Rediscover Breast Cancer Through A Functional Medicine Lens

Elizabeth Boham, MD, MS, RD

I was in my residency, yes.

Jennifer Simmons, MD

You got a very unintentional education, but you have shared that experience with the world and made many women’s journeys better because of it. First of all, I want to welcome you. I’m so glad you’re here.

Elizabeth Boham, MD, MS, RD

Thank you. Dr. Jenn Simmons and all of your people summit. It’s great, Jenn.

Jennifer Simmons, MD

I’m so glad you’re here. I should give a little background about you because you are the partner of the very famous Dr. Mark Hyman, you work at the UltraWellness Center, and you’ve been there since 2007. For a long time, you’ve been practicing integrative medicine at the Cutting Edge Ranch in Maddox, Massachusetts, and you were partners with the Albany Clinical Nutrition Specialists. You’ve been in this space for a long time, working in an amazing place and making an incredible contribution. But it started with your journey. Because you were originally trained in internal medicine or family medicine, what was your training?

Elizabeth Boham, MD, MS, RD

Yes. I’m board-certified in family medicine. My undergraduate and graduate degrees were in nutrition, so I was always interested in nutrition and using food as medicine. I was a registered dietitian before I went to medical school. So I was all into prevention. That was like my big thing. I had no idea what medical school training was going to bring because I didn’t have physicians in my family. So I’m in the middle of learning all about this acute care medicine, but still believe in prevention. And then I’m in my training, my residency training for family medicine. I found a mass, and I was 30. I had no family history of breast cancer. I never thought I was going to have breast cancer. I came up with all sorts of diseases for myself. But breast cancer was not one of them. But I was lucky from the standpoint of being around a lot of physicians. I had just trained with a breast surgeon, and everybody moved forward, even though I never thought it was breast cancer. I wasn’t thinking it was breast cancer, but it ended up being triple-negative breast cancer. So I did go through chemotherapy and radiation after the surgery. So, yes, 24 years ago.

Jennifer Simmons, MD

I guess the first question I have to ask is: I’m sure that a lot of people feel this way. Is that how someone who is focused on nutrition, who is so focused on prevention and wellness, not as it happened, gets breast cancer? Because I’m sure a lot of people ask that question.

Elizabeth Boham, MD, MS, RD

I did, too. I was pissed off, to be honest with you, like I went through those five stages of grief. But, anger was one of them because I was like, I’m 30 years old. Back then, it was rare for a 30-year-old to get breast cancer. I didn’t know anybody in their twenties. Unfortunately, we’re seeing a rise in young women getting breast cancer. So now it’s still not as common to get it when you’re 30. But it’s unfortunate. a little more common these days than it was even back then. But I was angry, and functional medicine was a great place for me to sort through all of this and make sense of it because, like, we know that prevention is important and lifestyle is important, as is what you eat, what you do for exercise, and how you manage stress in your sleep.

But we also know there’s more going on. We know that our genetics may have an influence. We know that our environmental exposures have an influence. We know that our mom’s environmental exposures have an influence. 

We know that our microbiome has an influence. There’s so much functional medicine that helped me learn about that. We have to take all of these different aspects into account and ask the question, Why for that person? For me, in terms of my lifestyle factors, I wasn’t that good at managing stress. I was working nights, and I wasn’t getting enough sleep. I was angry with the decisions I made. There was something like the stress piece that I had to work on. But then it also taught me there were other things in my body that weren’t working great. My microbiome and my gut health needed a lot of attention, just as the way I detoxified needed a lot of attention. What is wonderful about functional medicine is that it helps us work with that person so we can figure out where they need to focus.

Jennifer Simmons, MD

Yes. I’m sure that learning about functional medicine was eye-opening because what we typically consider healthy and what is healthy are oftentimes not the same. I don’t know about your practice, but I routinely have people come to me and say I’m healthy, but I have breast cancer, and this makes sense to them. They believe this. One of the problems with breast cancer is that you don’t feel sick unless it’s very advanced. So it’s sneaking up on you, and people don’t realize that there is something there that is out of balance that is leading to this breast cancer diagnosis.

Elizabeth Boham, MD, MS, RD

It helped me realize what was out of balance in my body and what I needed to do to put things into better balance and create that healthy terrain so that hopefully it won’t come back, or it hasn’t yet, and hopefully, it won’t. But all of that made me healthier anyway. Working on how I interact with the world, manage stress, take time for myself, and get more rest helps with all of my health issues. helps my body be able to heal much better as a whole. That’s very true.

Jennifer Simmons, MD

Breast health is health. the same things that we’re doing to improve our breast health. We’re doing it to improve our overall health. Let’s start to get into what those lifestyle factors are that contribute to an increased risk of breast cancer. Because when you were diagnosed at 30, it was pretty rare to see breast cancer that young, but it’s not so rare anymore. We’re seeing them at younger and younger ages. I suspect it’s because our environment and the way that we live are worse.

Elizabeth Boham, MD, MS, RD

The question is: why are we seeing more and more younger breast cancers? One thing that comes up a lot is that we’re eating more and more processed food. We’re not getting as much physical movement and exercise, and we as a whole are heavier; we have more weight. That we’re heavier or more obese. because we do know that our diet, our weight, and our exercise all contribute to the risk of breast cancer. But I do think, especially with certain populations and especially with the younger population, we also have to acknowledge the fact that our environment and our environmental exposures are having a huge impact here. that, outside of lifestyle, we know that our toxin exposures, and as I mentioned earlier, our mother’s toxin exposures and our grandmother’s toxin exposures, are impacting our risk. that we can’t just, I don’t think it’s the only lifestyle that’s impact, is the reason why we’re seeing this increase in lots of cancers in younger people, including breast cancer.

Jennifer Simmons, MD

Talk about a little bit of what you are referring to when you talk about mothers and grandmothers and toxin exposure. Connect the dots for people. in case they don’t understand that relationship.

Elizabeth Boham, MD, MS, RD

They’ve done a lot of research on endocrine-disrupting chemicals. Endocrine-disrupting chemicals are chemicals in the environment that are exogenous chemicals in the environment that interfere with the hormone action in our body. There are many endocrine-disrupting chemicals out there. One of the ones we know the most about is BPA. We started to learn about BPA, that substance in hard plastic, but also in the lining of cans, in dental sealants, and on receipts that you receive. We know that BPA is an endocrine-disrupting chemical. What that means is that it can impact hormone action, hormone metabolism, or hormones—all sorts of things that the hormones do in our body.

So they’ve shown that when women have exposure to endocrine-disrupting chemicals, either when they’re fetuses or.   They’re inside their mother’s belly. That’s going to influence their risk of getting breast cancer 30 years later or 50 years later. What’s fascinating about endocrine-disrupting chemicals is that it’s not like a linear relationship, like a lot of toxins. We think that, if you have a little bit of exposure to lead, that’s not good. But if you have a lot, that’s even worse. But they’re doing some research on endocrine-disrupting chemicals and seeing that there’s not necessarily a linear relationship. It’s more the timing of the exposure and that there may be some exposures that impact epigenetics, which means that it is your genetic expression. So they’re there. They’ve been doing some research to see how that impacts a woman’s risk transgenerationally. If your grandmother had exposure to some endocrine-disrupting chemical, how does that impact a woman’s grandchild’s risk of having breast cancer? There’s a lot that we don’t completely understand or appreciate in this area, but those scripting chemicals are way more pervasive. All of these toxins that we’re getting exposed to that we didn’t use to get exposed to 100 years ago, like BPA, plastics, parabens,  phthalates, triclosan,  and then just other pesticides and herbicides, have an influence.

Jennifer Simmons, MD

We’ve seen I’m like forgetting what the name of that drug was that was given to women in pregnancy. DES. So those children, children of women who were treated with DES end up having a whole host of cancers as a result. 

Elizabeth Boham, MD, MS, RD

It was 1971, for women, it was used for years to prevent miscarriage. It’s hard sometimes to find out, to get those records. Sometimes we’re in a situation where we’re trying to get those records to find out what exposure a woman had. It’s sometimes very hard to get those records. Now that we’re talking about grandchildren, potentially, it is very hard to always put the pieces together.

Jennifer Simmons, MD

Yes, we can’t help the things that we’ve been exposed to.  

Elizabeth Boham, MD, MS, RD

Yes. I’m sorry. I don’t mean to cut you off. 

Jennifer Simmons, MD

I was just going to say, like, how do we start today with whatever hand we were dealt and try to make it better?

Elizabeth Boham, MD, MS, RD

That’s interesting because lifestyle can have an influence here. We don’t want to just throw up our hands and say, Well, who knows what my mother was exposed to or what I was exposed to when I was a teenager? But there are things that you can do and that we’re learning about that can influence how that toxin can influence us. There’s been some interesting research looking at phytonutrients. The phytonutrients are the components of our plant foods. In plant foods, let’s just take spinach. You have vitamins and minerals, but you also have phytonutrients. These components are the parts of our plant foods that have this tremendous ability to impact our health.

Some phytonutrients have been shown to lower inflammation, and some phytonutrients have been shown to support detoxification. Some phytonutrients have been shown to decrease angiogenesis, which means the sending of blood vessels to a tumor that helps it grow, or lower aromatase, which can shift how hormones change in the body. But there’s been some interesting research looking at how phytonutrients can block the harmful effects of plastics in the body. an interesting study that looked at. If you have more phytonutrients in your diet, that can block the negative actions that plastics like BPA can have in the body and, therefore, decrease the growth and spread of cancer. it’s fascinating. We always talk with women about getting those eight to 12 servings of phytonutrients in a day, and so we get them by eating from the rainbow, which means that you get all sorts of different colorful plant foods in your diet because that’s where you’re going to get all sorts of different phytonutrients.

And there are so many things that fall into this phytonutrient category, from ellagic acid and lycopene, but also, like the ones we hear a lot about in the breast cancer world, the glucosinolates. They come from your cruciferous vegetables. They go on to produce sulforaphane in the body, and sulforaphane is magical from an estrogen metabolism perspective because it helps our body make glutathione, which helps the body detoxify from toxins. It feeds the good bugs in the gut. It’s a really strong antioxidant, and it can decrease DNA damage that occurs from carcinogens that we get exposed to in the environment. So,  cruciferous vegetables like broccoli, broccoli sprouts, Brussels sprouts, kale, and cauliflower are rich in this substance. So we are always encouraging that for that reason.

Jennifer Simmons, MD

Yes, we hear a lot about this term, estrogen dominance, and there is a preconceived notion that the reason that women get breast cancer is because they have too much estrogen. There’s estrogen dominance. Can you talk about that a little bit? Then, can we talk about estrogen detoxification as well?

Elizabeth Boham, MD, MS, RD

What’s important in this area is what we’re talking about in terms of estrogen metabolism and detoxification. Sometimes women will have what falls into the category of estrogen dominance, like having more breast tenderness around their period or more PMS, or they’re more prone to endometriosis or fibroid production. So the feeling is that they’re not able to metabolize and detoxify their estrogen as well. That’s something that we focus on a lot in functional medicine. We will focus on looking at how that woman metabolizes and detoxifies estrogen. So,  for example, after, like, ten years after I had breast cancer, I had a blood clot.

In my subclavian vein, well, that also means we’re more prone to blood clots when our estrogen level is higher. But what’s important to focus on is: how are you mobilizing that estrogen? We’ll look at things like genetic variations and SNPs, things like the low-penetrance genes. We’re always focused on those high-penetrance genes, like Baraka. which is important to look at. But we also know that there are these low-penetrance genes that lots of women have variations in. But when brought together, they influence not just how a woman processes multiple things in her body but also how she metabolizes and detoxifies her estrogens, and it’s not just the estrogen that’s already done its job and you’re working to get rid of; it’s also some of these xenoestrogens.

These estrogen talk, these toxins from the environment that we were talking about earlier that impact estrogen, the estrogen receptor in the body, unfortunately, like BPA, it’s in parabens. We look at things like C1T and some other genetic SNPs that are influencing how that occurs in the body. We can also measure it directly. There is a test that we can look at that looks at how the body is metabolizing its estrogen. How are we doing it? Also, look at the gut microbiome, because we know that the balance of good and bad bacteria in the gut influences how you get rid of multiple toxins, including things like estrogen that’s already done its job, and it’s time to move it out of the way. You want to eliminate it through the gut, but if you have an imbalance in the gut microbiome, if you’ve got what we call a dysbiosis, an imbalance in the bugs, you can have an elevation of this enzyme, beta-glucan, which allows the estrogen to get cleaved and get reabsorbed back into the body. I’m sure that’s influencing toxins and toxin reabsorption as well. So we’ll also look at the gut microbiome to say, Okay, how is the body getting rid of these hormones and xenoestrogens?

Jennifer Simmons, MD

Yes, people struggle to understand how the gut is connected to hormonal health. Will you talk about that a little more to make that connection a little more understandable for people?

Elizabeth Boham, MD, MS, RD

Sure, I will try. We are covered with these trillions of bugs. Bacteria, viruses, and healthy fungi. They cover our skin and our nasal passageways. There’s even certain bacteria in the gut, in our breast tissue, and in our vaginal area. When things get out of balance with these bugs, when they get out of balance, that’s when we call it dysbiosis. It’s not necessarily an infection. If you’ve got a stomach bug and you’ve got this bacteria, it’s an infection, and sometimes you might have to treat it, or you’re very sick. But dysbiosis just means an imbalance. not necessarily as acute or as symptomatic as when somebody has an infection, but there is an imbalance. This dysbiosis is sometimes hard to put your finger on. Sometimes women or people will have symptoms in their digestive system when they have dysbiosis. They might feel bloated, they might feel constipated, they may have diarrhea, or they may just not digest food well. But sometimes women have no symptoms. We find dysbiosis. that dysbiosis or imbalance in the gut microbiome can impact our body in so many different ways. One way is because it’s inflammatory. We know that when there is dysbiosis, it creates local inflammation because it’s out of balance. However local inflammation can create systemic inflammation. Meaning that our whole body has a higher level of inflammation. What we know about cancer is that it likes to grow when there’s inflammation. When inflammation is high in the body, cancer likes to grow. So that’s one reason that dysbiosis, or imbalance in the gut, can influence our overall health. In addition, the imbalance, or dysbiosis, can also influence how well we remove toxins from the body.

I just gave you that example of estrogen. What happens is that we’ve got estrogen going through the digestive tract after it’s done its job, and it’s going to get released in the stool, where it’s bound to this substance called glucose chronic acid. If there is this dysbiosis, meaning imbalance, in the gut bacteria, there may be an increase in this enzyme, beta gujaratis, and that will then cleave that bond and allow estrogens to get reabsorbed back into the body. So, as I mentioned, we thought that was all.

Jennifer Simmons, MD

Other toxins, not just estrogens, but other factors as well.

Elizabeth Boham, MD, MS, RD

As other toxins as well. That’s very important,  and if we’re not having regular bowel movements, If we’re not having regular bowel movements, depending on the gut microbiome, that’s going to influence what we reabsorb into the body and how well we’re able to eliminate those toxins from the body. So that could influence that. That could be one additional thing that influences how a toxin impacts a person and how it impacts one person differently than somebody else. Because we always want to figure out, well, you always hear that, well, this person smoked till they were 99 and they didn’t get cancer. We are all individuals, and we all have our weak points or Achilles heel. Where we need a little extra support.

It’s so important to pay attention to that gut microbiome because that is how you eliminate toxins and estrogen after it’s done its job. When the gut microbiome is out of balance, it can create more inflammation in the body. It’s been shown to create more insulin resistance. We know that insulin resistance, pre-diabetes, and high levels of insulin and blood sugar are associated with more cancer, especially breast cancer. There’s all these different ways that it’s all interrelated. One of the things we always pay attention to is that we get a good history from our patients and try to figure out what’s going on in their digestive system. How are things working? How is that microbiome? Did they have lots of antibiotic exposure in the past?

How do we need to support the good microbes we always want to support—the good bacteria in the gut—with prebiotics? Prebiotics are things that feed good bacteria; probiotics and prebiotics are things like all of those different phytonutrients I was talking about before. When you eat a high-fiber diet and have lots and lots of different plant foods in your diet, that feeds the good bacteria. They know that there is, for example, ellagic acid, which comes from pomegranate, and that it will feed the good bacteria in the gut. When people have whole pomegranate seeds or a pomegranate powder that can feed the good bacteria, or the EGCG from your green tea, that’s been shown to also feed the good bacteria in the gut when you have a major tea without added sweeteners. Or, like this sulforaphane that comes from your cruciferous vegetables, it also feeds the good bacteria in the gut. Prebiotics are important for building a good, healthy microbiome in your gut. In addition, sometimes we use probiotics or fermented foods to help build up the good bacteria as well. So that’s it. Does that help with showing the connection between the gut microbiome and cancer risk?

Jennifer Simmons, MD

It certainly does. that it brings forward the point that a healthy gut is tied to health and that it’s very hard to be healthy if you don’t have a healthy gut. With that in mind, how does functional medicine help to identify these imbalances? How do you identify dysbiosis? How do you identify hormone imbalances?

Elizabeth Boham, MD, MS, RD

Yes. The first thing is just getting a good history. In functional medicine, we use the go-to-it model, but the first part of that is gathering. We’re gathering all this information from our patients because getting a very good, detailed history helps determine where that person needs to focus. For example, as I said earlier about antibiotics, if somebody was on antibiotics for multiple years of their life, maybe they used antibiotics for acne treatment. That may be a sign that, okay, we’ve got to be focusing on the gut microbiome. A good history gives us a ton of information. That’s, I would say, where we always start. There are times when we will need some additional testing. We are using some stool analysis where we will look at the level of bacteria in the gut, and the level of diversity, because we know that the more diverse your microbiome is, the healthier you are.

We look for some bacteria that have been associated with increased inflammation or these signs of dysbiosis. We often do stool testing to try to get a better understanding. You can also do some other tests, like organic acid testing, that will give you a sense of whether this person has imbalances in their microbiome. Are they prone to yeast overgrowth or bacterial overgrowth? There are a lot of interesting tests that we can also look at in terms of hormone metabolism. We can look at it directly; we can measure how the body is metabolizing the hormones, and that can help give us more information. We will also look at genetic predispositions. I was talking earlier about those low-penetrance genes. that lots of us have variations in. We can do panels that evaluate your balance, what your different genetic variations are, and how that influences how you metabolize your hormones, how you metabolize toxins, and that kind of thing.

Jennifer Simmons, MD

In that instance, you’re not only talking about the genes that we typically associate with the development of key cancers, like BRCA1 or BRCA2, you’re talking about genes that help to influence how we deal with our environment. They help determine how big our bucket is, to be simplistic. Because some people have a big bucket and lots of tolerance. That’s that person who smoked all 99, ate bacon and eggs every day, and lived a full, healthy life.  Whereas, other people are born with a much smaller bucket and start to develop diseases caused by environmental exposures much younger.

Elizabeth Boham, MD, MS, RD

 100%.So when you talk about that bucket, that’s a great analogy. Depending on the size of the bucket, impacts not only how much toxins will influence you but also how you will react to your exposure, your genetics, etc. Which is the size of the bucket, but also the timing of the exposure, which we know is interesting. your lifestyle because you can influence your genetics. What’s needed about looking at these genes and genetic variations is that there’s a lot we can do in terms of our lifestyle that influences how they work. When we see somebody who has a harder time producing glutathione, which is so important for detoxification, we say to them, Well, make sure you’re eating your cruciferous vegetables every day. Or if they’re like, I just can’t. I have a hard time digesting them. then maybe that’s where you say, Okay, I’m going to add in this supplement. I’m going to give this person some extra salt purifying with miraz and salt. I’m going to support that part of their health. That’s where a supplement might come into play.

Jennifer Simmons, MD

Let’s shift gears a little bit. It’s easy for people to understand how plastics might be adversely affecting their health and how chemicals might be adversely affecting their health. But what about the role of stress? What’s happening there? How does stress directly affect our health?

Elizabeth Boham, MD, MS, RD

Yes, it’s interesting. It’s important to point out that, like, stress isn’t necessarily bad. We are made to handle stress. When it’s that acute stress, when we are running away from that tiger, our immune system is activated and is working increased, or better in a sense, because if you were going to get bitten by that tiger, your immune system is ready to heal. The problem is with this chronic, daily, unrelenting stress where we’re not giving our body time to rest, renew, sleep, and work through it. If we’re under chronic, daily, regular stress, we know that’s not good for the immune system. They’ve shown that when people are under chronic, regular daily stress without having the tools to manage it and without giving their body time to rest and rejuvenate, they have lower levels of this important part of the immune system called the natural killer cells.

Your natural killer cells are part of your immune system that is going around and finding abnormal cells in the body and gobbling them up. If you’re under a lot of chronic, regular daily stress and you’re not doing anything about it, that’s when the immune system doesn’t work so well. So it’s important to not just get people all worried. They’re like, “Oh, no, I’m having stress.” It’s not that stress is necessarily bad. It’s just that we need to have the tools to help us manage that stress. giving your body time to rest, giving your body enough time to get sleep, getting outside and getting into nature, going for moderate exercise, etc. walking and getting into nature, doing meditation and breathwork, journaling, and practicing gratitude journaling. All of these things—all of these tools are there. We support our body to handle all the stress that we’re under and all the stress that our body is made to be under. That’s why it’s important to have those tools in place.

Jennifer Simmons, MD

Yes. There are two things to say about that. Most people don’t develop healthy stress management tools until they’re forced to. I feel like in our society, the stress management tools are often alcohol, pot, and other things that quickly take the edge off for people. I do believe that that has negatively contributed to where we are today. The other thing is that while we are built for stress, we’re not built for the kinds of stressors that we have today in that we’re not built for constant cell phone barrages of messages and emails and deadlines, and the overconsumption that we have is that we have too much food, too much light, too much movement, too much everything, and too much oxygen either. so that while we have to have stress, Our bodies are made for that, like you said, because we are meant to be able to encounter the saber-tooth tigers of life and be able to run away. But we’re not meant to encounter them with the frequency and duration that we encounter them now.

Elizabeth Boham, MD, MS, RD

Yes. We’ve got to turn it off. We’ve got to turn off the phone, turn off the TV, turn off the computer, and turn off work. It’s so hard because we can now work 24 hours a day if we don’t turn it off.

Jennifer Simmons, MD

No, anything about that? I don’t know what you are referring to. I don’t know.

Elizabeth Boham, MD, MS, RD

We have to be the ones to turn it off, or we have to end it. But you’re right—you are right about our core skills in terms of stress management tools. Listen, I don’t know if I can say that I’m happy I had breast cancer. I don’t know. I haven’t gotten to that point where we’re like, “Oh, yes, it was a gift.” But there were a lot of things about it that were a gift. One of the things that forced me to do was change the way that I handled stress. I had to. I knew that I was like it was. That was the one thing that I could tell. I’m like, okay, you were not doing a good job at this, and you’ve got to figure out how to do it better. Not that it’s easy, but it forced me to say, “Okay,  are you getting enough sleep?” Are you saying no? Are you doing your meditation? Are you doing your breathwork? What are you feeling inside? Pay attention to that feeling; let’s work through it. Not just like you said, okay, I’m just going to deal with it by using a substance, ignoring it, or avoiding avoidance. I am truly grateful that having had this disease at that age forced me because it’s hard. I find with my patients that it is the hardest lifestyle modality for people to adjust to. Maybe it’s just who comes to see me and my practice. But a lot of people can say we’re like, okay, eat this, do this. They’re like, “Okay, got it.” Okay, do this exercise. Okay, got it. Get some sleep. I’m trying. It’s hard to meet with someone who you have a good community and network. Okay, I’m going to do this group support for stress management. I didn’t have time for that stress.

Jennifer Simmons, MD

I can’t meditate. I can’t sit still. It doesn’t resonate with me. I tried. It’s not for me. It doesn’t work. Yes, you’re right. But, having grown up in an environment where I had working parents, what we saw on TV was that the parent comes home and fixes a martini and has that at the end of the day, and my parents did that and fixed the martini and that at the end of the day. Like when we grew up, your reward at the end of the day was to have a drink or to have a meal. That was the way that we dealt with the stress of the day. I don’t think that my family was an exception to that, yes, and so many people have admittedly felt like I’ve been fired by patients who were like, I’ll do everything else you say. But if you tell me that I have to give up alcohol, it feels like our relationship is over. So people feel very strongly about their approaches, and it’s deeply built into them. It’s because we were not raised with healthy stress mechanisms.

Elizabeth Boham, MD, MS, RD

That’s very true. The research connecting alcohol and breast cancer is very deep, and it is consistent. We see that it’s a linear relationship. As our alcohol intake increases, so does our risk.

Jennifer Simmons, MD

It’s a direct relationship, without a doubt. Yes. I hate to be that bearer of bad news, but it’s impossible to heal as you continue to put that particular toxin in your body.

Elizabeth Boham, MD, MS, RD

And, like you said, where is it coming from? What is it covering up? What is it allowing you to avoid dealing with?

Jennifer Simmons, MD

I want to talk about what functional medicine adds to the breast cancer treatment paradigm in that what kinds of things do you include while someone is going through conventional medical treatment? Because I know that you’re like me and that I don’t say that functional medicine is in or that I say it’s in and.

Elizabeth Boham, MD, MS, RD

100%. What we are focusing on is not just the treatment of that cancer. The cancer cells or whatever. It’s treating the terrain, that whole body, because you want to create a terrain where, in functional medicine, we are working to create a terrain or soil where cancer is less likely to grow. So we are looking at all those things that help us identify what will be food to feed cancer and help it grow, and what will help prevent cancer from growing. We look at everything, from inflammatory markers. We’ll look at reactive protein because it’s a marker for inflammation. As I mentioned earlier, if C-reactive protein is high, then cancer likes to grow.

We are all going to measure what’s C-reactive protein, and then let’s see why it’s high. We ask the question, “Why is it high? What do we need to do to bring it down?” We will. We know that cancer likes to grow when insulin is high and blood sugar is high. We will measure your fasting insulin, your fasting blood sugar, and your hemoglobin A1C. If those aren’t ideal, we work to get them ideal. sometimes means that people have to cut way back on refined carbohydrates and sugar, get in more exercise, increase their lean muscle mass, and all of those things, so that’s because that’s important for creating a terrain where cancer is less likely to grow. We will look at markers that tell us how the body is methylated, so, for example, homocysteine, we want that to be ideal. Again, it can help influence and create a terrain where cancer is less likely to grow. I look at things like natural killer cell function. That’s an important marker to look at because it’s a marker of your immune system’s function, and does that need support? Does it need support from things like Asian mushrooms, zinc, or vitamin A—things that support that part of the immune system? I will also look at markers that look at things like oxidative stress. We know that oxidative stress is when there are too many free radicals that are formed in the body, and that creates a lot of disease and aging in the body. So, again, if we find those markers are high, we ask the question: why? What do we need to get a better balance? The terrain in the body is more supportive of health and less likely to cause cancer to grow.

Jennifer Simmons, MD

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

Elizabeth Boham, MD, MS, RD

Yes, so focusing on good nutrition is critical here because that helps with people just feeling better, avoiding like sometimes in those during those treatments, you might feel like, “Okay, I’m just going to run and grab some muffin or donut or something just to soothe my stomach.” But, good nutrition is critical because it helps us feel better by not doing as much exercise as we can.

moderate exercise.  So often we feel okay; I’m just going to rest. But we do know that for women who can do some exercise, moderate exercise doesn’t have to be crazy intense if you’re not up for it. But getting outside and going for a walk does help us feel better. Yes, I know. For myself. Yes, I know for myself and so many of my patients that the complementary treatments worked great. Getting acupuncture, your treatment I found helpful for side effects of Reiki cranial sacral massage, was helpful to help me feel better and do better. There are times, when I’m also looking at things from a dietary perspective, like the fasting-mimicking diet and some ketogenic protocols that can help people feel less side effects from their treatment. Sometimes, do we do better? Yes, we use that as well.

Jennifer Simmons, MD

Especially because chemotherapy affects rapidly dividing cells, and we have that. That is our entire GI tract. If we can fast during chemotherapy and make those cells quiet and shut them down, making them not metabolically active, then the chemotherapy does not have such an effect on them. It makes a huge difference. We also have a lot of our immune system in our gut. If that is quiet while we’re getting chemotherapy, that can also protect those cells. There’s a lot of protection going on while we fast during chemotherapy. The fast and minimally mimicking diet and the work of Valter Longo around that are amazing and have made a huge difference to a lot of people.

Elizabeth Boham, MD, MS, RD

It’s very powerful.

Jennifer Simmons, MD

Yes. I loved that you talked about exercise because there are so many studies showing the benefits of exercise during chemotherapy and that people maintain their energy, sleep better, have a better mood, a better outlook, and better outcomes.

Elizabeth Boham, MD, MS, RD

100%. Yes. I also often recommend gratitude journaling for people as well, because we know that when you have feelings of gratitude when you write down three things a day that you feel grateful for, those feelings of gratitude do help with mood as well. They can help with our anxiety about everything. They can help with depression. They give us and help us feel a better outlook on the whole situation.

Jennifer Simmons, MD

Yes. Let’s fast-forward past that, and for the people who have completed treatment, what are the best things that they can do to prevent a recurrence?

Elizabeth Boham, MD, MS, RD

The number one thing I work on with everybody is balancing blood sugar and preventing spikes in blood sugar and insulin. The number one thing is that you want to make sure that each meal of your day has a good, healthy source of protein, a good, healthy source of fiber, and a good, healthy source of fat. protein, fat, and fiber, because those three things will help prevent the spikes in blood sugar and insulin that we know can trigger the growth of cancer. I have people who focus on food and the power of food, both to help us heal and feel rejuvenated and to help prevent a recurrence. then and then we mentioned this earlier: avoiding too much alcohol. at least five or fewer drinks a week, though many times when women have had breast cancer, we’re going even lower than that. Then regular daily exercise and getting sufficient sleep. I would say those are at the top of my list.

Jennifer Simmons, MD

Yes, I agree with you. are there. First, I wanted to ask you: do you have people who use CGM, Do you feel like that is a valuable tool for people?

Elizabeth Boham, MD, MS, RD

Sometimes, yes. A CGM, or continuous glucose monitor, can be a valuable tool. What it does is measure how much your blood increases after a meal. For a lot of people, that can be very helpful information. It’s not; it doesn’t give us all the information. Some people have significant insulin resistance, and their CGM doesn’t look that bad because their body is making so much insulin and keeping the blood sugar in a pretty normal range. But with high insulin, if we were to test with either fasting insulin or a glucose tolerance test, looking at insulin is showing us that not all is well. There are times when the CGM doesn’t give us all the information. On the other end, some people get so concerned and worried about their CGM results that it creates a very unhappy, unhealthy relationship with food. So a CGM, to sum it all up, can be some good information, but it’s not perfect. There are times when it doesn’t work for every patient.

Jennifer Simmons, MD

That’s fair. Last but not least, what labs should everyone know about for long-term maintenance purposes? Like, what should people be checking and making sure that they know about themselves every year?

Elizabeth Boham, MD, MS, RD

Yes. Get your high-sensitivity C-reactive protein; that’s the marker of inflammation, and you want it to be less than one. Get your vitamin D level, your 25-hydroxy vitamin D level. People debate about what is optimal, but probably somewhere between 50 and 75 is a great place to be for vitamin D. I want to know your fasting blood sugar and your fasting insulin. Ideally, I like fasting insulin around five and fasting blood sugar, definitely less than 100, maybe even less than 90 for most people. Then your hemoglobin A1C tells us about your blood sugar and how it’s been over the last three months. Hemoglobin A1-C at five-point-five is pretty good. You don’t want it to get much; you don’t want it to get like five point seven, which is starting to get a little too high for you.

No, not greater than six. This means your blood sugar has been running too high. I also like to look at homocysteine. Homocysteine? I love to be around eight. That gives us an idea of the amount of folate this person is taking in, as well as B12 and B6. If you’re not getting in enough, it’ll start to go up. Those are some of my basics. I also look at zinc and copper. I want zinc and copper to be around one-to-one. If zinc is much lower than copper, I’m asking why I may be giving a little extra zinc because it’s good for the immune system.

Jennifer Simmons, MD

Great. Well, this has been amazing. I love having you. I love your perspective. Your patients are so lucky to have you. I am lucky that I have access to you, and I get you to come on and talk about all the wonderful things that you’re doing, the care that you’re taking of people, and the difference that you’re making in this world. Thank you so much for being here today. 

Elizabeth Boham, MD, MS, RD

I appreciate your welcome, Jenn. It’s been a pleasure being with you, as it always has been.

Jennifer Simmons, MD

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