From Death To Life: Dr. Dawn Mussallem On Surviving Cancer Twice, Running A Marathon Post Heart Transplant, & Why Mindset Matters More Than Medicine

28:41Not there. Like total awareness in this dream, like a sensory experience. Both of them really weren't dreams. They were more like sensory experiences. There's a door. And I remember crawling out the door, just like I did in the dream the night before. Crawling out the door, only this time it wasn't hands pulling me back. It was blades of grass. Do you remember as a kid, you'd be playing in the grass and the grass be kind of sticky, almost cut your leg. It was like the grass is pulling back. I flip over, there's these cumulus clouds going over me. And in the distance were these families, love, unified harmony, like the new world.

29:12And then this word came over me and it said grace. grace and i woke up in that moment and i thought i'm going to name my heart grace the very song at that moment instrumental song playing was titled grace and i opened my email because i thought you know i certainly couldn't sleep then and the email waiting for me was titled full of grace what do you make of all this it just set the stage for me to be in this position to help others in their moments of hardship and whether it's me sharing my story reaches someone so far across the world that we never would have met great but you know there is that listener out there that maybe this connects with them and i hope it does um but grace is powerful right it's this virtue that's within each of us to be able to get through trials and oh my gosh it's just helped me get through this and it was interesting rich so at the finish line of that marathon that i ran on my one-year heart transplant anniversary there was this massive construction sign and guess what construction company's name was.

30:16Grace Construction. Grace Construction. It was so cool. We're connecting all the, the red string is going from one thing to another here. It was beautiful. I see the through line. So it's just been this beautiful life. And, you know, so this donor heart of me, you know, and what I was fearful of is, you know, what your personality changed. It did change. It changed for the better. A lot of things changed for the better. I live with like conviction and knowing and purpose and meaning and intent and like just this tenacity. And it's just like so cool where before I used to be maybe a little more shy.

30:48Not anymore. That's hard to imagine. Well, it's certainly working because you're an energizer bunny. Like you have a lot of spunk and energy. You know, clearly you're not at 8 % anymore. You know, I think you're firing on all cylinders.

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32:43This episode is brought to you by AG1. You know it. You love it. One thing I've noticed about this time of year, especially February, is that all those routines that you promise to adopt or to adhere to in the new year, well, they tend to get a little wobbly around this time of year. January starts out with all this motivation and structure, and then, you know, life happens. Travel, late nights, people in town, work stuff stacking up. And suddenly, the days don't quite look as clean as they did a few weeks ago. And for me, that's where the small, consistent things matter the most. And AG1 is one of those anchors in my morning.

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34:31So with this unique set of life experiences that you've had, when a patient comes into your office or you're having a consultation and they've just been hit with the news you never wanna get, what is the first thing that you say to this person? How do you bring them into the fold and begin the process of treating somebody who's on the receiving end of very scary news, like perhaps the scariest. Yeah, the last thing you wanna have is toxic positivity, right? And I certainly don't have that. I acknowledge that there is suffering in all of this. This suffering is real. It is scary and it's true. And so I just hold space for them and their unique need and meet them where they're at.

35:16You know, what can I help you with? That's the first thing I ask them, what can I help you with? You know, and it's not always about what you would expect. It's not always about eating better, exercising more, avoiding toxic substances. Sometimes it's just talking about what's meaningful in life. What are you fearful of? How are your relationships? You know, those are some of my most powerful visits with patients. But it's exactly that. A lot of times they put blame. You know, a lot of individuals that come to see me, they already want to be healthy. A lot of them were already healthy and they get cancer, right?

35:55So it's that question, why did this happen? You know, and they want answers. And sometimes that need to look for answers is very turbulent. And so I really try to talk to them about, is there a lesson here? Is there anything that we can look for for meaning that's going to deepen our life? Because I feel when I see that turbulence, I feel it. You know, it's like that empathic element that all of us have. It's a little more sensitive. It doesn't deplete my energy, but I'm sensitive to it. And I honor that because I like it helps me be a better healer. But if I sense that turbulence, I really want to help that patient work through that.

36:31Turbulence over anything. I have someone coming in who lived the perfect lifestyle and they're so turbulent because they're so fearful. I want you to live that healthy lifestyle because you want to elevate your existence, not because you want to be held hostage to it, if that makes sense. so i really try to dial in to kind of that heart-centered energy and where it's at is it that place of still acceptance understanding and going to move forward or is this place of just resistance and those in that place of resistance i want to try to work with them and that moment of vulnerability try to ease up on that slowly surely i think it's just so important there's a a four hour podcast in just what you shared right there.

37:18There's so much to kind of tease out of that. But the notion that somebody comes to you, they've just received this news, perhaps they've been doing everything right. And there is that sense of injustice or like guilt, like what did I do wrong? And I think in part that's fueled by our information landscape where it's like, you open up social media and it's like, here's how you cure cancer. Here's how you'll be 100 % bulletproof, you know, health-wise or whatever, if you do this or that, or, you know, take this supplement or whatever it is, right? Meaning that it's all on us and there's no room for the fact that, you know, sometimes shit happens and you can do everything right and you can get diagnosed with cancer and it's nobody's fault, right?

38:04But the self-flagellation that I'm imagining that probably a lot of people are doing when they come to you, matched with the deep discomfort with the uncertainty of it that's driving like, I need answers and I'm going to go on the internet or whatever and tell me what it is so I can get into action is a means of not having to contend with the acceptance piece. Let's use an example. So the woman that I shared with you called, I had a conversation with her in the airport and then I spoke with her again this morning. She feels over the holidays she wasn't eating as good. And that's why her cancer came back.

38:43This isn't the case. Cancer is very complex. And I have this belief, I can't back this in science, but an understanding and knowing of someone I'd gone through, I so feel like everything that happens in our life was almost like predetermined, right? We're put on earth in this trajectory of what we're going to experience, including our decisions to eat healthy or not. All of that stuff may be predetermined. it's our job to just show up for ourself in that moment in our most authentic truth and what that means that may not be clear for many people but you know working with them to try to find that knowing and find that understanding for the person out there that has that question who has cancer who did everything right and you're beating yourself up the good news is this is and it's hard to find any good news i understand that we know like myself taking good care of yourself your whole life and god forbid you get this cancer diagnosis there's improved outcomes we also know and people who decide to finally start living a little healthier life because they have education that's coming forward to them.

39:43There's so many cancer programs that give this education that it's never too late to change. And so I think that this can be a very hopeful message both ways. We're not God. I mean, we cannot control everything. And when it comes to lifestyle, when it comes to cancer, when it comes to our genes, there's so many little hits that our body takes and you can't live in a bubble. And if you're saying that you eat the perfect diet, I know that's your ego speaking. We actually don't know what the perfect diet is. One day we may be able to bio-individualize nutrition, but we're really not there yet. We know what would be the best source of diet, but there's just not a perfect diet.

40:17Exercise, yes, you need to move your body. Toxic exposures, yep, you should probably try to avoid them. But we also get in a car and we drive, we speed. I mean, there's risks and harms in everything we do. And I just don't think we should live that way. I think we should do our best. I do think we have a responsibility to take good care of our body. I mean, it's our vessel. And if you want to feel good, you have to take care of your body. So one, taking care of your body so you can experience the vitality and the harmony of life. That's how you get there. Number two, taking good care of your body to reduce the risk of these diseases.

40:50And we know that seven out of the 10 top chronic diseases are preventable with lifestyle. That's significant. We know when it comes to cancer, the statistics are 50 % of those are potentially preventable from the World Health Organization. But if you really step back, you know, 5 % to 10 % of cancers are genetic, 5 % to 10 % are family history. So that means 75 % to 80 % of cancers are happening because of things, not because of genes in our family history. They're happening because of external causes, pollution, environment, nutrition, sleep, toxic exposures, etc. It goes on, Mom. What I like about your approach to this is that you have this integrative philosophy of care.

41:36It's not one or the other. You have, on the one hand, the conventional oncology treatment approach, radiation, chemotherapy, and the like. while on the other hand, you are also incorporating and weaving in in equal measure these evidence-based lifestyle changes with your patients, which provides a level of kind of agency, I think with the patients, like there are these things that you can do and here's what the evidence and the science says about how they impact your ability to weather the conventional treatments or prevent these things even happening in the first place or to put yourself in the best position to avoid a recurrence.

42:28It really is. The science is so deep and it's such an honor and a privilege and joy to witness what I witness in my patients. I am so proud of them for not just my patients, but all of the individuals that reach out to me that get the messaging about taking a little better care of themselves. Cancer is a teachable moment. You know, we should flip the script on cancer, heart failure, disease, and make that an opportunity to learn to live a healthier lifestyle and have joy over it. You know, this is your life. You're showing up for yourself. It's actually so exciting to do it. And when I see my women in some of their sickest moments, chemotherapy, radiation, these surgeries, and they meet me in their first visit and their vitality is a little bit down.

43:13and then all of a sudden they're having all these treatments, but they're starting to take care of themselves. And when you would think in the middle of chemo that they'd be so depleted, but their essence is actually elevated because for the first time they're practicing these lifestyle behaviors that are very powerful and meaning to them. And it's, again, they have agency over this and it's very, very, very exciting to see. There's many different forms of chemotherapy. So there's some that just really are harsh on women. And, you know, I share when it comes to the cancer treatment. We know that if you do eat better during chemotherapy, it seems to reduce fatigue.

43:50That's very, very important. We're still following those outcomes data during the actual treatment, what that means. Many of the chemotherapies now have immunotherapy. You've had Dr. Will on here many times. We know that gut microbiome is powerful for immunotherapy. And the best way to optimize the gut microbiome is with food as medicine, with nutrition. So So for the majority of chemotherapies partnered with immunotherapy, you definitely want to take part in improving the nutrition during that chemotherapy. It can be hard for a lot of people to want to take that on. I understand that. But I see with my patients, it gives them autonomy over their disease and they love that.

44:28It gives them their own ability to kind of be their own CEO, if you may, of their health while their doctors are doing everything they are doing. They're able to show up in that way. When it comes to exercise with cancer, oh my gosh, it's incredibly powerful. It's incredibly powerful during chemo. And I get to the point where I force, we're going to just use this word, but I joke with them. I said, I'm going to force you to exercise. And I do. It doesn't mean blood, sweat, and tears, but walking. Even if you can only walk five minutes, three times a day, they've got to move during chemo. Exercise during chemo improves outcomes.

45:03There was an amazing study with even colorectal cancer patients that showed that in colorectal cancer survivors, it showed to be almost as important as the chemotherapy. So you match the two of those together and you start to really ignite cure. And that's where we're at. We want to cure you. It doesn't mean that eating healthy and exercise can replace these treatments. It means we march it right alongside treatments to mitigate the toxicities, to improve your vitality during treatment, and then to enhance the treatment outcome for cure after. It's just incredible. But the exercise data is profound both during and beyond the cancer diagnosis.

45:39People have more energy and it gets rid of that brain fog when they exercise during treatment. So very, very powerful. And it's fascinating. The YMCA Livestrong program is a free supervised exercise program for cancer patients throughout the United States. So if people have a YMCA in their local community, this is a wonderful thing to take part of. And generally their domestic partner also gets a free membership, which is really cool. It may be different for different YMCAs, but I like to throw different resources out there because it's expensive being a cancer patient. And if you can find some of these free resources to help you exercise under supervision, it's wonderful.

46:15So I want to make sure I heard you correctly because you just said a lot of things, but I'm pretty sure you said that the evidence suggests that exercise is just as powerful as chemotherapy in terms of driving positive outcomes. Did you actually say that? I actually said that. This was a study that was published last year in colorectal cancer survivors. It was a powerful study. And it wasn't a study to replace the chemo. It was just showing that, wow, these numbers actually are on par with the benefits we see from chemo. So it is to take exercise as medicine, just like we say food is medicine.

46:53These numbers are incredibly exciting. For breast cancer patients who really subscribe to this more healthy lifestyle of working on a normal body composition, exercise, eating healthy, they improve outcomes from all causes after breast cancer. Do you want to guess the number? I don't know. It's probably some, based upon the expression on your face, it's probably an outrageous statistic. 58%. That's a massive number. How is that possible? I would not have imagined that. I know. And this is why every single cancer center needs to have individuals there to support their cancer patients, to work better at body composition, to help your patients move and exercise, and to help patients understand the importance of eating healthier.

47:37It doesn't have to be perfect. This is about progress, not perfection, but really getting excited about this. And Rich, this is why I'm here today. I mean, you know, I ate healthy my whole life, including during chemo, including during heart failure and beyond. Exercise during all this. even with heart failure, I really tried to move my body, even when I couldn't. Even if it meant I'd sit there and just do some calf raises, you know, or some arm curls with just my arms, I always kept on trying to move my body. Yeah, you mentioned, you know, these lifestyle medicine pillars kind of in passing very quickly, obviously nutrition and exercise, which we've spoken a little bit about, the avoidance of risky substances, restorative sleep, stress management, social connection.

48:21I wanna get a little bit more granular on the nutrition piece, this idea of food as medicine. And I've heard you say that food is the leading cause of death in America. This is crazy. So in 2022 in JAMA, the leading causes of death were all linked to food. That was in their 2022 publication. We know it in America. I mean, the average American diet is 60 % ultra processed foods. And so this new food pyramid flip, everyone's talking about it extensively. I was going to ask you your thoughts on the new inverted pyramid. Well, I think number one, no one really follows a food pyramid. So everyone's making a lot of attention to it, but I don't think anyone really looks at the food pyramid anymore.

49:07But the one thing I think was great about it, I always like to focus on the positives. Thank goodness we're talking about ultra processed food because it is a big concern. The ultra-processed food is weeded out anything healthy. So if we can get rid of the ultra-processed food and start to introduce more whole foods, that's a step in the right direction. I love that. Also, getting rid of sugar. They emphasized in the upper right-hand corner where the vegetables and fruits, it was partnered very closely to the meats and stuff. They did talk about increasing the recommendation for protein. I actually agree with that.

49:39I do think people need enough protein, but I think they should have drilled down before they drilled down on the protein to the importance of fiber because very few Americans are actually protein deficient, but pretty much every American is fiber deficient. And there wasn't really as much highlight to the fiber importance. And the reason I want to just bring this up is last year in 2025, there were incredible studies about fiber. There was an umbrella review with over 17 million individuals. So, okay. I want everyone listening, when you're hearing this food science research out there, because there's so many opinions, to first ask, was this study done in humans?

50:21That's number one. Number two, how many people were in that study? And number three, what are they comparing it to? Those are all very, very important questions. 17 million individuals. This is like so exciting. as a physician and a scientist, and all of us in food science love hearing this study. It gave us class one evidence. This is the strongest evidence we have in medicine that the fiber, those with more fiber versus less fiber, those with more fiber had up to a 28 % reduced risk of dying from heart disease. It also had the same reduced risk of pancreas cancer and diverticular disease. Now, the study also showed us reduced risks of cancer and dying from all causes, etc.

51:10But it was this class one evidence for those three things that I just listed at the top. Very cool. Also, in 2025, there was another cool study. We're into this era of GLP-1s. I'm not against them. They have beautiful anti-inflammatory properties. This is a moment to quiet the food noise. A lot of people are addicted to food. Why? Because they're ultra-processed. They're hyper-palatable. So everyone, you know, these foods were created to addict you. And the GLP-1 shut that down. So good, the food pyramid is going to try to get rid of those fake foods. The GLP-1 try to quiet that food noise so people have a little better control if that's what they need.

51:43And they can learn to eat healthier over this time. But what this other study in 2025 showed us was that in individuals overweight and obese, there was about 1 ,700 individuals in this study, is that it helped to improve metabolic markers. We know that 88 % of individuals in America are not metabolically healthy. This is a major problem. And I think metabolic health is one of the things we really need to drill down on. When you eat, what is your blood sugar doing? What are your triglycerides doing? What is your overall, as we were sharing before we started talking today, what are these metrics looking like?

52:17And so the study showed, yes, that it improved not just control of body weight, body composition, but also it lowered insulin. It lowered A1C. It improved the lipid profile. So fiber for that as well. And then cancer. We're talking about cancer. So we're getting back to the cancer discussion. But what's good for the cancer patient is good for the average person. Yes. It's basically what I'm gathering from looking into all of your recommendations. And so the fiber in the study last year showed a 22 % reduced risk of cancer and a 17 % risk of dying from cancer. And so you bring up such an important question.

52:53You know, I have women coming in and they have all these competing mortalities when they're diagnosed with breast cancer. heart disease fatty liver diabetes sleep apnea they're depressed they get breast cancer and they want to see me and they're willing to change what are we doing wrong in medicine that individuals with all these other health conditions have never been talked to about living healthier the number one reason we die is heart disease the number one reason breast cancer patients actually you know when they're cured their breast cancer they die is heart disease both men and women heart disease is the number one killer but we just don't have these programs, you know, to really engage people and to make them active participants and enjoy it.

53:31Well, also medicine is so hyper specialized that it's not interdepartmental in that way. So there's no cross-pollinization of advice and expertise from, you know, the oncologist to the cardiologist. You're right. It's just so segregated and the system is reactive. You know, $4.1 trillion in healthcare and 97 % is dedicated to sick care. There's no money going back to this preventive care and we just can't catch up. And so people get the disease and we try to get them to eat healthier, to exercise more, but it's still reactive. We need to get more active in the preventive phase. But the problem is developing behaviors that people enjoy and their willingness to do it.

54:16And this is why cancer is that teachable moment. It's their why, It's their meaning and their purpose. So it's that opportunistic time to pivot change. And so in my practice, grab them at the time of diagnosis, get them eating healthier, moving right away. Yeah, you said 95 % of cancer patients are not getting the recommended daily allowance of fruit and vegetables. So when you talk about fiber, I mean, that's what fiber, you know? So like, how is that possible? This seems also to be a very easy fix. It's such an easy fix. So, you know, when I meet with people, I say, listen, I want you to hear, and I say, hear my chirpy voice.

54:51So everyone listening, hear this little high-pitched voice of mine. Number one, get rid of the ultra-processed foods. Number two, every single time you eat, any time you eat, make half of what you're eating come from a vegetable and fruit. So easy. I'm certainly not counting my vegetables and fruits. Okay, I had two at breakfast. I had one at lunch. That would drive me nuts. Like, let's keep this simple. So just make half what you're eating come from vegetable and fruit. And that's pretty easy. And they all do great with it. So they're all getting seven, eight, nine, 10. It's not going to hurt you to eat more, you have unlimited amounts of vegetables and fruits you can enjoy.

55:19What are your top five or 10 foods to focus on and why? You know what my number one is going to be. So my favorite food, if I was dying tomorrow and you said, Dawn, we're sorry, it's over. I'd say, okay, well, bring me a good meal. And I'd want purple sweet potatoes. I love purple sweet potatoes. And I think purple sweet potatoes are really cool because there's a lot of phytonutrients. And with the anthocyanins, There's 150 % more than just in berries. So let's just put those purple sweet potatoes up there at the top because they're Dawn's favorite. But what I would say is there's four food components that actually are masterful at turning on tumor suppressor genes.

55:58So the cruciferous vegetables are powerful, and especially if we sprout them. And I know you've done interviews with Doug Evans, so folks should really go listen to that interview. But sprouts are powerful, not just in terms of the bioavailability of the nutrients, but also for the energy of food. People don't pay attention to this, but food is energy. And if you're eating this live food and especially growing food like sprouts or seeds, it really is wonderful for our vital existence. So number one, let's throw up there the cruciferous. Very exciting. They're also great at detoxifying. Of course, fiber is great at detoxifying, but cruciferous are great.

56:31You have turmeric. And you don't need to do turmeric as a pill. Just put it in your cuisine. You know, a lot of folks aren't able to take turmeric because of drug interactions. You don't need to. Just put it in your food. The gut microbiome loves it, and it's just a wonderful seasoning. Soy. I mean, I should have probably put soy number one. People are probably shocked I didn't. Soy is powerful. It's the biggest myth, and you know why? Because the studies were initially done in rodents. So that's why when we first started talking, I said, always ask, was this study in humans or rodents? So yeah, rodents, in the study several decades ago, they developed tubers in their mammary tissue, in their breast tissue.

57:04We are not rodents. We do not metabolize soy the same we do. We have decades of data to show us that soy not only is safe from a breast cancer standpoint, it's protective. This comes out of the American Institute for Cancer Research. Karen Collins has a really nice column on the myths about soy, that yes, it is safe. There was an awesome study that was published by the American Cancer Society in 2022, their update on physical exercise and nutrition. They dedicated three paragraphs to soy. And what they showed us is that breast cancer survivors who had more soy versus those that had less, those with more soy had a 25 % reduced risk of breast cancer returning.

57:45This is most predominant in those women with the most aggressive breast cancer, the estrogen receptor negative breast cancer. So this is a wild myth. Yeah, those are astonishing statistics. Sorry to interrupt, but why is this myth so persistent? You know, it's just people got into this old literature, this old data that just hasn't been, you know, dismissed. And unfortunately, doctors get at best six hours of nutritional training. They just don't have time. And at best, they get that in their medical years. And now they're years into their practice and they don't get it when they're doing their continuing medical education and or they're not taking part of it in their own lifestyle.

58:22Now, I think that's all changing. You know, I think with the American College of Lifestyle Medicine, I think there's more and more education coming forward to physicians about nutrition so that they're getting more and more knowledge. And for men, men are not going to grow breasts. We know that soy is suggested to reduce the risk of prostate cancer. Soy is suggested to reduce the risk of lung cancer and non-smokers. And it's incredible for that gut microbiome. And, you know, if we think about the power of the gut microbiome over cancer as it ignites the immune system and the stronger your immune system.

58:51I mean, really, the immune system is like this massive feature that we should really acknowledge when it comes to healthy aging longevity. And people just don't really, you know, give it a little, give it as much of an accolade as it deserves. But that gut microbiome is a harness to that. So the soy is really tremendous for it. Cruciferous vegetables. Turmeric soy. Turmeric soy. Purple sweet potatoes. Well, the other one that turns off those is the EGCG coming from green tea. So green tea is very powerful. So the top four was the cruciferous, the edamame, the turmeric, and the EGCG with green tea.

59:30Then we have the purple sweet potatoes, the berries. I absolutely love, love, love, love, love. Beans, and I love beans because they're high in fiber. They're an awesome plant protein. You can say beans, split peas, lentils, whatever you prefer. Very, very powerful. And we know that plant protein, when you can flip it out for animal protein, is gonna help to reduce that risk of cancer in many studies. So I shouldn't say many studies, but coming out of that NIH AARP study, it showed us some very interesting findings when you're able to try to reduce some of the animal protein for some plant protein.

1:00:02Not here to make people vegan necessarily, but we do know that if you can try to switch out some of those proteins, it's a favorable thing to do. Going down the list, mushrooms have a lot of health benefit that I think people ignore and they don't pay as much attention to. Even those simple little white button mushrooms tend to have some aromatase inhibitor activity. You'd have to eat a lot of them. But mushrooms are something that people don't always include in their diet and actually a pretty unique source of protein in some situations coming to market now more and more with some of the mushroom roots and such that are out there.

1:00:34Bottom line, I think the important thing to highlight here, Rich, is that it's a wide variety of the vegetables and fruits that you get. That's the key. The more variety, the better. So keep on just switching all those things around as much as you can. I love beets. I love those highly pigmented, colorful vegetables and fruits is what I would really, really recommend to people. I could go on a really long list.

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1:04:17I've heard you say that two servings of frozen berries per week can reduce cancer risk by 25%. This came out of the Nurses Health Study, both in terms of prevention, as well as for breast cancer survivors. So keep in mind, these are observational studies. So these are studies that they look at a group of individuals and they follow these patterns. So it doesn't mean that this is a direct cause and effect sort of thing. But T. Colin Campbell says something very cool. He says, hey, there's enough data out there that when you have enough numbers, that correlation eventually equals causation. So there is definitely some critics out there when I gave that statistic that said, you're kind of giving false hope.

1:04:59I said, well, this is what I'm going to say. And I got very firm to these individuals because these were physicians that feel like, you know, is that giving false hope? If it was to potentially harm a person, if I was talking about a pharmaceutical, that would be different. But since berries will never hurt you, they can only benefit you, I certainly think it's very exciting to share this data. Why would we not? Particularly when there's other studies out there that are similar in design. This was a very well-done study out of the Nurses' Health Study, over 8 ,000 women. And it showed that those breast cancer patients that had two servings of berries a week for every two servings, there was a 25 % reduced risk of breast cancer specific survival.

1:05:39You know, there's also like cool studies with coffee. You know, coffee is another cool one. That would have been at the top of my list. I know I tend to like go on. Thanks for letting me go on. Because when I talk about food, I'm like, Rich, I'm here to learn. I get so excited. I just want to like go. Clearly, I'm getting that. I'm sorry. Keep going. So like coffee is like really cool. And you know, it's the one thing that when people come in to see me, you know what they say, I stopped having coffee and I stopped having wheat. And I'm like, well, you kind of need to stop either of those. Let's talk about it.

1:06:09So when it comes to coffee, there was another cool observational study that showed that breast cancer patients who had three cups of coffee after their diagnosis had a 25 % reduced risk of breast cancer specific mortality. So that's not my point for necessarily sharing it, but bottom line, coffee helps a whole lot of things. It's always linked to kind of living longer on earth. So it is an observational study. So maybe coffee drinkers do drink coffee i do yeah i love coffee so there's a fun fact so it's the chlorogenic acid in coffee that's very favorable and then there's been recent research to talk about the gut microbiome coffee drinkers have an organism a microbe in their gut microbiome called losinobacter tim specter shared this with me it's really cool data losinobacter i'm not a cool organ like i we have more losinobacter than the non-coffee drinkers i feel very entitled So it's very cool though.

1:07:00So if you put dairy from a cow into coffee, it reduces your ability to absorb that chlorogenic acid. So that's why plant milk is going to be more favorable. Try to get your coffee light or medium roast because you'll have more chlorogenic acid. The more roast that goes into it, the more you kind of burn off that chlorogenic acid. But I think coffee is great. If you get palpitations from the caffeine, then you'd want to do a decaffeinated version of it. Some coffees, there's some concern about molds. So maybe we need to be mindful of that. I know I personally am, but that's hard in some situations.

1:07:32I certainly don't worry about it when I go to a grocery store. You control what you can control, right? It's that kind of thing. But I definitely like talking about coffee. I think you like talking about anything that excites you. I do. It all makes sense. It's all very logical. Essentially, what you're saying is, you know, eat these foods that are high in fiber. The fiber serves to improve the health of the gut microbiome. The immune system, for the most part, is seeded in the gut. And so, what serves the microbiome serves your immune system. You want all of these antioxidants, all of these phytonutrients, a high ratio of nutrients to calories.

1:08:14And these things all inform each other. And obviously, this anti-inflammatory approach to eating is in service of cancer prevention and even recovery from cancer and cancer treatments, right? What you're advocating for is essentially a whole food plant-based diet or a plant-predominant diet. And I'm curious about how that approach is received by your patients, many of whom I would imagine might be coming in thinking, hey, everything I read and I've heard is advocating for a ketogenic approach to treating cancer. Isn't that the better way to go? Yeah. There was a great review by Irvi Schall and Neil Einger out of Memorial Sloan Kettering that asked this exact question, what is the best dietary pattern for cancer patients through survivorship?

1:09:12And it shows that the whole food plant-based diet is the best or a plant-predominant diet is the best, including that for metabolic control. It was really interesting. We have access to this AI search engine called Open Evidence, and it goes through all of the peer-reviewed journals. And so I put in there, tell me about the long-term effects of a keto diet. Tell me about the long-term effects of a carnivore diet. Tell me about the long-term effects of a whole food plant-based diet. We have no long-term effects that we can comment on for a carnivore diet. There could be harm because of X, Y, and Z, because you're not getting enough fiber.

1:09:46Same thing with keto. Maybe there's some immediate metabolic control, but long-term, we don't have the data. We don't know what it means to have those higher levels of animal protein that individuals are consuming. What about a keto-like diet? If you could do it more with a plant-predominant flare or do more safer sources of animal protein, maybe. And I certainly do use that in individuals who have metastatic cancer, especially metastatic cancer in the brain with seizures. There's some situations where maybe a keto diet does have some value. There are some chemotherapies that there's some suggestion that maybe there's some value.

1:10:20But again, you tilt them away from such the heavy lard, butter, ultra processed like bacon and ham and those sorts of things. And you instead try to use fish and maybe some turkey and those sorts of things, avocado, nuts and seeds. It's not going to be truly a keto diet, but you can do your best. But at the end of the day, what this through the AI showed us is that with a plant-based diet, yes, it's always linked to a 10 to 20 % at minimum reduced mortality from all causes when you do the whole food plant-based diet. We see this over and over and over again. So it was pretty cool to look at that.

1:10:53We just don't have long-term evidence with the above. So when my patients come in and they've been told to do the keto diet, when you share it with them, the science, and in medical conferences, we talk about the science. Why do we not do that with the patients? And I do that with every one of my patients. I talk about the studies. I break it down on terms that make sense to them, layman terms. And the truth is, Rich, when I talk to doctors, I break down more on the layman terms too because they've never had the education in nutrition. And so it makes more sense to them. They enjoy it. It's more fun.

1:11:22And it's something they can apply to their own family. So I want the doctors we teach to be healthier. I want the patients to teach to be more healthier. And so the women do really good with it. Again, it's a teachable moment. They seem to onboard well. I really keep a close dial in to their energy during the visit. And I try to use my emotional intelligence if it seems like they're getting a little bit overwhelmed. And I share with them that this is going to take more time. You've got to show up for yourself. You may not be able to spend as much time on social media, watch TV, involve your kids, take the kids to the grocery store with you.

1:11:55You're going to be reading the labels. This is important. It doesn't have to cost more, but it is definitely going to take more time. And so I like to just put that up front and I want you to have fun doing it. You know, it's, I enjoy going to the grocery store and I'm there like forever. You know, it's just what you do. And you think you and I kind of know when we go to the grocery store? No, because there's always new products. And so it created novelty out of it. I really work with patients with appropriate food swaps. So if they're doing toast with butter, well, okay. I try to maybe flip into a healthier form of toast.

1:12:27I love the Ezekiel bread. The sprouted breads are so wonderful. They're actually a complete protein, which is kind of cool. Not that we have to worry about necessarily getting complete proteins at each meal, but it's neat when you can. And then use some avocado on it. Avocado is so settling for cancer patients during treatment, especially if they're having some GI distress. So it works really lovely for them. If they need to up the protein a little bit, hemp seeds, three tablespoons of hemp seeds has 10 grams of protein. That's pretty cool. They could put some microgreens on it. Some of my patients do eggs.

1:12:57I try to limit it to preferably no more than two, up to four, but if they're doing a lot, I just dial them back by 50 % at first and let them just navigate from there. Meeting them where they're at, dialing back just a little bit of maybe we don't want to get excess of and moving forward. The egg research is really hard to talk through. It's just not clear cut. It is a whole food. So I really talk through patients with that. And it's always going to be, what are they going to replace it with? And you do need some protein. So my patients, a lot of them do have some eggs. I think it's really important to look at what is the food that we want to get rid of and what would be a healthier form of food that can be similar in palate and texture and taste to make that swap.

1:13:42And there's so many. And by the way, you can use AI. You can go to chat GPT. I love eating a soft taco with beef and cheese and blah, blah, blah. The AI will tell you, why don't you try it like this? Try using some beans with the seasoning. Instead of using the cheese, why don't you try putting some avocado because it's going to be creamy and it works really good. In the hierarchy of foods and substances to avoid, what tops the list and how do you go down from there? That's great. So number one, ultra processed foods. And what does that mean? You know, so I basically say, we're going to read the labels.

1:14:18And when you see those ingredients that you just have no idea, you can't recognize them or your great grandmother couldn't recognize them. Those are the ones you really want to avoid bringing into the home if possible. I really want them to avoid added sugar if possible. On the ingredient list, if there's oils, I mean, I think this whole seed oil debate needs to be put to rest. I'm not really worried about seed oil, but the oils that we put into packaged foods is usually industrialized and it's junk. And they're usually putting that oil into the food to make it more hyperpalatable. And it's just going to be more calories that have no nutritional value.

1:14:51And again, going back to every time we put food in the mouth, it's an opportunity to nourish the body or to potentially harm the body or to get unnecessary calories. So I typically, when the oils are on the ingredient list, I want them to scrutinize that oil. And what kind of oil is it? How high up on the list is it? Those are the main things on the ingredient list that I want people to avoid. When it comes to red meat, it's pretty clear from the American Cancer Society, the American Institute for Cancer Research, that, yeah, you need to limit it. I mean, this is evidence-guided practices. This isn't my opinion here.

1:15:22This is based in the evidence that for cancer survivors, we want to prioritize plant protein. That's in every recommendation out there. And so try to swap some of that red meat for plant proteins, whether that's edamame, tofu, tempeh, beans, quinoa, sprouted bread, et cetera. And what do you say to the person who is new to eating plant-based or predominantly plant-based, who has concerns around protein? Because you did mention when we were talking about the inverted food pyramid, that you believe in making sure that everyone is getting an adequate amount of protein. And now you're saying, and you're going to have to get it from plants now.

1:16:05So what do you say to that person to make sure that they are feeling good about their protein intake and kind of know what to eat? I really appreciate that question. So, you know, the guidelines with the recommendation is 1.2 to 1.6 grams per kilogram of ideal body weight is what the recommendation is for protein. So your kilogram would be your body weight divided by 2.2. And then they can do that calculation. So I don't really strive to make people plant-only unless they really want to. I think it's very hard for most people to become plant-only. So most of my patients will do a plant-based breakfast.

1:16:44They're usually doing soy milk, like with overnight oats. And most of the overnight oats that my patients are preparing is 30 grams of protein. People just don't realize how much protein you get from plants. I think it's hard if they're not doing soy to get to their protein goal. Soy seems to make it much easier to get to the protein goal for most folks. You can certainly do it, but I find my patients have an easier time if they can use the soy. For lunch, it's typically very, very easy. I use a lot of grain bowls for patients at lunch or soups that would be higher protein for patients at lunch.

1:17:12And again, they're usually doing beans at the lunch hour to get their protein there. And then usually a combination of some nuts and seeds and some of the hemp like we talked about if they sprinkle it on top. Nutritional yeast is another cool way to really up that protein content. And so many people aren't even aware of nutritional yeast. And then I get pretty traditional with my patients. You know, if dinner time is with the family and they enjoy having a little bit of fish or some turkey and even some red meat, it doesn't mean that you can't have red meat. The American Institute for Cancer Research Guidelines are about 12 ounces a week, actually.

1:17:44It's way more than I would personally recommend to my patients. And you know, the interesting thing, Rich, is my patients coming in, none of them are doing red meat much. They're doing it at max once a week. Number one, it's expensive. Number two, they just don't desire it. So it's not something that I see Americans are overdoing at this time when it comes to red meat, typically in my own personal practice. So dinner time is where if they're going to opt to do the animal protein, I typically say three to four ounces. We don't want to overdo it. That's a pretty small serving size. So if you're doing a grain like a wild rice or a quinoa, ancient grain, add some bean into that when you cook it.

1:18:18And then, again, half your plate is going to come from the vegetable. That makes it so easy for them. They're like, oh, I can do that. This is easy. Dairy, you know, there was a beautiful study that really opened my mind up to dairy. And I know some of my plant-based friends, they're a little disappointed when I have a little more of an open mind to allowing some of the animal protein into the dietary patterns of my patients. But I just think that when you're getting all the things you need, like the fiber and the vegetables and fruits, it's not going to hurt you if you get a little bit of animal protein.

1:18:49It's just not. If that's what the patient prefers. And I'd rather the patient be in harmony with their nutrition. Food is love. And you need to make sure that they can still cultivate that in their home. So with dairy, the dietary pattern for healthy aging was published last March. It was a beautiful study. And it talked about the fact that, again, the ultra-processed foods, that the ultra-processed foods are going to contribute to a 32 % more likelihood of not aging healthy. So we've beat that into the ground. Everyone got that one. But what it did show is that eating a healthy dietary pattern can help you age healthy by up to 86 % more likelihood.

1:19:26That's cool. Like that's a super cool study. That is like, should be at the pinnacle of what everyone looks at. But guess what was part of that? Low fat dairy in moderation. So I love that. So, you know, if my patients did hit their protein goal, it's getting some Greek yogurt. This is awesome because it's great to get some fermented foods. And I didn't put that on my top 10 list, but we're going to add that. We should do this way. We should just keep on adding. I don't know how many rat words. I'm supplementing it. I'm going to keep adding. I'll remind you afterwards. So yeah, so fermented foods, you know, you want to try to get three servings a day.

1:19:54And that's really hard. I don't do it. I'm not good at that. I try. I try to be very intentional. But for patients consuming dairy, low-fat dairy moderation, I try to get them to do the fermented. Kefir, I'd rather them do goat or sheep if they can. That's pretty hard for a lot of people to find it or to afford it. It tends to be a little bit more expensive. One of the interesting things that you recommend for your patients is to undergo a fasting mimicking diet. Now, like this is starting to stack up. Like if you are diagnosed with cancer and you're in this integrative approach and you're doing radiation or some type of chemotherapy, and you're also trying to master your lifestyle habits and you have zero energy because you're getting beaten up by these treatments, but Dawn's telling me I gotta exercise and I gotta swap out my comfort foods for these healthy things.

1:20:48It starts to get a little overwhelming. And then on top of it, it's like, oh, well, why don't you do this fasting mimicking diet also? Like it's a lot. I think it's important to acknowledge that, right? It is. And so it comes across that way. But when I meet with them, it depends. Some of them wanna go all in right away. And as a physician who's new to lifestyle medicine and working with patients, you need to really dial in to the patient in that visit and really use your emotional intelligence to know how far you should push that patient because you don't want them to tilt to the point they're turbulent.

1:21:22And so it's been this, it's joyful. I have so much fun with them and Mayo Clinic gives me 90 minutes to meet with my patients. And this is the allocated time I need. I could never do it in less time to have that communication in a way that we can understand each other and I can help them. I can understand what their patterns are. And sometimes we just fix breakfast, you know? And sometimes if it's going to be a lot, then I just say, hey, let's try to get, So half that plate vegetable and fruit. And again, during chemo, I tread pretty lightly. If it's going to be hard, depending on the chemo regimen they're getting, then we just do our best.

1:21:57It's really into the survivorship phase that we really drive forward with this. But it's been amazing. And the majority of breast cancer patients during treatment gain weight. And if we can try to work with them with being aware of not going towards comfort foods that are high in calorie and they're not going to feel as good on those foods anyways, then And it's a good time to do it because it's harder to lose that weight afterwards. So, you know, I kind of made that joke when I was talking to Simon Hill and it's true. It's like every friend and church member brings you macaroni and cheese. And I don't know what it is, but it's like, I think that's what every cancer patient wants.

1:22:32It's like the worst food in the world. Because they're thinking, well, that's what they give them at the hospital. Yeah. And it's also comfort food. It's like, oh, it feels like love. Yeah, it feels like love, but there's a lot of great ways to do it. And so this is where, you know, I just have a bunch of recipes and share with them that, hey, this is an easy way you could do this and enjoy it. But you asked the question about fasting mimicking diet. And so I use a fasting mimicking diet actually during the chemotherapy week. And so with the Prolon, they have the five-day kit, but they also have the one-day kit.

1:23:03And so if anyone's listening, you need to talk to your healthcare team if this is something you want to do. but there's been research to show that with certain chemotherapies not all chemotherapies but the chemotherapies we use for breast cancer that fasting can help individuals to mitigate some of the toxicities because what happens is when you fast your healthy cells get out of the way they go to sleep but the cancer cells they don't know what you're doing they kind of if anything there's some theory that maybe they get irritated you know maybe it's even an opportunity for the cancer to kind of find them easier because they're irritated they're kind of a little more on alert.

1:23:37So what we do with the Prolon, what I love to do because people are still eating, is they would do the Prolon one-day kit for three days, two days before chemo and the day of chemo. And that's really nice. And so if women are doing certain chemotherapy regins like the adriamycin, cyclophosphamide, the ones that really kind of make them just not feel well, they don't want to eat anyways. A lot of my patients have opted to use that and they feel great and they really restore their energy and feel better days after their chemo in doing that. So it's very individualized with my patients that want to do that.

1:24:06It's not for everyone. It's very dependent on the chemotherapy regimen that they are going to be given. The chemotherapy regimens that are running weekly, I only do the ones that they're running every two weeks or every three weeks, and if the patient is interested. When it comes to fasting, I think it's great for individuals that could do a 12 to a 13-hour fast. There was one breast cancer study that showed 13 hours seemed like to be the sweet spot. So the Americans kind of have it wrong, though. So a lot of times we want to eat till 10 at night and we don't eat till like one in the afternoon.

1:24:36Breakfast is critical. Every study always shows that if you don't eat breakfast, it's linked to increased cardiovascular disease mortality. So we want to encourage breakfast. We want to encourage more of like a circadian rhythm eating. You know, as sun's going down, you don't need as much energy, so you shouldn't need as much food. So try to stop your food intake close to sundown by 7 p.m. and then start eating by, you know, 8 or 9 a.m. That's ideal for patients. if they can do that. I personally can't fast. I wake up super early and I like to have my coffee with soy milk first thing in the morning.

1:25:07So I'm not good at it. And I just accept that. Like I know I'm missing the opportunity maybe to be the healthiest version of myself, but that's okay. I don't judge it. I just do my best. I love my mornings the way I love them. And I think that's how each of us have to approach our lifestyles. We do what we feel we adopt that is aligned with us and we move forward. But I don't know if you do a 12 hour past each night, but it's very hard for me. I'm really committed to overcoming my habit of late night eating and eating dinner late. And this is a big deal for me because it's my Achilles heel. And I can tell you that in this new year, I have not every, look, it's not perfect.

1:25:50Like there's been nights when I'm out or whatever, but for the most part, I've been eating my final meal by around five o 'clock at the latest. Wow. And it's been pretty dramatic in terms of the restfulness of my sleep and the vitality that I experience the next day. But I have like incredible hunger pangs. Like I just wanna devour everything in the middle of the night. And like I can see with my wearable what's happening to my stress levels throughout the night when I do that. And the impact on my sleep has been pretty significant. So it's improved when you're not eating, when you're stopping your food by 5 p.m.?

1:26:33Yes, but this is not easy for me. This has been very difficult. I think it's hard, especially with your athletic, with your cardiovascular. But I'm not like doing... The thing is like I'm not exercising a lot right now because I'm still in my recovery from spinal surgery. So, you know, perhaps it's different when I ramp that up. Like I am exercising, but it's pretty modest. So it's not driving like intense calorie needs. But the problem is my appetite is still, it's pretty consistent whether I'm training a lot or doing nothing. And so I have like these appetite, these overwhelming cravings for food that I'm trying to manage.

1:27:14I understand what you're saying. And I'm kind of the same way. I mean, for me, it's the morning when I wake up early, I need something like as soon as I wake up and I've tried, but I'm like, no. See, I don't have that at all. Like I'm not hungry at all in the morning. I wish I wasn't. Yeah, I am. You mentioned that your appointments with your patients are 90 minutes. This is not the typical experience of the average person when they interface with the healthcare system. What is it that's different about what you've been doing with the Mayo Clinic as compared to traditional, you know, traditional kind of healthcare?

1:27:49How are we gonna fix this broken healthcare system? I know. It's a hard question, Rich. And I mean, it's something that hits really close to home because my visits were 90 minutes and it's something that even at Mayo Clinic, they realize that it's not sustainable in that time. And as a physician, I know I need that time. And how I structured my practice was it was a 90 minute visit, the first visit. And then, you know, patients would be able to go, you know, many, many, many, many months, six to nine months before they'd see me back. Or many physicians see their patient in a short winter time, let's say 15, 30, 60 minutes, However, but they see him back, you know, much more quickly or they see the nurse practitioner back.

1:28:26That wasn't how my practice model was. So it worked really well for me. But because of reimbursements, it's something that, you know, Mayo Clinic was no longer to do with the 90-minute visits. So they needed to cut that visit time in half. And it wasn't something that really aligned for me. So I am – my last day at Mayo Clinic is actually January 31st, which has been very emotional for me. My patients are like my heart and soul. And they are my purpose and my meaning. And they're how I got through my hardest days because I could work. People never realized it, but when I was no longer able to exercise and really move much, even in the hospital, I would still see my patients on telehealth.

1:29:01So this has been really hard on me. But I just know that to cut back my patient appointment time, I would not be able to have these conversations. Like you said, how do patients accept that news? How do they get more into a plant-based diet? Because we talk, we have conversation. I meet them where they're at. And it's not about making a plant only. it's about let's just tilt towards a healthier diet. A lot of times it's more like a Mediterranean style diet that's whole food based. Give them recipes. We have fun. It's playful. We're also doing exercise and all the other pillars of lifestyle medicine in that discussion, plus optimizing their cancer treatment strategy, whatever that may be, and optimizing their health related quality of life.

1:29:38So there's a lot that we did in the visit. There's accountability, there's followup, there's engagement. These people are being looked after and they know that they're being looked after, which is very different from you do the appointment and I'll see you in six months. And yeah, here you should probably do these things, but nobody's really paying attention. I agree. And, you know, healthcare just doesn't value the importance of this sort of practice. And so, you know, it's hard for any, even the best in the world healthcare institutions to just, you know, when you have a physician seeing a patient, there's about 15 individuals underneath them, lifting up that practice in terms of scheduling, keeping the computers, all these things.

1:30:18It seems like it's just a physician, but it's really not. It's a lot to be able to have a provider in a clinical setting. And so this is really opening up this opportunity for me to be in this space to help to democratize wellness, where you can get this voice out there to help more individuals. And it's going to come to informing policy. So how do we do that? So I am the new chief medical officer for Fountain Life, where what we do there is it's advanced multimodal testing, early diagnostics, doing this advanced testing to find disease states early. And what we find is that out of all the individuals screened, about 14.4 % of them have what would be considered a potentially life-threatening finding.

1:31:0114.4%. Yeah. Whether it's cancers, whether it's aneurysms, very significant. So, in this setting, they go on to get care. But, of course, they're also going through the trajectory, all the healthy people, of living these healthy lifestyles, having interventions and following them longitudinally. So, it's very, very exciting. There's AI analytics looking at this massive amount, billions of data points. It's so incredibly exciting. But then to have this ability to follow these healthy numbers, which is what no one does. You know, when do you get all this testing and then you get to follow it for years?

1:31:39And so it will help to educate us to understand the importance of these interventions, the importance of downstream reduction in cost if we find things early or if we can put them on the preventive track from day one and how that can help to offload the current cost of where we're at in healthcare with that$4.1 trillion. Right. Where are we at right now in terms of insurance reimbursement for this stuff? We're nowhere. And people are suffering. Yeah. The morbidity, mortality. It's expensive. And so it becomes something that only the privileged have access to. And that needs to change. So my goal, I won't be seeing patients anymore, but it's really, I am on this mission to democratize wellness.

1:32:15I'm very excited to do it. I will still be doing education to try to help people and to try to understand a platform. And that's why I love just being this very practical voice. I pride being a double board certified physician. Most of what I'm proud of is being a lifestyle medicine physician to help people step into their aliveness. like right i mean every minute every breath we take we're closer to death but our job as doctors is to help our patients feel alive feel good experience their vitality not just quickly write a pill write a pill and keep them putting band-aids over every single problem no elevate them feel great and to witness what i've witnessed in my patients has been just a dream because i know it's possible if i can do this for individuals in their sickest moments there's no reason we can't do it for everyone else in the world.

1:33:02So this is a major lift. I'm just one voice. There are so many doctors out there that are really in this path of trying to elevate this message and to help people be inspired to try to take part in their wellness. This is the first generation that's starting to cut back on their alcohol consumption. The youth of our country are very interested in their wellness because they've seen us suffer in our chronic diseases. So it's going to be pretty exciting, I think. But it's fun to see the young kids taking part in their wellness and exercising more regularly, it's these, you know, generations currently that we're tackling, so.

1:33:32Yeah, I never thought for a second about my long-term health when I was a young person. You know, it is an amazing shift, and I think we're on the precipice of so many interesting breakthroughs technologically. I mean, the diagnostic capabilities with the advent of these new, you know, artificial intelligence technologies, I think are revolutionary, And I think downstream of that, there's this domino effect of tools that are gonna become available. Just early detection alone could revolutionize health. And so it's exciting that you're on the cutting edge of that. I think it's cool. I do wanna talk a little bit about, we've talked about our food and nutrition, like our dialing in our diet.

1:34:21But there's another kind of diet that I think it's important to dial in, which is our information diet. And I think when you think about cancer, that is mana from heaven for less than savory, let's just call them grifters, shilling all kinds of snake oil, because there is nobody more vulnerable and desperate than the cancer patient. And so this is a real problem. And I'm interested in how you think about educating your patients and what it is you wanna say to the broader public about how to curate your information diet so that you're getting good information. I mean, there's just all kinds of insanity out there.

1:35:05And if you're just scrolling on social media, there's all manner of drink this, eat this, this supplement, and it will prevent cancer or cure your cancer. I mean, I think, was it Mel Gibson who was on Joe Rogan and basically said he had friends who took ivermectin and they became, you know, it cured them of cancer. I'm like, you know, the biggest media outlet in the world. So how do you think about this and what is it that you want to say about it? Yeah, thank you for giving me space for this. Because it is a vulnerable population and they are taken advantage of. And, you know, here's a good example.

1:35:40There's a supplement out there that's called apricot seeds or B17, latrel. you know it it's linked to cyanide and so you know they tout it as being something that can help cure you and so everyone goes and takes it but it's not just about being taken advantage of it's that some of these things can actually harm you um individuals taking the ivermectin sometimes they pair it with a veterinary grade medication called fibendazole you know and it's just in my practice i have not seen personally benefit from ivermectin or fibendazole there's a lot of questions I have about ivermectin is I've never written a prescription myself because there's too many other things we can use that have evidence to help to increase the quality of life during chemotherapy.

1:36:24So I was co-author on the integrative therapies with the American Society of Clinical Oncology Guidelines during and after breast cancer diagnosis. It was really fun to dive in and to see how scant the evidence is. This is the other problem. It's very hard to get the evidence because these studies are very hard to be funded. I have written so many grants that have been denied for so many studies in my career that it's just hard because you're competing against pharmaceutical companies that have billions of dollars. And with a nutraceutical, you really don't have money to back you for these expensive studies.

1:36:55So it's hard to get the science off the ground. So number one, you got to make sure it's safe. Number two, you got to ask, you know, what in the literature showed this to be safe? Was it an animal study or was it a human study? It's usually animal studies. So if it's an animal study, I just want to rely on it. I just don't think there's safety data that would allow us to move forward with it, if that makes sense. You need to talk to your medical team. Most National Cancer Institute designated cancer centers have integrative medicine specialists, part of that cancer center that meet with you to review what it is that you want to take.

1:37:27And within your set of symptoms, what modalities would be safe, have some evidence to say, hey, why don't you try this instead? So there's therapies out there that are just easy. I mean, there's some that are just so valuable during breast cancer, any cancer treatment. I'm sorry I keep on saying breast cancer. It's just second nature for me to do that. Acupuncture is one of them. Again, it's this financial toxicity though. It's expensive being a breast cancer patient, cancer patient, and all of a sudden you add on acupuncture, but it is a modality that can be very beneficial. Many private paid insurers are now starting to cover acupuncture.

1:38:02Medicare, unfortunately, only covers this very minuscule amount, so it's usually not enough to cover it but acupuncture is very safe mind-body therapies there's absolutely no harm to acupuncture mind-body therapies these are things that we want people to consider and like you said not these therapies out there that may otherwise ignite harm there's so many out there i have a case recently of a family out here in california there was someone that was offering them this dendritic cell therapy it's a therapy also being done in mexico and the dendritic cell therapy would have been illegal because it's not fda approved.

1:38:33Not only was it illegal, they were going to charge them$1.2 million to give them this therapy. And it wasn't even legitimate because you only give it to someone who has active cancer and this individual no longer had active cancer. They were in remission. So I felt so honored that I was called to say, what do you think of this therapy? And to be able to say, no, you're unfortunately being taken advantage of. We don't want you to do this. And this is a woman who is much older and it's the older population oftentimes has taken advantage of. So this is just please seek out an integrative medicine specialist to review these questions with.

1:39:08Your other option is many pharmacies. If your cancer center does not have an integrative specialist, many hospital pharmacies have an expert in the supplement space that you can meet with instead. There's always resources out there. So please seek that guidance. How do you deal with the appeal to nature fallacy? Imagine a patient comes to you and they're in an advanced stage of breast cancer and they say to you, look, I know you're going to tell me to do radiation or chemo or whatever. and I came to you because you also have this integrative philosophy, but I'm gonna dispense with the traditional therapies and I just wanna, I'm gonna do a juice fast and I'm just gonna focus on all of the kind of like holistic nutrition aspects of this because I'm convinced that by doing what's quote unquote natural, that's the best way to heal me or cure me.

1:40:09How do you balance respecting the patient and their wishes and their choices in their agency while also making sure that you're being responsible as a living up to your Hippocratic oath. It's the hardest and it's very hard, especially when it's a young woman with children and a husband and you can't rely on the natural things usually as much as you can rely on the conventional things because we have data to show the improved outcomes. This is the importance of finding cancer early. because we can use less toxic therapies, we can use less of it, and we have improved outcomes. And so that's the importance of early detection and screening.

1:40:50So in this situation, it's very important. I've talked to my colleagues about it, that we just give the information. We should not be in the business of changing minds. And I have seen colleagues of mine get upset at patients, and the conversations kind of elevate and tone. And that's not what this is about. The lecturing and the condescension. Exactly. I mean, listen, it's your body. Give me an example of how you would respond to that person. Exactly. So, I mean, I usually have them just share with me what their concerns are. What are you scared about with the conventional treatment? And what is it that you're hoping to find with the natural treatment?

1:41:23It also matters a lot, too. How are they living before their cancer? Because most of the people doing this were living perfect lifestyles before, you know, very healthy lifestyles, and they want to continue to do natural. Well, the cancer happened while you were living essentially a very healthy lifestyle. We really need to stop the cancer in its tracks. There is very interesting data that shows that individuals who forego the conventional therapy for alternative treatments have a two and a half fold worse outcome, poor outcome after their cancer treatment. And what usually happens, Rich, is some of these patients that opt not to do the conventional care and they go and they do the natural, the cancer eventually comes back and then they eventually end up doing it anyways.

1:42:01And this is what I always see. But they're doing it so late in the process. Yes, and so it's more toxic. And so, you know, I typically talk with them and say, you know, I share, I'm fortunate. I have this lived experience. I share my story. And I was into natural medicine. I went to naturopathic school before traditional school. I was really into natural medicine. But I knew with how advanced my cancer was that I needed to do the treatment. And guess what? My existence elevated during my treatment. Like everything. I was not sick a day in my life during my treatment. It's fascinating, right? It's mindset.

1:42:30You know, I didn't allow myself to be sick. I was too busy. I had purpose. I had meaning. I had my medical training. And so I let them know, listen, if you're going to do your chemo, we could do the fasting. Hey, when we do this fasting, here's the research. We can help to put those healthy cells to sleep during the cancer treatment and maybe even heighten the cancer cells and go after the cancer in a way that we have science to show it's going to give you this outcome. While you're doing that, we're going to do X, Y, and Z. You're going to exercise. You're going to meditate. You could do acupuncture.

1:42:55And guess what? At any point, if the treatment doesn't seem right for you, you can stop. But at least you know you tried. Because if you don't try, and God forbid the cancer comes back. I'm not saying it's going to. We don't know. But God forbid you go the natural path and it comes back or it progresses and gets worse and you end up here. Then you have blame. I kind of push to the point and I share with them. I say, I am just so passionate about this because of what I've seen over the years, because of my own lived experience. Please, please don't take this personal. It seems like I'm trying to push you into this.

1:43:24This isn't my intent. I don't want to hurt your feelings. I just care about you. I love you. And that's what I'm really trying to have this conversation about. So I feel if we just connect on like a heart level with patients and let them know that it's really because I care. It's not my ego. It's not like I'm trying to convince you. It's just because of where I stand with this that I'm... You're gifted with an incredible mindset. I mean, the fact that you were able to weather all of these experiences with such hopefulness and a sense of purpose and self-belief. And you mentioned, you said like, well, I think I was born with it and I was ingrained with it and you have your faith and the like, but this is not the common experience.

1:44:08So how do you think about the importance of mindset? Because when I hear your story, I hear somebody who survived in large part because of your perspective and this mindset that you had about what was happening to you. but it's difficult to instill a mindset in a patient. Do you find that the ones with a positive affect and that sense of optimism and self-belief do better? And for those that come in with a different disposition or perspective, how do you help those people shift their mindset so they can be in a better position to recover? Love it. So optimism has been shown to improve outcomes by 15%.

1:44:58So it really does matter. So how can you help a patient ignite it? So that's kind of the gift of lived experience. So any of us physicians or healthcare providers who have had lived experience that have that ability to connect with others, it takes that individual from that place of hope to knowing that, hey, I too can do this. And they can kind of cultivate their own optimism as a result is what I've seen. But there's not everyone that's kind of wired like that. And you have to just honor every individual for their unique qualities and character and, you know, let them open up their vulnerability to you when they're ready.

1:45:35And not everyone wants to pivot and shift. So you have to wait for that invite. and most people coming in to see me already in that active phase or trying to move in that direction. But if someone's not asking me for my help, I don't try to change them because that's just their authentic self. And you can't force someone into this. They have to want it and desire it. And when it comes to mindset, it's what matters most. More than food, more than exercise, more than sleep. Yeah, love, number one, love harmony connection and mindset and during my heart transplant i actually used no narcotics and um i get really sick from narcotics and you had a you had a heart transplant and you did not well you were under anesthesia but when you came out you had no pain meds none wow they tried and i would you know as you couldn't move and i i threw i said i i cannot It was a very low-dose.

1:46:33I cannot. I will get sick. It's how I've always been. And I did. And I vomited and I aspirated. It was big. So like, okay, she can't. So I'd use no pain meds. And so the reason I share this is powerful is it was extreme suffering and it was mindset. And there were moments when I thought, I don't know what I'm going to do. I learned how to work with my mind. And so this was when I didn't even have mindset. I was in my most vulnerable moment of despair. And so when we don't think we can, I'm here to say you can. You just, it's hard. It's not easy. But the ability to rise above that trauma, that's how you harness post-traumatic growth.

1:47:17And oh my gosh, that's why I've ascended this escalator of existence that is beyond the possible. Like I'm in this other realm. I mean, sometimes, Rich, truly, like I think about, am I alive? Like, I don't know. Like, I'm in this total different existence with most of humanity. And guess what? That's what extreme suffering introduces us to. And I think you've had a lot of experiences in your life, too. And any of us with adversity, cancer can be a gift. And, you know, you just have to work through it and pivot it around. And when you're in that hard time, feel it. Don't run from it. Feel it. Because when you're beyond that moment, life becomes so effortless, so easy, so immensely beautiful.

1:48:05It's just like this bliss state. I just invite patients to just be there for what awaits you because it's very special. And there is a reason that every person who experiences adversity is experiencing it. And it may not be within you that that lesson is intended for. it may be someone outside of you, but there is a reason. And so just trust that and just kind of ride the wave. But for me, I was actually very happy that I had to go through that because that was hard. So you have gratitude for all of these experiences. You know, I am just so grateful for every single moment. I always say I stay in just the present now because it's just so enriched with the level of gratefulness I have for every single breath.

1:48:51But I do. You know, there's a cool longevity study even with gratitude. Like gratitude helps everything. And it's so hard, but just pause. You know, when you put your feet on the ground every single morning, first of all, just ask yourself, what excites me about today? What could possibly give me a few goosebumps or chills? Because that's your meaning in life right there. And that's really, really important. And then right there in that moment, just reflect on one single thing you're grateful for. even if life sucks like there there's got to be one thing like okay i'm grateful because the bed i'm sitting on is kind of soft right now or i don't know there has to be something there's always something that you can find that you're grateful for to play devil's advocate a little bit here uh for me these ideas are so abstract like i had arthur brooks here the other day uh and he and he shared i asked him like what was uh you know the most profound thing that you've learned through your friendship with the Dalai Lama.

1:49:50And he talked about the Dalai Lama reminding him that, you know, he's one of 8 billion or whatever. And it's like, yeah, but we all know this, you know, we all know we're supposed to be grateful. Great. You know, when your feet hit the ground in the morning, like remember, you know, like what you, what you're here to do, or it is like on some level, like I'm so cynical that it hits me like platitudes occasionally. And I know you when you are saying these things that you're saying. I think for me, and I haven't suffered, you know, a fraction of what you've gone through, and yet it can be so difficult to stay connected to gratitude, to feel this consistently.

1:50:29You have an experience, an extreme experience that connects you more deeply with those emotions. And yet we so quickly snap back into our, you know, like put our blinders back on and we're just kind of like living our lives the way that we always have. So my question to you is like, how do you stay in constant contact with that? Like you're living and breathing it every day, it feels like. Maybe because I work with patients so regularly, like it's hard not to fall out of it because I'm always actively working and discussing and guiding. But I think because I was on this brink of death so many times that I really am just so thankful.

1:51:14And I think anyone who has really faced death head on and, and, or died that you do enter this position of just, it's like a eternal bliss state. It just is. And my, I, it's not about happiness that comes and goes like we, that's because of external variables. So this is something innate. It's something within. And I think it's probably hard to teach, but it is teachable because I've seen many, many of my patients able to do the same thing. And it's also not judging. It's just being there with yourself. And I feel like some of what you're saying, there's a little bit of judgment on that. And I think that's hard.

1:51:59I think that's hard to put that expectation on self. So I keep it pretty easy. I'm so in love with life, you know, and I just keep it simple. Like I live actually really simple life. It's kind of funny. I, I, I don't always know like all the studies that tell me this and that I don't, I don't do a lot of reading because I'm like there, you know, and so I'm more there to help guide people about the possible because I didn't write a handbook to help me with any of this. It was just trusting, quieting the mind, getting into the heart and feeling what the heart was telling me to do. Get out of the head.

1:52:33That's one thing I would say, because that head is very noisy and it usually will misguide us. Well, you're definitely living your dharma. You know, when you look through the rear view and the rear view is always 2020, it's so clear that all of how all of these experiences in your past inform your ability to be this healer in the present, you know, there's a connective through line that's really easy to see. And it's like, oh, you're in the, you're doing what you're supposed to be doing, You are living your fully expressed, authentic life. Do you feel that way? I do. I mean, I keep it light, Rich.

1:53:15I'm very playful. I'm filled with like awe and wonder. It's almost like I'm stuck in that seven-year-old body that used to watch the Today Show with the Willard Scott with the nightgown and the heat. Like, I'm just like that little girl. I never lost that, like that childlike spirit. And I think sometimes we wanna like try to simplify a little bit and just get back to that little psyche some. I just think it comes down to judgment. I just see people are so hard on themselves. I am too at times. We all are. I mean, that keeps us in check so we can be successful. I mean, we need some element of that.

1:53:47It's not like getting rid of it in its entirety. But when it comes to this whole idea of self-growth, I think people have become obsessed with it. Same thing with longevity. We're like obsessed with it. And it's, you know, I think that life is probably should be a little less about self and should be more about serving others too. and maybe that's why it's been easier for me, but I just make life a little simple and I keep it playful as much as possible. Before we end on, I think it would be helpful if you could share some wisdom and some insights for the young woman out there, the woman who is just in the beginning phases of her life at the start of her career.

1:54:28Maybe she's 26 like you were when all of this happened. And how should that person be thinking about their well-being with respect to cancer risk? Such an important question because today I actually see a lot of young cancer patients. My youngest patient is actually 20. And so it's so important, Rich, to be aware of your body. And it's also important that when you go to see a doctor with any concern, that they listen. Make sure they listen. If they don't, go see another doctor until you have someone hear your concern. So when it comes to breast health, the American Institute for Cancer Research guidelines, they really march out 10 things that we should really focus on to be the healthiest version of ourself.

1:55:12And we know in those guidelines for breast cancer prevention, when individuals hit five to six of those guidelines, it can reduce the risk of breast cancer by 50 to 60%, big numbers. So it's what we talked about today. It's that eating healthy, moving the body, trying to avoid those risky substances. it's breastfeeding for women also. Now I'm not going through all of the AICR guidelines because within the nutrition, that's four guidelines within itself. And we talked about all of those. It also talks about how there's no supplement that's going to prevent cancer. You want to make sure you close nutrient gaps.

1:55:44So if you have vitamin deficiency, you treat it. If you're vitamin D deficient, you get it treated, but there's no magic bullet as we talked about with, hey, there's a lot of snake oil out there saying it does X, Y, and Z. There's really no magic bullets. So know that. So those are kind of the pillars of cancer prevention. But what's important is if you have a family history, if you have a unique risk factor, to speak with your doctor and your medical team about, is there any imaging that is necessary for you? And women, particularly with family histories of breast cancer, we want those women to start screening 10 years younger than the youngest relative diagnosed.

1:56:18And when women are really young and they're doing that, oftentimes that may even include breast MRIs. So these are things that need to be individualized. We typically start mammograms at the age of 40. And in those situations with family history, we dial it back 10 years as well in those women. So it's just important that you speak with your doctor, speak with your women's health specialist to individualize this to you, to individualize it for the family history for that woman that's listening. But it is just so important, so important to show up for yourself and live that healthy lifestyle. and again I think you know a lot of times the guidelines when we look at the eating the exercise avoiding toxic substances x y and z they never hit on the importance of living a life that means something to you you know career is it just a job or is it your passion and your purpose and within your job because it's what you're going to be doing the most part of your younger years make sure you find meaning in that enjoy in that and connect with the people you work with And I think all of that is just so, so important.

1:57:19Conversely, what is the message to the person who's on the other end of the spectrum, who's much older, has lived a lifetime, ends up, you're patient, and you are suggesting all of these lifestyle interventions. And that person's like, listen, it's too late for me. I've been eating this way, this terrible way my entire life. I've been, you know, all these habits are ingrained in me. And maybe I can change them and move the needle a little bit. But is that really going to make any difference at this point after 40 years, 30 years of whatever it is I've been doing? Awesome. Awesome. I have a great study for this one.

1:57:57This is one of my top studies of all time. So if an individual decides to start eating healthier at the age of 60, you can have eight healthy years to your life expectancy. If you start doing that at 80, you can have 3.4 years of healthy life years. That's powerful. So it's never too late to start. And the most important thing is, yeah, it's great to add some healthy ears to your life, but the powerful thing is you start feeling better right away. You have more energy. You start sleeping better. Your mood feels better. There's more joy. There's less worry. So this is so important for just experiencing one's joy in life, period.

1:58:34So leaning in and starting to live a healthier life, regardless of what decade of life you're in matters, whether it's at the younger extreme or the older extreme. It's never too early and never too late to start. Incredible stuff, Dawn. I was saying to you before we started that typically my guests fall into one of two buckets. Either they come in with this incredibly inspiring story of resilience that is empowering for me and for the audience, or they come in with subject matter expertise with all this knowledge and experience that they share. I don't know that I've ever had somebody who inhabits both of those worlds.

1:59:22Your personal story is super inspirational, but equally impactful and powerful is all of the incredible information that you shared with me today. And I appreciate you being here. And I think the best way to end this is by asking you if you just had to distill down everything that you've learned in these two aspects of yourself that you wanna share with the audience here today before we conclude this conversation, what would that be? You know, really just trust what is your truth. And again, I'm going to go back to this. Don't judge. We're so hard on ourself. And learn to fall in love with yourself again.

2:00:07And that will be your best guide to falling in love with life. Keep it easy. There is no perfect diet, by the way. And I think so often people hear me speak and they strive to do this perfect diet. And individuals come in to see me and they say, you're going to be a little disappointed I'd do this. I would never be disappointed. Just do your best. Try to move your body more. Try to limit those toxic exposures. Definitely, we don't want people smoking. When it comes to alcohol, you really want to avoid it. There's no health advantage there. Sleep, you got to sleep. Sleep is when your entire body is restoring itself, including the brain, and it's going to energize you the next day.

2:00:43But the most important thing that we can do in life is to love and connect with others. And so life is just way too short not to pause and take that opportunity to be with others that are special to us. That's what I would say. Beautiful. Thank you so much. Rich, thank you. This is just like an aha moment for me to be here with you. And I listened to all all your shows and episodes and I have for so long. So I just want to thank you for being that source of hope for me and bringing experts here that allowed me during some of my hardest days again to inspire me to be here today. This is unbelievable.

2:01:24So thank you. That means a lot. I appreciate that. Thank you so much. Yeah. Amazing stuff. And come back and share some more. I will. All right, Dawn. Thank you. Thank you. Peace. Plants.

2:01:40That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests, including links and resources related to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, my books, Finding Ultra, Voicing Change, and The Plant Power Way. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube and leave a review and or comment. And sharing the show or your favorite episode with friends or on social media is, of course, awesome and very helpful.

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2:03:00And of course, our theme music was created all the way back in 2012 by Tyler Pyatt, Trapper Pyatt, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace. Plants.

2:03:26Thank you.