Jennifer Simmons, MD

Yeah. And talking about a normal BMI, so many people struggle with this because they feel like if we are talking about weight, it’s a punishment and we’re calling them out. And, you know, this is just a reality that the more fat to muscle ratio you have, the higher your risks are of getting breast cancer. So can you can you uncover that a little bit?

Michael Greger, MD, FACLM

Right. Your adipose tissue, your fatty tissue in your body actually produces estrogen. It’s not just your ovaries. That’s why postmenopausal women, for example, still have it in their bodies, just not as much once their ovaries shut down. But fatty tissue produces estrogens more. And that’s why you have kind of feminizing effects in overweight men. It’s because they’re their fatty tissue is making estrogen, too. And their action can act as a fuel for the growth of breast cancer, which is estrogen, possibly the most common type of breast cancer out there. And so by when I say having a normal BMI, actually a normal BMI is terrible. I mean, the normal BMI.

Jennifer Simmons, MD

In this country yes.

Michael Greger, MD, FACLM

Actually, 28.6 is the average BMI in the United States. When I read that, I couldn’t believe it. But that is not usual, that is for an almost overweight, almost obese average person is almost obese.

Jennifer Simmons, MD

But I think that that is exactly the problem, is that what we consider average in this country is just normalizing our lack of health.

Michael Greger, MD, FACLM

Yeah.

Jennifer Simmons, MD

It was just normalized so much. Right. So we shouldn’t be talking about average BMI. We should be talking about optimal. So where do you think that is?

Michael Greger, MD, FACLM

Yeah, exactly. You know, it’s like having normal cholesterol or normal blood sugar or normal blood pressure in the United States. Well, I mean, having normal cholesterol is having deadly cholesterol. The number one cause of death of women in the United States is heart disease. So we don’t want normal. We want optimal, right? Yeah. And the same thing with weight. And so the optimal BMI for longevity is between 20 and 22, but staying under 25. So just not being overweight is, is what the ACR determined, which significantly decreased the risk of breast cancer. So going from overweight, which is the average weight in the United States to a BMI under 25 should significantly decrease your risk of breast cancer. As well as you know, osteoarthritis and there are all sorts of other things that come with having excess weight in your body.

Jennifer Simmons, MD

Yeah. And I think that it’s more because, you know, those excess fat cells they’re not just benign things hanging around. These are very active cells secreting in lipo kinds that are quite damaging and inflammatory to your health. And at the end of the day, this is a game of inflammation, right?

Michael Greger, MD, FACLM

Certainly, inflammation plays a role in a number of cancers. That’s why, you know, you can get something like hepatitis can lead to liver cancer because the inflammation of the virus can spur the can cause the transformation of the cells into cancer. And inflammation does appear to have kind of a fueling role. And so we’re talking predominantly about visceral fat, not the superficial jiggly fat they see in the mirror but this is the deep abdominal fat below your stomach muscles that it’s kind of infiltrating and wrapping around your internal organs. That’s the really dangerous kind of fat. But thankfully, that’s actually the first fat we lose when we lose weight. Our body knows this is the most dangerous fat, and we start cutting down on our visceral fat. I wrote an entire book How Not to Diet on the healthiest ways to lose weight, encouraging people to go to their local public library and check it out.

Jennifer Simmons, MD

Yeah, and that visceral fat is obviously the most dangerous fat. And that’s why when people lose weight we see their inflammatory markers drop pretty quickly. And it’s not because they’re at their ideal weight, but because they’re losing that inflammation, generating weight that is around their abdomen. So the different body shape shapes actually matter because some are more inflammatory than others. And that is mostly a genetic thing. So the people that tend to deposit the fat around their abdomen, that’s actually the most dangerous body type. Right?

Michael Greger, MD, FACLM

Yeah, that’s true. But, you know, regardless of what kind of genes we were dealt with, regardless of what our family history is, most of the risk of these kinds of chronic diseases really comes down to simple lifestyle behaviors. The fact that those three simple lifestyle factors can decrease your risk of breast cancer by 62% shows that genetics just plays a very small role. You know, we hear a lot about so-called breast cancer genes, but that accounts for just a very small percentage of these kinds of rare, kind of familial causes of breast cancer. Most breast cancer is sporadic breast cancer and really comes down to how we live our lives.

Jennifer Simmons, MD

Yeah. So let’s get into the plant-centered diet that you were talking about. Why does that decrease inflammation? Because there are a lot of carnivores out there that will say otherwise. There are people talking about lectins. There are people talking about, you know, that there’s too much starch in the vegetarian proteins and it into high glycemic diet and it’s carbohydrate-rich. And so can you address some of those things?

Michael Greger, MD, FACLM

Yeah, well you can get a lot of the I mean, sure, you don’t necessarily have to cut out meat to get a lot of the benefits of eating more plants. And so there’s so it’s kind of a twofold. So one thing by cutting down on me, you cut down on breast carcinogens like heterocyclic means which are compounds that are produced by the combination of creatine and muscles. When muscle ruptures under high dry heat and high heat, the creatine in the muscle can turn to these heterocyclic means, which is a known breast cancer carcinogen as its estrogenic effect. And so that’s grilled, baked, barbecued, fried, any kind of meat. And so if you are going to eat meat, it’d be better to do stewed, you know, meat and soups, poached anything that where the moist, the moisture keeps the temperature low. So steaming as well.

Jennifer Simmons, MD

It’s the burning that creates that thing.

Michael Greger, MD, FACLM

If you don’t I mean, just if you bake it and you don’t burn it it’s still just that high dry heat combined with muscle tissue that can produce these carcinogens. So even just shifting the way you cook meat can do it, minimizing the intake. And then, well, there’s all sorts of things in plant foods that can help. So, for example, fiber was found in all plant foods concentrated in whole grains and legumes, beans, green beans, chickpeas, and lentils. They act as prebiotics for gut flora that when we feed them. They feed us right back. They produce the short-chain fatty acids that are absorbed from our colon into our bloodstream, circulate throughout our bodies cause the blood-brain barrier, improve our immune system, decrease our appetite, and dampen inflammation. 

That’s why you give someone a high-fiber meal. I give asthmatic high-fiber meals also and they can breathe better. You said, wait a second, what does the gut have to do with breathing better? In fact, and you can even do, you know, having cough-up sputum cells, less inflammatory cells just after eating, you know, being burrito than before and it’s because we feed our good gut flora. They produce these short-chain fatty acids which have an anti-inflammatory role throughout the body. And so fiber may be one of the reasons why a more plant-centric diet reduces the risk of breast cancer.

Jennifer Simmons, MD

Yeah. And what about the argument that the meat people say that you, that it’s I mean, it turns out, you know, I have a lot of haters on social media. People really get angry when people are plant-based. I don’t understand the anger.

Michael Greger, MD, FACLM

I mean well, you’re calling it. I mean, I think at some level at this point, they realize at some level that they’re kind of on the wrong side of history, on the wrong side of science. 

Jennifer Simmons, MD

Holding on tight to it though.

Michael Greger, MD, FACLM

And so it’s like, you know, non-smokers upsetting smokers. It’s just like there’s this kind of, you know, it reminds them, oh, yeah, what I’m doing to myself is going to hurt me. And so, you know, people don’t want to hear bad news about their good news. The bad news about their habits.

Jennifer Simmons, MD

Yeah.

Michael Greger, MD, FACLM

So, you know, they just kind of.  Yeah, kind of kill the messenger kind of thing. Yes. It’s like the evidence is really overwhelming. We know what a healthy diet is. Now, look, it doesn’t mean you look, you know, one day, you know, don’t beat yourself up. You just try better the next day, right?

Jennifer Simmons, MD

Yeah, exactly.

Michael Greger, MD, FACLM

It’s all about just reducing your risk. Putting your seatbelt on, smoke alarms, and not bungee jumping like you do that just decreases your risk. Is it kind of guarantee you something bad is not going to happen? No. But we have this huge mountain of evidence that suggests that eating healthy, not smoking, exercising, and all these things can lead to longer, healthier lives.

Jennifer Simmons, MD

Address the lectin thing for me, because I think a lot of people I get asked about this a lot and a lot of people struggle with this and they’re worried that their vegetables are poisoning them and that their beans are poisoning. So can we talk about that a little bit?

Michael Greger, MD, FACLM

Yeah. So I mean, for all the science, yeah, I did a series of videos. You can just type in lectins in nutritionfacts.org. It really started with this book by Dr. Gundry called The Plant Paradox, where he argued that these compounds and you know in what we think of as really healthy foods may be hurting us but unfortunately it’s really confused a lot of people. There are, for example, you know, lectins and beans that can be harmful, but they’re destroyed by cooking. No one eats raw, hard beans. You couldn’t even you like you’d break your truth or something as soon as you can. like a mushroom beam with a fork, electrons are gone. And so, yes, you can point to and there’s these famous case reports of someone who like soaked their beans overnight and made some kind of raw being salad and they got really sick. Well, yeah, because you did not cook the beans, you got to actually cook. But everyone cooks beans, all like canned beans. Those are all precooked. Yeah. And if you can chew it, the lectins are gone. And how you know, and the lectins and like tomatoes, for example, are totally harmless.

Jennifer Simmons, MD

Cucumbers. Eggplant, 

Michael Greger, MD, FACLM

I mean. Yeah. I mean look at the data. I mean the longest-lived populations in the world center their diets like the blue zones center, their diets around not just any source of protein, but specifically beans help these people eat beans. Beans reduce your, is associated with a reduction in risk of breast cancer. And so there’s just the data doesn’t support it at all.

Jennifer Simmons, MD

Yeah.

Michael Greger, MD, FACLM

So I mean, it’s just, you know, I know it sounds when someone says something controversial, you know, it’s hard to sell a book that says like eat more broccoli. If your book does say eat more broccoli, who’s going to buy that book? But if the book said to watch out for broccoli, what? oh, my God, I got to click on that link.

Jennifer Simmons, MD

Ah, yeah. My husband didn’t eat cucumbers for like a year and I said, stop, you can eat cucumber. Your cucumbers are not killing you. The vodka you’re putting them in might be killing you, but the cucumbers are not killing me. All right, let’s talk about soy because I have people write me every single day. Is soy dangerous? Is soy good for me? Is soy going to bring my breast cancer back? Is soy causing breast cancer? Are we can we address this?

Michael Greger, MD, FACLM

Sure, sure. Yeah. Soy is really misunderstood. People don’t understand. There are two types of receptors in the body, alpha and beta. The phytoestrogens found in flax seeds and soy, for example, bind to the beta receptors where our own endogenous ovarian estrogens bind to alpha receptors. And so the effect of soy on different tissues depends on the relative concentration of alpha versus beta receptors. So, you know, estrogen has positive effects on some tissues and negative effects on the others. So you know what we want. So, you know, for example, estrogen is good for the bones but bad for the breast. So ideally we’d have some kind of selective estrogen modulator where we had estrogenic effects in some places and antigenic effects in others. And that’s exactly what we get with phytoestrogens, right? 

Soy appears to lower breast cancer risk. That’s an interesting genetic effect with the same time reduces menopausal symptoms hot flashing. That’s an anti-estrogen. Excuse me that’s a proestrogen.  Or you know, increased bone mineral density so that’s a pro-estrogen effect. So, with soy, you get the best of both worlds and the same thing with flax seeds. There are some plant phytoestrogens like the ones in hops. They’re used to make beer that actually has alpha activity and is presumed to increase breast cancer risk. In fact, hop workers in the fields actually start menstruating because of those estrogenic effects. But we really kind of lucked out with soy. So there’s been since the first one got about 10 years ago now there have been five studies on breast cancer survivors of soy. And you put them all together and thousands of breast cancer survivors studied. Those who eat soy live longer and have lower breast cancer recurrence rates for a low risk of breast cancer coming back and a lower risk of dying from breast cancer.

Jennifer Simmons, MD

Yeah. So we can tell everyone that they have and eat their soy.

Michael Greger, MD, FACLM

We should go out of our way to include showing the diet because soy decreases the risk of getting breast cancer in the first place, doing 30 to 50% earlier start the better. And you know, one more thing I’d just like to add about plant-based diets. People don’t understand that, and actually, I didn’t either. I was surprised to learn that the number one killer of women diagnosed with invasive breast cancer is actually still heart disease. Heart disease still kills about a little over half of women with breast cancer. So the number one reason a woman with breast cancer is going to die is actually heart disease. We know we can reverse heart disease with a plant-based diet. And so even if a plant-based diet had nothing to do with breast cancer, we’d still want to do it to save the lives of all women. But I think that’s critically important. So it’s just kind of knock-on benefit after knocking-on benefit. A breast-healthy diet is a heart-healthy diet is the liver. A healthy diet is a kidney. A healthy diet is a brain-healthy diet. And so encourage people to add more healthy plant foods into their diet.

Jennifer Simmons, MD

Yeah. And I think that that’s a really important point that you bring up in every generation of a woman’s life. Women die two to seven times more frequently of heart disease than they do breast cancer. And it goes up with every generation. And I know that in my 17 years of practicing breast surgery, never, ever, ever knew that or spoke about that that I was trained to believe that people who got breast cancer were going to die of breast cancer. I think we never connected the two. And the truth is that the vast majority of women will die of heart disease. And that includes the women that have breast cancer. And so, you know, it’s no different than any other disease because the truth is that the environment is what is responsible. The environment and the choices that we make within our environment are responsible for the vast majority of chronic diseases.

Michael Greger, MD, FACLM

Such great news because it means we have the power.

Jennifer Simmons, MD

Yeah, it is. We have the power.

Michael Greger, MD, FACLM

I’m forced to run for my next.

Jennifer Simmons, MD

Yes, you do. I want everyone to read How Not to Die. Go to nutritionfacts.org for all these great answers. This was awesome. I am so grateful that you could be here today. Thank you so much for spending your time and sharing your wisdom. I just want to summarize that vegan is not healthy and that the diet that we’re talking about is a whole food plant-based diet. And you don’t have to be perfect because it’s what you do most that matters. The three things too lead to a decreased risk of breast cancer are limiting alcohol, not normalizing your BMI, but optimizing your BMI, and adopting a plant-centered diet.

Michael Greger, MD, FACLM

Thank you so much. Keep up the good work.

Jennifer Simmons, MD

Thank you, Dr. Greger. Bye for now.