In short
Breast cancer risk and prevention through lifestyle medicine, plus exercise guidance for breast cancer survivors. The episode frames breast cancer awareness as “action,” emphasizing modifiable risk factors (weight, activity, diet quality, alcohol, smoking) and whole-person care (sleep, stress, social connection). It also covers screening basics (mammograms annually starting at age 40 for average risk) and cautions against unnecessary whole-body scans due to incidental findings.
Guests
Dr. Amy Comander, breast cancer oncologist (rerun). Hosts: Haley and Laura (The Body Pod). No other medical guests appear in this rerun.
Key claims
Only 5–10% of U.S. breast cancers are due to testable genes; up to ~40% of risk may be lifestyle-related. Breastfeeding is protective. IVF is generally considered safe. Earlier menarche and later menopause increase lifetime estrogen exposure and risk. Exercise reduces recurrence risk and improves outcomes; lifting weights is safe and does not increase lymphedema risk.
Notable examples
AICR recommendations (more fruits/vegetables, legumes, whole grains; limit ultra-processed foods, red/processed meat, sugar-sweetened beverages, and alcohol). Example alcohol guidance: “one glass for a special occasion, not nightly.” Example scan caution: lung nodules leading to repeated follow-up scans. Mentions “Paving the Path to Wellness” survivorship program and lentil-based protein/fiber tips.
Written by AI. May contain mistakes. Listen to the episode to check what was said.
Chapters
Tap a time to open that second in VOBreast Cancer Awareness Month and Its Importance
2:16 to 4:26
Discussion on Breast Cancer Awareness Month and the importance of education.
“Hey everyone, on the episode of The Body Pod today, we are actually rerunning Dr.”
Understanding Breast Cancer Risks
4:26 to 5:21
Dr. Commander shares breast cancer statistics and risk factors.
“So I want to start with kind of some, just some basic facts.”
Breastfeeding and Risk Factors
5:21 to 6:18
Exploration of how breastfeeding impacts breast cancer risk.
“The statistics from the American Cancer Society, which were recently updated, do state that this year it is expected there are about over a little over 300 ,000 cases will be diagnosed in the U.S.”
Modifiable and Non-Modifiable Risk Factors
6:18 to 9:18
Discussion on genetic and lifestyle factors affecting breast cancer risk.
“I was like, wow, I shouldn't have stuck it out the first one.”
Hormones and Breast Cancer Risk
9:18 to 12:18
Investigating the impact of hormone exposure on breast cancer risk.
“So I hope that helps address your question.”
Breast Cancer Incidence Worldwide
13:14 to 13:41
Discussion on the prevalence of breast cancer globally.
“With the American Express Platinum Card, I can unlock experiences like no other.”
Breast Cancer Incidence Worldwide
13:43 to 14:00
Discussion on the prevalence of breast cancer globally.
“Does the USA have higher breast cancer rates than other countries?”
Understanding Breast Cancer and Lifestyle Factors
14:00 to 16:48
Explore the connection between breast cancer prevalence and lifestyle choices.
“Or when I say skin cancer, I'm, you know, including like basal cell, squamous cell and melanoma.”
The Impact of Lifestyle on Cancer Risk
16:48 to 19:16
Learn about the significant lifestyle-related risk factors for breast cancer.
“And a lot of it is stuff we've already talked about.”
Key Recommendations for Cancer Prevention
19:16 to 22:22
Discover actionable lifestyle changes to reduce cancer risk.
“So those are all listed on the AICR website.”
Show all 24 chapters
Alcohol Consumption and Cancer Risk
22:22 to 23:21
Understand the relationship between alcohol intake and cancer risk.
“thing because you obviously can't tackle it all at the same time.”
Alcohol Consumption and Cancer Risk
23:25 to 25:05
Understand the relationship between alcohol intake and cancer risk.
“You know, and especially since COVID where we started having like women started having like these wine online wine parties.”
Behavioral Change and Community Support
25:36 to 28:00
Discuss the importance of community support in making health behavior changes.
“but maybe drink two or three glasses of wine a night and don't even think of anything of it.”
The Importance of Community in Health
28:00 to 29:50
Learn about how community support can impact behavior changes in health.
“because we're just like robotic a lot of the time, especially when we're so busy that these things are just getting missed because we're not present.”
Whole Person Care in Medicine
29:50 to 31:00
Explore the concept of whole person care and its significance in healthcare.
“we interviewed you that you really focused on asking your client about their lifestyle.”
Return to Exercise Post-Treatment
31:00 to 32:00
Understand the guidelines for returning to exercise after breast cancer treatment.
“So these are all things that I think are going to change.”
Exercise Recommendations for Survivors
32:42 to 34:31
Learn the basic exercise guidelines for breast cancer survivors.
“We debate about food, deep dish, tavern style.”
Empowering Women in Fitness
34:31 to 38:09
Discuss strategies to encourage women to start and maintain fitness routines.
“Again, let's just start with the basics.”
Paving the Path to Wellness Program
38:09 to 41:02
Learn about a lifestyle medicine program designed for breast cancer survivors.
“And it doesn't, it's meaningless of what, you know, someone else is recommending on their journey or what's optimal.”
Dietary Patterns and Nutrition
41:02 to 42:01
Explore the importance of a balanced diet and protein intake for health.
“Fradies and colleagues, we actually have a nonprofit and we're hoping to bring this program to lots of populations, not just women with breast cancer.”
The Importance of Protein and Fiber in Diet
42:01 to 45:01
Learn about the balance of protein and fiber in women's diets, especially during dietary changes.
“So she's now, so it was eight years ago.”
Breast Cancer Screening and Awareness
45:02 to 46:32
Understand the importance of regular mammograms and breast cancer screening for women.
“each other and share ideas with each other and strategies.”
Advancements in Breast Cancer Treatment
46:33 to 48:26
Explore new developments in breast cancer treatment, including the role of AI in healthcare.
“They're usually super tiny, five millimeters.”
Lifestyle Medicine and Wellness Resources
48:27 to 50:48
Discover resources for improving health through lifestyle changes, including a workbook on wellness.
“You can, you know, you're going to be able to buy one in 2026.”
Transcript
Automatic transcript. May contain errors.0:00Dr. Amy Comander:Hey, it's Haley. I want to take a moment to chat to the woman in midlife who's done guessing about fat loss and ready to understand her own body instead. You've tried keto, fasting, low carb, the apps, the macros somebody handed to you, but you didn't fully grasp. Maybe some of it worked for a while. I bet none of it told you why. So the moment life got busy, things fell apart. What if I told you that you could go into every holiday, every vacation, every birthday dinner, knowing exactly what to do because you'll finally understand your midlife metabolism. You can be that woman that doesn't reach for another diet.
0:40Dr. Amy Comander:She understands exactly how to fuel her body and live lifestyle lean. That's who I want to help you become. Fat Loss Happens Education is seven weeks of evidence-based guidance from registered nutritionists, menopause doctors, and exercise physiologists with me teaching right alongside them. You'll learn how to do your own macros, work with your hormones, strategies for fat loss training, and the reverse dieting skills that keep your results in place for the long term. You'll learn to think it through yourself so you never have to hand your body over to someone else's plan again. This is a live course and we start in early September.
1:21Dr. Amy Comander:To get first access in August, go to hayleyhappensfitness.com forward slash fat loss happens education or grab the link in the show notes. Now back to the show. 10 hours on my feet, traffic, noise, everybody needing something from me. My head is spinning. I just need the world to stop for one second. But then I get home, shoes off, phone out, and I open Modo Casino. Hundreds of slots, classic table games. It's my instant reset. The variety I want and the quiet I need. Modo Casino is a social casino. We're prohibited. No purchase necessary. Visit Modo.us for more details. Download the Modo Casino app today.
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2:05Dr. Amy Comander:Hi, everyone. My name is Haley. And this is Laura. And welcome to The Body Pod.
2:16Dr. Amy Comander:Hey everyone, on the episode of The Body Pod today, we are actually rerunning Dr. Amy Commander, who is a breast cancer oncologist. And we thought this would be an appropriate time to run it as it is Breast Cancer Awareness Month. So enjoy this rerun with Dr. Amy Commander.
2:39Dr. Amy Comander:Amy, we are thrilled to have you back for part two and we are in breast cancer awareness month. Thank you so much. It's great to be back with you. Is this, uh, this is also menopause awareness month. I feel like we should have broken those. Somebody should have broken those up into different months because they're both like heavy hitters. They deserve their own month. Yes. But hey, let's just go women's health. We're just glad to raise awareness and provide education. So that's awesome. Yes. Great. And I was talking to last year at this time, I was talking to Dr. Jessica Shepard and we were talking about how we need to have like a color, you know, because breast cancer has like the light pink.
3:21Dr. Amy Comander:And then we were like, well, menopause should have a color. Clearly nothing happened. Maybe someone's named a color by now. And I don't know. But anyhow, here we are. So a few things that I wanted to ask you kind of before we dive into this, you know, lifestyle medicine, which is kind of our topic for today. I'm fascinated by it. I love that the, you know, the greatest of the great are getting on board with educating patients around this, because I tell you, every time I have someone on, and obviously it has something to do with lifestyle health. nutrition, everyone is saying the same things. I'm like, okay, so we see a pattern in, you know, all of these things, which doesn't, it's not new information, but it's clearly we have work to do from where, you know, to get this into mainstream still, which we just, maybe I just hear it all the time.
4:19Dr. Amy Comander:So I'm like, okay, we're saying the same things in every field, but there's still a lot to learn. So that's really exciting. So I want to start with kind of some, just some basic facts. So we talked about the different kinds of breast cancer last time. I was just reviewing. So one in, there's a one in eight chance of getting breast cancer and there's over 300 ,000 cases a year. Yeah. So thank you so much for inviting me back, by the way, love chatting with you both. And I just want to say it is Breast Cancer Awareness Month, but I like to call it Breast Cancer Action Month, which what are we doing to actually raise awareness, make it impact, help improve women's lives?
5:03So that is our Sharon goal. So I just have to say that. But you're absolutely right. For women living in the United States, we all have a one in eight lifetime risk for development of breast cancer. It is what it is. And some of us, it may be higher because of family history or other factors. So we can talk about that. And you're right. The statistics from the American Cancer Society, which were recently updated, do state that this year it is expected there are about over a little over 300 ,000 cases will be diagnosed in the U.S. of invasive cancer. That also includes ductal carcinoma in situ, which is essentially like a stage zero breast cancer.
5:42Dr. Amy Comander:Oh my goodness. I was actually shocked when we start to go over like the risks. Is breastfeeding a risk? Actually, breastfeeding is protective. Breastfeeding is - That's what I thought. Yeah, decreases your risk, right? You must have read that wrong because I was like, wait, what? How is this great natural thing like we're all doing? But I don't want someone, obviously we know so many women have a tough time with breastfeeding. So again, taking that away. don't beat yourself up or feel bad. We know many women have challenges with that, but it does actually decrease risk. So that's good. Not increased risk.
6:19Dr. Amy Comander:Okay. I was like, wow, I shouldn't have stuck it out the first one. My youngest did not, was all formula fed. And I mean, he was my easiest baby. So I have nothing to say there. Eat best sleeper, all of that. But yeah, I was like, Wait a second. OK, got that that fact straight. So as we look for these risk factors and obviously we know genetics is is at the top of the game. But what are the other risk factors that we're looking for when we're approaching this this type of cancer? Great question. And I think it is good to highlight. You're absolutely right. Genetics is so important to think about in family history.
7:04But actually, in the U.S., of all breast cancers diagnosed in this country, only 5 % to 10 % are due to genes that we can currently test for in 2024. There may be another 10 % to 15 % due to familial factors, which maybe we can't find the gene yet. Maybe it's a few genes working together that increase risk. But the majority of breast cancers are not due to genes that we can test for. So that's why I encourage everyone who listens to your podcast to like know your family history, make sure you're on top of screening and recognize that even if you don't have a family history, unfortunately, you're still at risk.
7:42So then we talk about other risk factors. Great question. What are some factors that we can potentially change, which are what we call modifiable risk factors? And what are some factors that we can't change? You know, like our age, for example. You know, so we wish we could change that one. But anyway. Exactly. Right. So thinking about the non-modifiable risk factors. Yeah. So being a woman and increasing age are your biggest risk factors. So it is what it is. And then thinking about when I see a new patient, you know, we ask about other risk factors related to exposure to hormones over the course of a woman's lifetime.
8:22So we ask about what was your age of menarche when your period started? If a woman's gone through menopause, what was her age of menopause? If a woman's been pregnant, when did she have her first full-term pregnancy? How many pregnancies? Did she breastfeed? Did she take, you know, exogenous hormones? Like we ask all of these questions. Did she have chest wall radiation for any reason? Sadly, some people have a cancer diagnosis at a young age and need radiation to their chest. So these are all the questions that we ask someone that are sort of these are like facts about someone's medical history that potentially can influence risk.
8:57But then there's the modifiable risk factors that we can all talk about. What can women do to help reduce risk? And those refer to things like what is her exercise level? How much alcohol does a person drink? What is her body weight? Does she smoke? You know, those types of factors. So all of these come together to play a role in a person's risk. So I hope that helps address your question. I have a question about the hormones. Do you see an increase in risk for anyone who's done IVF, like several rounds of IVF, so they are pumping all of these hormones into their body? That's a great question.
9:36And certainly we know that many women need to consider techniques such as IVF to pursue pregnancy. And I would say for the most part, the data suggests that IVF is safe. So I don't want someone who's thinking, oh my God, I had IVF. I'm at such great risk. The modern techniques that are used for in-feture fertilization are felt to be safe. And I think if a woman wants to pursue pregnancy, she should do that. And if a woman does have a strong family history of breast cancer, or if she's had breast cancer, the reproductive endocrinologist does take that into account and may use it, modify the protocol that they use.
10:14So if someone's had IVF, it's okay. I guess that's what I would say.
10:20Dr. Amy Comander:Well, I'm kind of interested in the, if we look at, obviously we're all aging. And when you ask about like the age of menarche and the age of menopause, What does that like? Does a later menopause help or hurt? And does a later menarche help or hurt? Right. So actually it's thinking about our body's exposure to hormones like estrogen is the number one over the course of the lifetime. So actually earlier age of menarche, so having a period at eight or nine actually is a greater risk factor for breast cancer later in life. and a prolonged, like a later age of menopause. So that's more years of exposure to hormones.
11:05That is a risk factor. So we look at all of these factors into account. It's not like they're just all pieces of the puzzle. It's a puzzle that we're always trying to put together when we're trying to help understand risk. But for an individual patient, it's actually, we don't really comment particularly on that. It's just, we ask these questions, but it's really, it's just good to understand what potentially contributes to risk. But breast cancer is the most preventable or one of the most preventable cancers, correct? Well, obviously, I wish we knew all the reasons why someone would get breast cancer.
11:43I mean, I saw a patient yesterday in her 40s, healthy exercises, takes good care of herself, healthy body weight, eats healthy. And unfortunately, she's in my office, right? So there's so many factors that I just don't understand. And I think that's just what's hard about medicine in general with any medical problem, whether that's cancer or some other things that we, infections we get, whatever, you know, sometimes we don't fully understand all the risk factors and why a person may get a certain diagnosis. Well, and environmental takes a big role in this, right? Yeah. We're learning more and more about environmental factors and cancer risk and, you know, thinking about things like air pollution and hate to say our food environment when we think about, you know, our exposure to ultra processed foods, particularly here in the U.S.
12:32with our sad diet, standard American diet, which I know we both are providing education about that. So, you know, there's lots of environmental factors that potentially are playing a role to plastics too. We're learning more and more about that. Hi, Uncle Lazer here. America's built on fast cars, fast food, and even faster women. Moto Casino is built in America. You know what they're fast at? Fast cash prize redemption. You see, only Moto is U.S. owned and operated. Moto. It's American-made. That's who we are, and that's who we care about. Play for free at Moto.us. Moto Casino is the social casino.
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13:48Dr. Amy Comander:Does the USA have higher breast cancer rates than other countries? Well, breast cancer is the most common cancer diagnosis in women now worldwide. So in developed nations, in particular, breast cancer is still, you know, after skin cancer. Or when I say skin cancer, I'm, you know, including like basal cell, squamous cell and melanoma. But like, you know, basal cell and squamous cell, those types of skin cancers are obviously very common. but breast cancer is really the second most common type of breast cancer. And it is really worldwide, the number one cancer. It used to, you know, so I think that's important for people to recognize too.
14:26Yeah. Wow. Have you seen a correlation to your dental health, like the health of your gums and in relation to breast cancer or infection or cancer of any kind? Yeah, that's such an interesting question, thinking about oral health and cancer risk. Oh, I'm not particularly aware of a risk with breast cancer per se, but I do think if you think about it, I mean, oral health, are we also thinking about our microbiome, which certainly is in all aspects of our GI tract, including our mouth and all the way down. So, you know, I think that's an emerging field, like learning about the gut microbiome and certainly risks for many chronic diseases, including cancer.
15:16So I wonder in the next 10 years if we're going to learn more about that. So, but it's such an exciting breast cancer. Yeah, it is very exciting.
15:25Dr. Amy Comander:Yeah. I love that the whole gut microbiome. I mean, everyone's kind of coming to the party for it, but it's, it's just like in, in its infancy. I mean, we're just really scratching the surface and have how that plays a part in everything. So I read this on one of your, I don't know, in a blog or either listen to it in a podcast, but 40 % of the risk factors for breast cancer are lifestyle related. I mean, that's almost half. It's huge. Yeah. So, yeah, so reputable organizations like the American Cancer Society, American Institute of Cancer Research, you know, when you look at large population data and try to understand contributing risk factors for breast cancer and other cancers, it is felt that up to 40 % may actually be due to lifestyle factors.
16:15So these are risk factors that we can control. And so I think it's really important to highlight this. And actually, a great resource, which is on the American Institute of Cancer Research's website, AICR.org, they list this figure with like the top 10 recommendations for cancer prevention. And these are all lifestyle related. So what can each of us do? What can we do to take action to hopefully lower our risk of cancer? And I'm happy to talk about those. And a lot of it is stuff we've already talked about. But I think it's really important for us to be aware that our lifestyle does potentially play a significant role in risk for cancer.
16:59Dr. Amy Comander:Well, that's just alone. I mean, I'm like, if I have a 40 % less chance of getting breast cancer or any type of cancer just from my lifestyle, Well, that's like, you know, good, good bets that if you're kind of on the fence of like, well, I may, you know, I may know, I know that substance abuse or, you know, alcohol intake and smoking is probably not great. Well, we all know it's not great, but like if somebody were kind of borderline there, it would be really easy if I heard these statistics to be like, all right, how important is this and how important it's going to be in 15, 20 years? you know, if I keep going at the rate, we all have our, our, uh, vices and it can be different things for different, different women.
17:47Dr. Amy Comander:But let's talk about those areas of the lifestyle medicine and how we are helping, you know, prevent, but then also helping, you know, with the, um, cancer survivorship after, and really seeing how that goes with your patients once they have come through breast cancer treatment and what that looks like. The American Institute of Cancer Research's recommendations, the first one is being at a healthy body weight. We can, by the way, go into greater detail on all of these. We know that's a challenging one. Being physically active. Thank you for all the work you do to help us with that. But that is key when we think about cancer risk reduction.
18:26And then thinking about our diet. And there are many recommendations. Eating a diet rich in fresh fruits and vegetables. vegetables, fruit, legumes, beans, whole grains, so important. Limiting the ultra processed foods that are so prevalent in our diet, the fast foods, all these things out here that we're exposed to in our environment here in the US, which are things we need to cut down on. Limiting red meat consumption and really eliminating a lot of these processed meats that we consume. And then thinking about limiting consumption of these sugar sweetened beverages. I know we all love to go to Starbucks, but like being mindful of what you're ordering there is so important.
19:08And then of course, alcohol is key, limiting alcohol consumption. And then the last two are really focusing on, you know, supplements, unfortunately do not prevent cancer. We can talk a whole thing about that. And then breastfeeding is protective. So those are all listed on the AICR website. And these are all steps we can all take to help optimize our health in terms of our lifestyle to reduce risk of cancer. And they're also important for cancer survivors.
19:35Dr. Amy Comander:So to follow these particular recommendations as well. It's tough. We just had a nutritionist on that lives in New Zealand. And, you know, she was like, our environment is just not set up for success. And I'm like, well, I've been to New Zealand and it's way better than what we're dealing with in America. So true. All of these things. And I feel like, you know, where a lot of women may be like, yeah, yeah, yeah, we get, you know, we get the message, we get the message. But, you know, it's also hard. I see the other side, working one-on-one with women and in these groups where, you know, the healthy relationships and the poor sleep and the stress.
20:17Dr. Amy Comander:It's like, yeah, great. I don't want to have any of those things, but I have them. Yeah. And that's where it gets a little bit trickier to really work on that because that not only helps with obviously reduction of cancer risk, but that helps with body composition. And that helps with, you know, our lifestyle there and how we're going to either lose weight or gain muscle. I mean, so it really comes full circle with everything that we do. So what do you tell your patients when, you know, they're struggling with any of these issues that are harder to tackle? Right. I mean, you raise such important points.
20:59Oh, my goodness. You're absolutely right. I'm just going to when I first wanted to start some type of lifestyle medicine based program for my patients with breast cancer, I actually wanted to just, you know, think about let's talk about the diet and the exercise. And, but you're so right. There are so many components of our lifestyle, which is really what lifestyle medicine focuses on that are key. When we think about that, as you do in your programs to like, again, restorative sleep, so important. So many of us struggle with that thinking about social connection, the community, and you do that so beautifully with your programs.
21:32And I love that. That is so key to help anyone affect behavior change, limiting risky substances such as alcohol. We could talk more about that. That's a tough one, but we really should focus on that since it is unfortunately a risk factor for cancer as well. And then talking about stress management, which you just alluded to, which is a challenge for so many of us, in particular women, we're juggling so many balls at the same time. And so we really need to address that too. And so all of these factors, social connection, I just highlight that again, I think it's so important and sometimes overlooked.
22:07So all of these factors are absolutely key to help us optimize our health. And really, like, where do you start? And I think like what you would probably say, just pick one thing to start on, you know, say that sleep, or let's say it's trying to get more protein in your diet, maybe just for breakfast, start with breakfast, but like, just pick one thing because you obviously can't tackle it all at the same time.
22:30Dr. Amy Comander:Well, what would you say is too much? How much is too much of alcohol? Because that's going to be the question. I feel like we live in this last decade where... Every dating app swap is another loss. Jim bros, fake CEOs, straight up losers. So now the only app I open is Moto Casino because at least there I'm surrounded by winners, real winners, thousands of them. While everyone else is in the single swamp, I'm at home relaxing while stacking bonuses, hitting wins and playing all my favorite Vegas style games. Moto Casino, the only app worth your time. Moto.us for more details. Download the Moto Casino app today.
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23:25Dr. Amy Comander:You know, and especially since COVID where we started having like women started having like these wine online wine parties. And, you know, it's pretty much alcohol is at every almost every event that you go to for adults. Anyway, that just reminds me of a Seinfeld episode where George is trying to bring Pepsi and he's like, why can't I bring Pepsi? Because we're adults, George. so i mean it's kind of just like it's like embedded into our all of our activities in our social life but there is this pull kind of pulling back over the last i've seen it a lot over the last couple of years and and still very new of like these um you know non-alcoholic clubs opening and a lot of mock tells on on the you know so i i feel like there is this kind of trend shifting where have we been using this for a crutch a little bit for some women?
24:25Dr. Amy Comander:So what would you say? And I try to tell people like, okay, well, it's not like you have to eliminate everything. It's, you know, everyone thinks they have to come in. Okay. I can have no, I can't have sugar anymore. I can't drink like this is going to be the, you know, great fun life for me for the rest of the, you know, second, you know, second part of my life, but how much is too much or is there any guidelines there? Yes, such an important and timely question since it is Breast Cancer Awareness Month or Action Month and actually just recently another big organization, the American Association of Cancer Research, AACR, another reputable organization, came out with this cancer progress report for 2024.
25:06And it did really highlight, not to be a downer, but that alcohol is a significant risk factor for six different types of cancer, including breast cancer, and also highlighted that over 50 % of Americans are not even aware that alcohol, unfortunately, is a risk factor for cancer. And we think about women, you mentioned, certainly over the pandemic and people socializing, even Zoom alcohol parties, things like that. So many women are so focused, like you know, on eating organically and getting the exercise, but maybe drink two or three glasses of wine a night and don't even think of anything of it.
25:42So I think it's important that we spread the message that alcohol is a cancer risk factor. It is what it is. So I'm going to cite one recommendation from another organization I like, the AICR, which I already referenced, American Institute of Cancer Research. You can drink, but just think before you drink. Why are you having that glass of wine? So I'll just share a personal example. The other night I was at a special dinner at an Italian restaurant honoring a colleague who unfortunately is leaving our hospital for another opportunity. And we were all celebrating and there was a glass of red wine being poured for everyone.
26:17And I was like, I'm going to have this glass of red wine. I'm celebrating my colleague. It's a special occasion. And so I enjoyed it. But would I do that like every single night when I'm at home having dinner? No, I don't think that's a good idea. So especially for women, we really do need to be mindful of our alcohol intake. So I think that's a really important message that we can spread through this podcast today. Yeah. That's a good tip to be mindful. Yeah. And have intention. Do I need to have a second glass? Do I really need a second glass? And I love, Haley, that you mentioned mocktails.
26:54They are having a moment and there's so many like fun mocktails out there. Like, I'll be honest, I have not really made one yet, but like, I'm always inspired when I see someone showing how they make their mocktail. I'm like, oh, that looks really good. I should make that.
27:07Dr. Amy Comander:Yeah. Yeah. It's nice to have options there, but you know, I, I, I've been seeing a theme in, in again, just from this week in the podcast that we filmed and, um, the nutrition course where we've talked a lot about disassociation and really how women especially have gotten to this point where we just like disassociate. We, we don't even subconsciously maybe even, you know, think about pouring the drink at night or eating the extra food or something of, of we're, you know, we're living in this high stress. We're trying to do all the right things. And usually there is something obvious that I always say, if I, you know, if, if me or, or even you could go and be a ghost in someone's house for 24 hours and watch everything that they did, it would probably be easy to spot, but they might not even know it because we're just like robotic a lot of the time, especially when we're so busy that these things are just getting missed because we're not present.
28:10Dr. Amy Comander:And it's really hard to be present when we have, you know, everything going on all the time. I totally agree. And that's why I think, I just think about the programs you offer, which I'm so fortunate to be involved with right now, the power of the community. Like if you have, obviously you're not going to have someone in your house with you all the time saying, do you really need to eat those chocolate chips right now? But like, you know, the community support, I mean, we can provide all the education about every health and wellness topic in the world and make it as evidence-based and amazing as possible.
28:45But if we are not also focusing on what are the steps we need to do to help an individual make these behavior changes, like eat more fruits and vegetables, eat more protein in her diet, strength train three to four times a week, whatever it might be, you know, we are not going to make progress. So that is really hard. As a doctor, I can tell you, was I taught like, how do you coach your patient on behavior change? Like I wasn't really taught the coaching strategies that you have that expertise. And I think I've actually learned some of it along the way since then, but I will say that is so important.
29:16So the coaching piece and the community piece to help people make these changes, because it is really hard, especially when we have so much going on. I'm so glad you bring up social health because I think it's something that is not talked about enough and I really think that social skills are off balance and I mean it's a proven fact that social connection helps you live longer for sure and living a healthier and happier life creates longevity too I just have to commend you that I was so impressed with this the first time we interviewed you that you really focused on asking your client about their lifestyle.
29:58Because I find that a lot of doctors, it's okay, you have this, this is X is wrong. And this is what we do to correct it. And they're not examining and taking a glimpse of the whole big picture. And I just, I am so glad that you are doing this. And I just have to commend you. Thank you so much. And I agree that we all need to have, there's this like a buzzword now in the literature, it's called like whole person care. And it's like this new thing, like take care of the whole patient, ask about her lifestyle, how she's sleeping, how she eating, how she exercising. To me, I'm like, haven't we been doing this?
30:40Like this should be like very bread and butter medicine 101. And it's interesting that you say that, Laura, I guess I hate to say it, not first of all, to defend my colleagues, we are very limited in time and a routine. And it's just a fact. And also, I will say when it comes to the lifestyle piece, a lot of us were not really educated in medical school, residency, fellowship, whatever, about all these lifestyle factors to the degree that we feel super comfortable talking and counseling our patients about it. So these are all things that I think are going to change. But you raise some really important points that as a medical field, you know, we're wondering, it's great that we can work with a wonderful team, but we also need to be doing a better job addressing all of these concerns for our patients.
31:22Dr. Amy Comander:Yeah, absolutely. Well, if we look at a patient after treatment, so say that they are kind of in recovery, they're in a recovery period, and you're coaching them, what does the return to exercise look like? Now, obviously I would treat it as someone who had any surgery or injury or a long time off of fitness, regular movement. But are there any things that you would stay away from? Obviously, I'm thinking anything chest related. But what does that look like for women that may be out there? Because I get asked all the time, like, do you have a breast cancer kind of recovery program of where to start?
32:09Dr. Amy Comander:And it's just made me pause and think about the importance of that. And I know that you offer something as well. So let's dive into that. Every dating app swap is another loss. Jim bros, fake CEOs, straight up losers. So now the only app I open is Moto Casino. Because at least there, I'm surrounded by winners, real winners, thousands of them. While everyone else is in the single swamp, I'm at home relaxing while stacking bonuses, hitting wins, and playing all my favorite Vegas style games. Moto Casino, the only app worth your time. Moto Casino, the social casino. We're prohibited. No purchase necessary.
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33:56They know I do, and I've shared your amazing program, and I will continue to do so too. So exercise is absolutely important for women with a history of breast cancer. In fact, studies show that doing regular exercise, and we can talk about what those basic guidelines are, can help reduce risk of recurrence and improve outcome from breast cancer. So right there, exercise can improve a woman's outcome from her breast cancer. So that is the most important thing, right, when it comes to treating my patients and helping them optimize their health and well-being. So what are the basic guidelines? Again, let's just start with the basics.
34:35And it really is similar to like what the CDC would recommend for all Americans, 150 minutes of moderate aerobic activity each week or 75 minutes of more vigorous activity. But let's just focus on the 150 number. and that could be walking, jogging, cycling, kayaking, vacuuming, Zumba, whatever that may be. And two sessions of strength training. I know it's not a lot, but two sessions of strength training. That's good. Yeah. I will tell you, and you know this from your work, like the majority of people do not meet those criteria. And certainly when we think about the cancer survivor population, the majority do not meet those very basic guidelines.
35:18So that is where I often start with a patient. Of course, probably like you do with the people you work with, like where are you starting from? What are you doing at this time? What are you comfortable with? And really for me, it's helping my patient. Maybe she's going to start with walking. Like I actually said this to a patient yesterday. We set a smart goal together. Maybe you can walk for 15 minutes, three times this week and see how you do. Cause she's someone who doesn't exercise at all. So start with that and then gradually introduce more aerobic activity, introduce the strength training.
35:51And you do raise really great questions. What if a woman just had a mastectomy? Like what are her limitations? What can she do? When can she start lifting weights? What is safe for her? What's a warning sign? And I will tell you, I'm very fortunate where I work to work with physical therapists who have specific training and how to work with women who have had a history of breast cancer, but I will tell you that many studies show that lifting weights is safe and very much important for our patient population for all the reasons you talk about muscle mass, bone health, metabolic health, we can go on and on.
36:28And there is a condition called lymphedema where a woman can have swelling of her arm on the side where she had her breast cancer, especially if she had many lymph nodes removed in her surgery, or if she had radiation on that side. And exercise does not increase the risk of lymphedema. It can actually help it. So it is, we do get into some of the technical aspects of how a woman should be assessed, et cetera. But in general, exercise is good and beneficial and should be strongly encouraged for everyone.
36:58Dr. Amy Comander:Yes. And I just want to plug this and I feel like I've been plugging it and I'm like a broken record. But I'm going to say it again. I think as women, when they're coming into the field, because I have obviously all levels, but the ones that are really beginner, like they've received the message, they're ready to go. It's, there's so much information out there. That's good information that's thrown at them, but that we peel back and just be like, it doesn't matter what you start with, like just start. Don't worry about the guidelines for optimal body composition or optimal fitness or taking yourself to this high level.
37:38Dr. Amy Comander:Yes, we can program that over time, but we start with just like, what makes you happy? What gets you out the door? I mean, none of those should ever be discounted. And then it's like, well, once you're there, now do you want to add something? Is there something else we can add there? But the, you know, exercise in general, there's a lot of specifics, but I want women to know that like you start with what you can do and what you can manage. And it doesn't, it's meaningless of what, you know, someone else is recommending on their journey or what's optimal. If for you, this is what is, is, is making you feel okay and be active and do that.
38:25Dr. Amy Comander:So anyhow, I mean, there's a place for everyone. There is a place for everyone. And it's usually the very beginners that are very timid and just feel like, you know, they, they don't have the confidence yet to really get, get out there and do a lot of things. So they should be doing just the bare minimum of what they can, that they feel comfortable with. so let's talk about your your um path to the path what is it path to pavement something in pavement you have a book i didn't know you had a book but actually i want to say one thing because it's actually in the beginning of this book and it's totally related to what you just said and you're welcome to use this quote it's not my quote it's from like this chinese philosopher lao zu too, but the journey of a thousand miles begins with a single step.
39:20So I love what you just said. Just taking the first step is so key. So I love that you just talked about how the beginners struggle so much. Just take that first step. So yeah, paving the path to wellness. So this is a wonderful collaboration that began with my colleague, Dr. Beth Frady's five years ago. It's like hard for me to like fully wrap my head around. Really? Five years? That's gone by really fast. But it's a lifestyle medicine-based survivorship program for women with breast cancer who really want to learn about what we've been talking about, the evidence-based recommendations in terms of nutrition, physical activity, sleep, stress management, all of these topics after diagnosis of breast cancer.
40:01So we meet virtually and each week and go over each of these topics in great detail and also work together in the community setting to help people make these behavior changes. And it's really been such a wonderful undertaking. And we've also talked about the power of community. And that's been such a key benefit of this program as well. So this program is for people that have breast cancer and then are living with it afterwards, like after they go through it. The program that I'm offering is specifically for breast cancer survivors and thrivers. They like to call themselves that. I love that. But I will tell you that Dr.
40:39Fradies, when she first came up with this program, she was offering it to stroke survivors at a hospital called Spalding Rehabilitation Hospital, which is here in Boston at Philly with Harvard Medical School. So she was first offering the program there. And I met with her many years ago to learn about lifestyle medicine. And then we adapted this program. And I started offering it specifically for women with breast cancer. But I know Dr. Fradies and colleagues, we actually have a nonprofit and we're hoping to bring this program to lots of populations, not just women with breast cancer. But my passion, of course, is helping the breast cancer survivor community.
41:14And that's, that's really my why. I love that.
41:20Dr. Amy Comander:So you're a vegan, right? I would say I've been having some salmon, like once in a while to get my omega threes in, but like I do otherwise follow very much plant predominant diet. I call it that, but I was realizing I needed to find some ways to get my omega-3s, which we know are so good for our cardiovascular health. How long have you been vegan? Well, I mean, I go back and forth. Right now I'm not totally vegan, I should say. But gosh, when did I become essentially vegetarian? A long time ago, I don't even remember. That's honestly the truth. I don't even remember. I guess my daughter was nine because she, she became a vegetarian at that time too.
42:01So I can do the math. So she's now, so it was eight years ago. How old does she now? She jumped on the bandwagon too.
42:09Dr. Amy Comander:Yeah, that's great. Well, I like how you talk about the plant-based diet here. And this is where it's going to be like, okay, well we hear protein and even with the importance of protein, that's never going away or I don't foresee it ever going away. But if we look at the importance of that. It's hard for some women who start to change their diet and then it's really protein, you know, muscle, like a muscle centric approach, which is a lot of protein to support the training. But then a lot of the good fruits and vegetables might get lost in the mix because we're so pro protein. So do you have any advice on that?
42:52Dr. Amy Comander:Because, you know, ideally we're all getting the 30 fruits and vegetables in a week and we're all having the right number of protein. But I mean, in like real world, it's freaking hard. It is. I know. In fact, my colleague and I, shout out to my colleague, Chef Laura Klein. We taught a culinary medicine cooking class on Wednesday to a group of women with breast cancer. And we tried to do some education about nutrition along the way. And we talked about our favorite topic, gut microbiome, protein, fiber, and we did really talk about the challenge of getting in those 30 plants and getting in your protein.
43:28So one of the things we made was this soup with lentils. Lentils are pretty awesome, by the way. My colleague, Chef Laura, showed there's like five different types of lentils, all these different colors. I don't even know if you know there's black lentils, there's yellow lentils. I was like blown away. I'm like, I need to go buy all of these pretty lentils because they're packed with protein. Like one cup of lentils has like 18 grams of protein and they're packed with fiber. So you're getting fiber and protein when you have lentils, which are so yummy in a soup, or you can put them in a salad.
44:00So many things you can do. So that was a tip and trick we did share with our group because we all need to get at least 30 grams of fiber a day. And most of us are not getting that either. Not to stress on that. We talked about this earlier, but it's important.
44:14Dr. Amy Comander:Very important. And that's the hard transition is like, that's what I see with women that go into like a fat loss, um, you know, course with me is, is the fiber takes the hit because the plant and vegetables, like all of the plants take a hit. And so if we're just like, it really is, it seems like it's, it's simple information, have a lot of variety of fruits and veg and like have protein. We're like, okay, cool. But, um, it's really hard to, to get all of those balances. But again, start somewhere. If you're eating three vegetables a week, the same ones, then maybe add a fourth. I mean, that's how I'm doing it because it's, it's tricky to do it, especially when you're in limited time, you know?
44:58Yes, I definitely agree. It's, it's tricky. And that's why I love that. There's also, you have this wonderful community so people can support each other and share ideas with each other and strategies.
45:07Dr. Amy Comander:Yeah. I love that. And, uh, you know, we're running out of time here. I'm so sad. I feel like, where does the time go? We can't have been talking for 40 minutes. I know. I just thought the same thing, but I do want to just touch on one thing because it is breast cancer awareness month just to remind people. So screening, you're supposed to get a mammogram once a year, correct? Correct. And our recommendations starting at age 40, unless you have a strong family history or other significant risk factors. And then you would talk with your doctor about potentially starting earlier. But a woman of average risk should be starting at age 40 and doing it every year.
45:49What do you think of the Pronovo scan? Am I saying it correctly? The full body Pronovo scan? If you're referring to like, I'm not sure specifically about that particular one, But if you're thinking about full body, again, I do not recommend testing like that because I will tell you, anytime you order as a doctor, anytime I order a scan on any patient, I have to have a good reason. Why am I doing this? Because often there are incidental findings. And what does that mean? Something you will find that you were not looking for. And now you're going to go down that rabbit hole of chasing it. And it may or may not turn out to be anything of clinical significance.
46:31I'll give a common example. I know we're short on time. lung nodules. Lots of us have lung nodules. They're usually super tiny, five millimeters. You see it on someone's scan, you're going to follow it. So now she's getting a scan, maybe initially every six months for one or two years to make sure they're stable and nothing's growing or whatever. But now that patient is getting all these extra scans and extra exposure to radiation that she did. So I am not a fan of doing scans on people when you don't have a really good reason why you're doing it. Okay. That's great advice. I just wanted to ask, yes, since we're in this, but mammograms.
47:07Yes. Okay. Yeah.
47:09Dr. Amy Comander:Oh, that's, I didn't even think about that, but that's, I'm going to do the regular one that is not as fun, but at least it's, it's not causing me to get another scan. Is there anything new since we talked to you last about six months ago in the breast cancer treatment world, any new information that you can share or something that you found interesting? Oh gosh. In the breast cancer world, there things are always evolving, always changing. That's why my job is very exciting because there's always new research studies with new treatments and new findings that are being released. And I'll just think of one that, you know, is super interesting.
47:49Recently at my hospital, we had a retreat actually focused on the role of artificial intelligence in cancer care. And that's obviously a field and your field too, that's really taking off the power of these tools to enhance whether it's health and wellness, or maybe in the breast cancer field, helping us identify cancers earlier on mammograms, using all these really cool AI algorithms. I do not claim to be an expert on this, but it's super interesting. So that's an area that I think we're going to really see take off in the next few years.
48:21Dr. Amy Comander:AI, get in or get out. I just watched a Tesla with my son this morning. He's like, mom, look at these robots. You can, you know, you're going to be able to buy one in 2026. I'm like, I feel like that's where in Halloween, my son loves animatronics. I feel like it's an animatronic walking around the house. I don't think I'm comfortable with, with that quite yet, but, you know, I guess the, you know, the AI world is, is, it's not going away. So it's, it's quite interesting on all spectrums there, but fascinating information. I think I love the lifestyle approach and I love that there's so much power in lifestyle medicine and that it's kind of getting into the main medical stream and getting talked about because it really is, we're all working together for someone's health.
49:12Dr. Amy Comander:I mean, and there's lots of participants in a client's journey that, you know, we all, we all benefiting each other by helping out with our specific area. And so there's, there's lots of good, it's an exciting time to live. For sure. I agree with you a hundred percent. So Amy, can you tell us about, is your book available? I didn't know that there was an actual book. Same. I'm like, we got to get the book. So this is a wonderful workbook that I was fortunate to collaborate with Dr. Beth Frades and Dr. Michelle Tollefson. It's called Paving the Path to Wellness Workbook. It is on Amazon or on the publisher's site, healthylearning.com.
49:55And by the way, the proceeds do not go to me. They go to our nonprofit called Paving Wellness, and that's pavingwellness.org. But bottom line is this is a great workbook that goes with our program. And I am working on one focused on breast cancer. And we also have one already written by my amazing colleague, Dr. Tollefson. She was the first author focused on menopause. And by the way, you would love it. It's all about, it's somewhere over there in my house. It's focused on lifestyle strategies to optimize our health during menopause, which is something that you're already an expert on. So, but I think you would love it because a lot of, she does focus a lot.
50:35We focus a lot about everything, but certainly exercise is key in that too.
50:39Dr. Amy Comander:All right. I'm getting it. I feel like I order more books from podcasts. It's going to be a gift for me. I'm sending it to you. So I'm sending it to you. So I will do that because you will absolutely love it. Oh, I'm so excited. Well, thank you so much for your time, Dr. Commander. We is always just a special treat to have you, especially during the month of breast Cancer Awareness and Menopause Month as well. So we kind of tackled two big women's health. Yes, women's health. So thank you so much for your time and we will catch up with you soon. Thank you so much for the opportunity and thanks for all the amazing work you do.
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From the publisher
Dr. Comander shares expert insights on how nutrition, exercise, stress management, and other evidence-based lifestyle changes can significantly reduce your risk of breast cancer, support recovery, and enhance long-term health outcomes.
Whether you're a patient, survivor, caregiver, or simply looking to take proactive steps toward better health, this episode offers practical, science-backed strategies for early detection, cancer prevention, and overall wellness. Tune in now to empower yourself with life-changing knowledge and actionable steps from one of the field’s leading voices.