Lower Your Breast Cancer Risk: Doctor Explains HRT, Nutrition, Anti-Cancer Foods & Mammograms

Today I'm joined on the Being Brigid Show by Dr. Elizabeth Boham, who is both a physician and a registered dietitian and a leader in the field of functional medicine with more than 25 years of experience. Dr. Boham is also the medical director at Dr. Mark Hyman's clinic, the Ultra Wellness Center, and she is a breast cancer survivor herself. In today's episode, we'll focus on how what we eat can prevent up to 30% of risk of breast cancer. Evidence-based nutrition recommendations to help prevent breast cancer, controversy around hormone replacement therapy, mammograms, lab testing, and more. Dr. Boham, thank you so much for being here with me today.

Oh, Brigid, it's so great to be with you again. I love doing things with you. This is so much fun.

I do. I love doing things with you too. I was thinking about, I think our first time we did anything together was 2015 when we presented together at the National Nutrition Conference in Nashville.

Oh, that was— and that was so much fun.

That was so fun. I mean, it was really— I feel like at that point, functional nutrition and functional medicine was still not, you know, really recognized as, as much of a thing. And then it was such a big deal that we had standing room only in our room because they were like, wow, there's so much interest in using food as medicine from this group of dietitians, right?

Right. It was, yeah. And it was just, it's so, you know, it was fun being, I can remember us being on the stage together and all your great energy and the energy of the crowd. And yeah, absolutely.

It was the best. Okay. Thank you for being here today to have this really important conversation around breast cancer. 1 in 8 women will develop breast cancer in their lifetime, and there's a real fear that a lot of women have. I wanna start out with a common belief that a lot of women have that breast cancer is largely genetic. How true is that statement?

Yeah, so I mean, we know, you know, genetics plays a role, of course, but it's estimated that between 5 and 10% of cases of breast cancer are related to genetics. I mean, a lot of that calculation is based on the high penetrance genes, like, like BRCA, um, BRCA1 and 2. And so there's probably other genetic influences that we do look at all the time. I kind of put in this category of low penetrance genes that impact what we need to do to support our detox system and our vitamin levels and, and many different things. But, you know, it, there is of course genetics that impact our risk of everything, but there's always, um, a lifestyle component. But even more so than just lifestyle, There's also, you know, influence by all the different systems in the body, you know, our gut microbiome, the toxins we were exposed to, you know, so there's— so there, you know, the level of inflammation in our body. There's so many things that come together that impact a person's risk of getting breast cancer.

And I think that's helpful because then you can put it into context of there's a lot that's within your control. Is that right?

Absolutely. There's a lot that's within your control, you know, that's for sure. And, you know, You know, but as I've, I've, you know, many people have heard my story. I'm, uh, 26 years ago when I was 30, I was diagnosed with a triple negative breast cancer. I was in residency training. I had no family history of breast cancer. Um, and at that point, not a ton of cancer in my family either. And, um, so, and I thought I was doing everything right. You know, I was, I was, my undergraduate and graduate degrees was in exercise physiology and nutrition, and I was really taking care of myself. Mostly, except I was in residency, so I wasn't sleeping enough. But, you know, I, I, I really thought I was doing everything right and trying to do everything right. And I think what that experience taught me— so I still believe tons in prevention, but that's when I sort of after I got through the whole treatment process and everything, I started to learn about functional medicine, which brings, you know, lifestyle to a whole nother level, right? Yes, we've got lifestyle, but we also have lifestyle that impacts how we're managing toxins and our toxic exposure and how, you know, how stress is involved and our sleep and our rest. And, and as I said before, our microbiome. And so I think there's a lot of, there's a lot of angles we can look at when we're working to decrease our risk. But yeah, you know, women are really empowered to decrease risk of breast cancer. And, you know, we know that so many women have had breast cancer and luckily a lot is 1 in 8 will have it in their lifetime, but, you know, 1 in 39 die of breast cancer. So a lot of women are living with a history of breast cancer and feel very motivated to say, what can I do to decrease my risk of getting this again? Or, or, and a lot of the things that we do to decrease our risk of getting breast cancer again or controlling the cancer that we're living with, you know, influences our risk of heart disease and our risk of stroke and our risk of dementia. And so it's, it's, you know, there's a lot we can do to decrease our risk and also stay healthy. That's for sure.

Yeah, that's so empowering, especially with you developing it at such a young age and then that impacting the, you know, trajectory of your career going into functional medicine. Do you remember there being moments where as you were going through and you thought that you were eating really healthy and like taking care of yourself, that you were like, oh, looking back, not, not from a place of blame, but from a place of like, oh, these are the things that I wanna do moving forward to decrease my risk of that recurring.

Absolutely. For me, it kind of highlighted how important the stress reduction piece is. So, you know, when you look at all of the lifestyle factors, and this is really important with the medicine we practice, is we want to personalize it for the patient. So some people who come in to see me, we need to clean up their diet, right? But for me, when I, when I kind of went through this, it really helped me realize I have to be paying attention to how I manage stress, and I wasn't doing a very good job at that. At all. And, and I wasn't taking the time to let my body rest. And so that, that, you know, just having a life-threatening illness at such a young age really sort of said, okay, you've got to do this a little differently and, you know, try to be paying attention to what your body is saying to you. And okay, you need to take a break here. You don't need to just keep work, work, work, work, work. You know, you need to get enough rest and sleep and do some stress reduction activities every day. Absolutely. That was kind of— there was, and there was other things that I needed to really focus on too that we could go into, you know, but, but that from a lifestyle perspective, that's where I needed to focus.

Yeah. I mean, you obviously have been an overachiever, I'm sure for most of your life, given that you got your master's in exercise and nutrition and you were a dietitian, board-certified dietitian, and then went back to school to do medical school and residency.

Right.

I mean, it's very, very impressive. And I lo— I love that, that how that has shaped so much because there's not a lot of doctors who have such strong nutrition background that you have, which I think is, is so amazing. But at the same time, when you talk about the stress reduction piece, you've gone on to create the Breast Wellness DVD that you initially came out with that maybe now has been kind of like repackaged because of how much you believe in the stress reduction component for women that are diagnosed with breast cancer. Cancer and prevention. Is that right?

Absolutely right. So we speak a lot to that. So I, I redid— because most people don't have DVD players anymore— in, um, last year I took the information from the DVD that I had done in 2015, and with my daughter, who, um, is now 25, she helped me sort of take that information, update— we updated the ref— the references and the resources, and then we turned it into an ebook. And actually they publish it on demand with, with Amazon. And so I really wanted people to have the tools so they could kind of think about for them, how can they get to their, their, their, their personal optimal health. And, you know, and, and so we talk a lot about all the lifestyle factors, right? You know, in terms of optimal diet and nutrition, cuz there's a lot that we can do there and why exercise is so important. And from a, you know, from a everyday, you know, anytime you exercise, you decrease risk of recurrence or even getting, cancer in the first place, right? And, but of course the stress management, the sleep, the community, all of those things are really critical. But then we also go into the systems in the body and recognize that there's things that we can do within, within each system. And so I give ideas of what symptoms you may be having that may be giving you a clue that this is an area I need to focus, or, or maybe, you know, my digestion or my microbiome is an area I need to focus, or the detox system. And we kind of, go into each, each of the systems in the body to help, to help a woman. 'Cause we want everyone to have sort of the tools to say, okay, for me, where do I need to focus? What can I do to, to decrease my risk and also just get my, to my optimal health?

I love that. We'll link to that in the show notes so that people can, can access it. Okay. I wanna ask you about something that I read on Wikipedia, which I have to admit, I do not usually prep for podcast episodes with Wikipedia, but this just happens to be the case. So Wikipedia states that risk factors for developing breast cancer include obesity, a lack of physical exercise, alcohol consumption, hormone replacement therapy during menopause, ionizing radiation, and early age at menstruation, having kids older in life and older age, having a prior history of breast cancer, and a family history of breast cancer. Which components there do you feel need further discussion?

Yeah, I mean, you know, those are some of the traditional risk factors that we have, we have known about, and some of them are are, um, you know, related to how breast tissue shifts. So when you get pregnant, for example, and you breastfeed, that changes breast tissue in a way that you decrease risk of getting breast cancer, which is great. And that's why there's the association with when you have a pregnancy earlier in life and you breastfeed earlier in life, that does have a, you know, does influence your risk. There's been a lot of conversation around hormone therapy for the perimenopausal and postmenopausal woman. And, you know, this is an area where there is, you know, we really have to think about the nuance of each individual woman and her situation when we're kind of making those decisions. It's not as cut and dry as we would like it to be. When you look at all of the research now, it's probably showing a very small increased risk if we are doing hormone therapy in a safe, bioidentical way. But, um, but it, but it may be more the, you know, the progestin piece versus the estrogen piece. And there's a, there's a lot that we're kind of working through and trying to think about, but there's, it's not as kind of cut and dry as we used to think it was. And we, what I would say about hormone therapy or hormones in general is we're not necessarily thinking that the hormone therapy is causing the cancer. And I say this to women all the time, but, but we do know that hormones can cause cancer to grow. And even, I mean, I had a triple negative breast cancer, which means there was not this elevated amount of estrogen receptors or progesterone receptors on the cancer cells. But there are also the estrogen receptor positive and progesterone receptor positive cancers that have this. Excessive amount of receptors on them, not the normal amount, but lots and lots of extra ones. So we know that hormones can cause cancer to grow. And so, so, you know, and that's how I explain it to women. We're not necessarily thinking that when we do hormone therapy in a, in a healthy bioidentical way that we're, we're causing the cancer, but could it cause cancer to grow? You know, yes, absolutely. And our, our own estrogen and our own, of progesterone and our own testosterone can cause a cancer to grow. So we have to, we have to kind of think about it. It just takes a little bit more thought. It's not as cut and dry, I guess, as maybe that's the answer.

And so if a person has a family history of breast cancer, can, can that person still do hormone replacement therapy?

Mm-hmm. Yes, absolutely. You know, I think that, you know, each, each woman needs to kind of have that conversation with their provider, but there are, um, healthy, safe ways to do hormone therapy for women who are at higher risk if they have a strong family history. And there's even, you know, there's even some hormone therapy we do with women who've had breast cancer, you know, and, you know, the vaginal estrogen, the estrogen that is used in the vaginal tissue, that most of it, if not, you know, all of it is staying vaginally. There's been a lot of research to show that that type of hormone therapy, you know, vaginal estrogen, vaginal DHEA can be used very safely for almost all women, even those who've had breast cancer. And so, and then in terms of the systemic estrogen or systemic progesterone, you know, I, I really work with women to personalize their care. Think about, okay, what are your, what is your individual risks and benefits? What are your symptoms? What are we trying to alleviate? And, you know, um, and, but, but I do think it takes a, it takes some good conversation and a good practitioner to kind of help a woman work through that whole process of perimenopause and menopause because, because it's, um, you know, some, there's a lot of symptoms going on and there's a lot of ups and downs in hormones. And so, you know, I think we also wanna recognize the fact that hormones don't fix it all. Like I, I think a lot of, you know, there's a lot of excitement around the benefit of hormone therapy, and there are a lot of good things about hormone therapy that can help a woman feel better, but, but it's not that. It's not a magic bullet. Like, it's not like, oh, I'm going to go on hormones and then everything's going to be better, and if I just take more, then everything will be better, you know. And those are some of the pitfalls I see, you know, in terms of, you know, the negatives of the, of the treatment, if that makes sense.

Yes, I could not agree more, and I'm so happy that you, that you stated it in that way. So when it comes to risk factors for breast cancer though, the, the, the ones that do stand out are carrying excess body fat, lack of physical activity, alcohol consumption. We're gonna talk about food. Um, and age as well, correct? That after the age of 50, a woman's risk increases.

Yeah. I mean, you know, with all cancers, our risk of cancer goes up as we age. Um, uh, that's just part, unfortunately, you know, we've had, as we age, there's more aging in the body, there's more toxin exposure. You know, our risk of all— of most cancers go up as we, as we age, and definitely breast cancer as well. But unfortunately, we're seeing more and more cancer in young people. You know, I mean, we're, we're seeing even 70,000 new cases a year in this country for— of, of people between the ages of 15 to 35. So, you know, young— younger people getting cancer and You know, and we know that's, I mean, we, people have all sorts of speculations, but there's, you know, a lot of that is toxins. I mean, I think, you know, I mean, of course lifestyle and our food supply, but that can include toxic toxins, right?

Yes, 100%. So when you say that with breast cancer rates increasing in younger women, you feel that there's an environmental toxin component, and then what do you recommend to offset that?

I definitely, when, especially for younger people with cancer, I think we pay even more attention to, to toxins. Um, and we, we, we, we always have to take each person as an individual and figure out for them where they need to focus. But I think with cancer, and definitely when younger people get cancer, we really think a lot about toxins. We know that toxins are, are carcinogens. That means they can trigger and cause cancer in the body. And we know that there's a lot of toxins in the environment that are endocrine disrupting chemicals, right? So that means that they impact our hormones in our body. They can impact the estrogen receptor, they can impact other hormone receptors in the body. They can impact our risk. They can shift our breast tissue in a way, for example, that can impact our risk later in life of getting a, a breast cancer. So endocrine disrupting chemicals are, are something that we're always thinking about and we wanna work to decrease the, you know, our exposure in our, in our environment. So that would include things like the plastics, right? BPA is the one you think about a lot, but even the pesticides and herbicides, you know, parabens in your makeup and your moisturizers. And but, but I think that toxins can be overwhelming, too, right? So we are always being exposed to toxins, but But what I always work with people on is, okay, let's just try to lower our exposure as much as possible and at the same time help support our body's natural detoxification capacity. And I think that's a good area to, you know, really focus on because sometimes it gets overwhelming out there when, when, you know, just seeing all of the different toxins in our environment. But we do know, you know, when we prepare more of our own foods at home, when we eat less packaged foods, we, we can lower our exposure to plastics, to phthalates, even to parabens significantly. And these are all endocrine-disrupting chemicals. So just, just the act of preparing more whole foods at home and not eating as many packaged foods is really a great first step to lowering our toxic load.

Oh, I love that. I actually regularly am telling our members that because we, we do the meal planning for them each week, and I'm like, if you can just decrease the amount that you are eating out, not only are you saving this money, but it's also one of the most effective ways to know what ingredients that are going into your body and also minimizing those exposures. So I completely agree. You've also shared that what we eat accounts for 30% of our risk of cancer. What are some of the most significant nutrition behaviors that can increase that risk?

Right. So I mean, I think that anything that spikes our blood sugar or spikes our insulin response, we know is associated with more cancer. Um, and definitely not. You know, there's lots of cancers this is, is associated with. In terms of breast cancer, we know that when insulin is higher in the face of insulin resistance, then we are more likely to get breast cancer. We are more likely to get a recurrence, and we're more likely for that cancer to spread to other aspects of our body to metastasize. So we know that, we know that anything we do that causes spikes in our blood sugar and insulin and triggers this whole process of insulin resistance, where our body's insulin isn't working as well and we're making more and more of it, has been associated with more cancer. So anything we can do to, to balance our blood sugar and balance our insulin is like kind of my number one. So at every meal, right, we— I know you talk about this all the time, right? You have a good source of protein, a good source of healthy fat, and lots of healthy fiber. And that just helps slow the, the rise in blood sugar and the rise in insulin. And that is probably like the, the number one thing we can do.

And then what would you say are the number two and number three if you had three nutrition pillars?

Three nutrition pillars. So my second would be just getting lots and lots of phytonutrients, right? So those, that, those phytonutrients are your components in your plant foods that are not vitamins, they're not minerals, but they are these components in all of your colorful plant foods. And you know, vegetables, fruits, spices, teas, even coffee that have been associated to low, you know, been shown to lower inflammation in the body. They can feed the good healthy microbiome. They have anti-cancerous properties. So eating from the rainbow, getting all of those colorful phytonutrients in your day, I think is a really great pillar in terms of nutrition. And one thing we should always be focused on.

I love it. And I've learned so much of that from you with all of the, the work that you've done through the Institute for Functional Medicine and the nutrition trainings that you do that has played a major role in, in my recommendations too. Okay. Pillar number 3.

Mm-hmm. I'm gonna say, you know, just avoiding excess alcohol because we know that alcohol is associated with increased risk of many different cancers. And there is this linear relationship between alcohol and breast cancer. So, uh, um, as, as our intake of alcohol goes up, so does our risk of breast cancer. And so the older recommendations used to be 5 or less drinks a week for a woman, and a drink would be, you know, 5 ounces of wine, 1.5 ounces of hard alcohol. Um, but, you know, with higher-risk women or even, you know, many women, we're trying to get that even a little bit lower. So, you know, maybe, uh, you know, closer to 1 or 2 drinks a week or, or even less. And and really having those conversations of, of why are you reaching for alcohol and what, what else can we have instead?

So helpful. So that actually came up this past week in our community where they said like, what is your stance on alcohol and how much is too much? So you're saying that more than 2 drinks potentially per week could increase risk of breast cancer?

Yeah, unfortunately all the research shows that any alcohol increases risk of breast cancer, which is really, you know, it's like, how do you, you know, how do you You know, anything increases risk, unfortunately. So, so, but I would say what, you know, because that research is always so tricky and, and nuanced and everything, I think in, in general, we're keeping it, you wanna keep it, you wanna keep it as low as possible. But, you know, we, a drink or two a week, um, or even less is probably a great goal for most people.

And then what is your stance on organic versus conventional? There's a lot of doctors out there today that They're typically the ones that also are like calories in versus calories out, and here's all the scientific research behind that, that are also like, there is no research behind the benefits of organic produce compared to conventional. How do you feel about this in, in relation to risk of breast cancer?

Yeah, I am, I, I think we should all try to go organic as much as possible. You know, oh, um, unfortunately there's so many pesticides and herbicides that are used on our food supply. And in addition, You know, with, with meats, the non-organic can have a lot of antibiotics that are used just to help them get bigger faster, and that's messing up our microbiome. So, so yes, I would say as much as possible, choose organic. I think that's not only better for us, it's better for, better for our environment, of course. And, you know, I think that's a really important part of lowering our toxic load, right? When we're saying, okay, I just wanna decrease my exposure to toxins, choosing organic as much as possible.

And then what foods are on your list that have the most powerful anti-cancer properties?

Ooh, yay. Okay, so whenever some of my favorite mushrooms, so Asian mushrooms, you know, shiitake, um, maitake, the Asian mushrooms and even the button mushrooms, you know, they are a wonderful food source. They actually have vitamin D in it, which is, you know, hard to get from food, but they are rich in these beta glucans. And these beta glucans have been shown to improve our immune system, right? They can help our natural killer cells go around, these cells in our immune system go around and gobble up precancerous cells and viruses in our body. And they can actually, they've been shown to also improve the gut immune system. So mushrooms are a wonderful thing to start to incorporate if you're not already into, you know, your stir fry or a soup or, you know, and they think they're a really great, great addition and yummy too. Most people think they're yummy. That's like one of my favorites, uh, for, from an anti-cancer perspective. I also, I always talk about the cruciferous vegetables. We have to always talk about these cruciferous vegetables, right? Broccoli, cauliflower, cabbage, kale, Brussels sprouts, broccoli sprouts. These cruciferous vegetables are rich in these glucosinolates, a phytonutrient that's in the cruciferous vegetables, are these glucosinolates, which then get converted into sulforaphane. And sulforaphane is this amazing phytonutrient that has just incredible anti-cancerous properties in the body. It helps the body produce glutathione, which is this very important antioxidant that helps the body detoxify. The sulforaphane also supports the metabolism of our hormones. So there's like phase 1 detoxification in the body, there's phase 2 detoxification, and this, the sulforaphane helps with both. And so it's really a, an amazing food source. It, it helps with decreasing the oxidative stress in the body and even inflammation. It's been associated, it can epigenetically improve the tumor suppressor gene, which helps prevent cancer from from growing. And so, you know, really even a cup of broccoli sprouts a day, which it's a lot, but that can give you those, you know, the, like a 20-gram, you know, amount of this sulforaphane, which is pretty similar to about 4 cups of broccoli. So broccoli sprouts have way more than the actual, than the grown broccoli, but they're both wonderful to have. And so I'm always encouraging people, throw in cruciferous vegetables, And, um, it's great for detoxification and, uh, feeding the microbiome and increasing glutathione. So that's my, like, power, power food.

I love it. So for broccoli sprouts, we usually recommend putting it in the freezer after you've bought it in case you're not doing like a full cup a day, just because they are expensive and they can go bad quickly. What, where do you recommend for patients that you're working with for them to add it into their diet? Like what kind of meals are you recommending that they add it to?

Oh, you know, I love putting it in my salads. I love that. I think it tastes great in salads, but a lot of people put it in smoothies and, you know, you can throw it on top of a soup. Those are some of my favorites. A cup is a lot, you know, but, but, you know, if you, if you, and some people grow it on their own. I've grown it at home myself and, and that is a fun thing to do. And yeah.

You know, the reason that I, I, there's so many reasons that I love you so much, but the fact that you are, you're like a, an amazing physician with 25 years of experience, this powerhouse leader in functional medicine, teaching for the Institute for Functional Medicine. Like you've gone to Cornell and Columbia and you add so much validity to the power of using food as medicine and you like truly love it to the point that you are growing your own broccoli sprouts. It's like you blend the, the art and the science in the most beautiful way.

Oh, thank you.

You're welcome. Okay, so we have broccoli sprouts, we have mushrooms. Any other foods that you would add to that list?

Green tea. Green tea is great. So green tea, um, has EGCG in it, right? That's the epigallocatechin-3-gallate, which is the phytonutrient that has these anti-angiogenic properties, which means it prevents blood vessels to grow to the tumor, which was, which, which is necessary for that tumor to spread. So it has these, these healthy anti-angiogenic properties in it. Green tea also has been shown to improve insulin sensitivity. So it's been shown to help with weight loss and, um, insulin sensitivity. And, um, and, and it's, it's also feeds the microbiome in a really nice way. And I, I, so I love green tea. I always recommend this is an area where you definitely want to go organic, especially if you're drinking a lot of it. With teas, I always want to go organic as much as possible, but, but, but definitely with your green tea. And I'm always recommending people get the loose tea most of the time and then, you know, steep it within a stainless steel strainer so you don't have to think about what is in those tea bags. You know, of course, some unfortunately have the microplastics in it, but, you know, using, you know, using some loose leaf tea in a stainless steel brewing is a great way to go with your green tea. And sometimes people are like, oh, it gets too bitter. I don't like green tea. And so just think about there's lots of different types of green tea out there. So you can always try a different one if you don't like the one you're drinking. And, and also pay attention to the, um, how hot your water is and how long you steep it. 'Cause some, sometimes if you steep it for too long or your water is too hot, it will get more bitter. So if that bothers you, try some of those things.

And matcha I think is a great way too. And it has even higher amounts of EGCG to get those benefits.

Matcha's great. Exactly.

I'm obsessed with matcha.

Organic, organic matcha.

Yes, yes, yes. Organic matcha.

Without added sugar.

Without added sugar. There are so many specifics. And without oat milk. Right, right, right. Okay, so we have mushrooms, we have broccoli sprouts and cruciferous vegetables, we have green tea. Anything else?

You know, so, so seafood and seaweed, you know, will be rich in iodine. And iodine is also really good for breast breast health. Um, we know that when we're— our iodine levels are low in the body, we're more prone to get lumpy, bumpy breast tissue, which is painful. But also, you know, low iodine is just associated with not as healthy breast tissue. So, you know, iodine-rich foods like nori and then, and then seafood. And then the other good thing in seafood is like, um, the fatty, the fatty fish. So salmon, um, sardines, you know, those are great in omega-3 fats, which help lower inflammation in the body. I love ground flaxseed because that's also rich in omega-3 fats, fats, uh, which help lower inflammation and also great fiber source. So I love throwing that into things as well.

Beautiful. This is so helpful. Okay, let's talk about vegan diets. For a lot of women that are diagnosed with breast cancer, who, or who have a strong family history of breast cancer and are trying to prevent it. I'm hearing a lot of doctors making recommendations around going vegan. And I do wanna add the caveat that of course you always want to listen to your physician if it seems like they know, know you well and so they know the research well. But we do wanna always remember that physicians receive 20 hours or less of nutrition training. And so most of them are not like the Liz Bohams of the world who have immense amount of training in nutrition in addition to immense amounts of experience and training in medicine. What are, what are your thoughts on this trend?

Yeah, you know, so, um, uh, T. Colin Campbell was one of my professors at Cornell. So, oh, he was, yes, right?

So interesting.

Um, and brilliant, brilliant man, researcher, and wrote the China, you know, did the China Study, which, and, and was a big proponent of, of vegetarian or especially vegan diets. Um, in a lot of his research. But, but what I'd say is, can I add one thing?

This is so funny because he did Forks Over Knives with Caldwell Esselstyn. And when I started at the Cleveland Clinic Wellness Institute before I went into functional medicine, I was in Caldwell Esselstyn's department. So I was interpreting the research that they were, um, pulling from the participants who had gone through the Forks Over Knives documentary had been released that they did together, Colin T. Campbell and, um, Esselstyn. Yes. But anyway, yes, I digress.

No, you know what? And I think there's a lot to be said about vegetables and plants, and we all want to eat more vegetables and plants. That is for sure. And I love vegetable proteins, like I love tofu, I love beans and legumes. But what I will say as a— both for myself, but really for my patients, what unfortunately often happens when we— when people go vegan is we start to see is if they don't do it in the right way, which, um, I can't— I don't know if I have a percentage, but most people don't, right? Um, we start to see a lot of issues over time. And so what we will start to see is insulin resistance or prediabetes because you're getting too many carbs based, you know, you're— when you— when you— your macronutrients are, are too heavy in the carbohydrate And a lot of times when people eat out, right, there's not a lot of good options. And so they end up getting more— too many refined carbs even, you know, you go out to eat and you want to get that. The vegan meal is pasta, right? Well, I think that's the first issue we see. We also start to see some new, you know, some nutritional deficiencies such as low zinc, low iron, low omega-3 fats, low B12, and low, you know, of course, all the issues with low protein, and then you have low lean muscle mass, and then your metabolism is, is a concern. And so, so I think over time, we start to see a lot of these problems with, with a strict vegan diet. And it doesn't mean that you, you can't get a lot of the benefits from a vegan diet. But honestly, this is where I love Mark Hyman's recommendation of the Pegan diet. I think it's just beautiful when he married the whole vegan diet with the, with the, with the Paleo diet and came up with this Pegan recommendation because it's really— we want to take all the benefits from the vegan diet, all of the higher fiber, the, you know, the, the plant proteins. Some of them are so wonderful. More vegetables. Absolutely. But then some of the great benefits of, of animal protein that really are easier, you know, some of the proteins that were easier to get our minerals, our B12, our omega-3 fats. And balance our blood sugar when we bring the two together. And so I think for most people, that is my recommendation, that we do a balance of both animal and vegetable proteins, where sometimes you're getting your protein from your fatty fish or your grass-fed, grass-finished beef, right? And then sometimes you're getting your protein from your bean stew or your tofu and vegetables, right? So I think bringing the both together is where we often see the best outcomes. For everyone.

And then you get the variety of the essential amino acids as well. And I think, like, to your point, that if you're decreasing your total protein intake because you don't have enough varied sources that are available to you, and you don't want to be eating tofu at every single meal— tofu and tempeh really being the most complete sources of animal or plant-based proteins— that it helps get those essential amino acids and also prevents lean muscle loss, which is incre— you know, when you lose lean muscle, then you increase your risk of insulin resistance because you don't have that muscle base to soak up the glucose.

Absolutely, absolutely. So, so, you know, really, I mean, the balance is best. I mean, though, balance doesn't always sell, right?

It does not. It does not. Consistency and balance and all these unsexy words that no one wants to hear. They just want the, the colostrum supplements and all the— Exactly. The shiny— Right.

But with nutrition, there's a lot to be said. And I'm not talking about balance between like, you know, having, you know, this junk food with this junk food. No, we're talking about good, healthy foods. But the— but there's a lot to be said about, you know, balancing lots of different things and getting a variety of lots of different things to get all your nutrient needs. And I have a few patients that, you know, want to stay vegan for all sorts of— for many different reasons. And it's just a lot. It's a lot to make sure they're getting all of their amino acids, all of their protein, all of their essential fats, and, and all their minerals. And a lot of times they're just doing a lot of supplements on top of it. And so I don't, I don't know if that really, really makes sense.

Right? Agreed. Yes, I completely agree. I was a vegetarian for 7 years, um, when I was working in that department that I, that I shared about. And Dr. Hyman, when we were actually training at the Ultra Wellness Center, remember when we came to the Ultra Wellness Center before we opened Cleveland Clinic to train with your team, and I was doing the 10-Day Detox Diet at the time, and I was like, I am so hungry. And he's like, it's because you can't do the 10-Day Detox Diet when you're vegetarian, Brigid. You're not getting enough protein, uh, like with, you know, having to remove so many other things. And I had gotten a full panel, and my hemoglobin A1C was actually higher than I would expect it to be in my, you know, like mid/early 20s. And, you know, a number of factors— my insulin, I think, was an 8 or a 9— a number of factors that I was like, okay, I I, I, I understand, um, I understand more of the, the thought process behind it, but it goes against what a lot of, you know, mainstream nutrition will share of, you know, the importance of avoiding all animal proteins. I'm curious, you as a physician and a breast cancer survivor, do you eat red meat?

I do. I do. I, I do. I don't eat tons of red meat. I think the issue, you know, when you look at the research, there's more concern around the processed red. Red meats when you really— when they really break apart the research, right? So, so, you know, you really want to be careful with bologna and salami and, you know, deli meats and, you know, not too much bacon and sausage. And, you know, the processed red meats, there's a— there's, there's more concern. And, you know, the, you know, more than 18 ounces of red meat in a week, there's been some question like we should stay below that. But I mean, that's, I don't know if that's truly teased out because have we done the study of, well, was this a grass-fed, grass-finished, what type of red meat was this? What was that animal fed? And how does that really impact? So we wanna go as, you know, clean sources of our animal protein or all of our food as much as we can. And we wanna think about balance and we don't wanna, you know, overdo it. I think the, that's, you know, some people, if they're eating lots and lots of red meat, but they're eating hot dogs and hamburgers and, you know, deli meats. That's a very different diet than having a little bit of beef within your— within your— within your diet. So, yeah, I do eat.

And then— so I'm so happy you brought up the processed meats because we just went through the Blood Sugar Reset, which I do twice a year, where we create the nutrition, like the meals for everyone, and then they follow them. And so we had chicken sausage and chicken sausage, and on one of the days, uh, organic turkey roll-up with, you know, like inside of it being chopped peppers and vegetables that was rolled up in the turkey lunch meat. And so I, you know, there was concerns around processed meats being included in the nutrition plans. And I also feel that when you even tease it out into processed meats, there's not a differentiation between something like salami or a hot dog that you're getting at a baseball stadium and something like an organic organic turkey deli meat. What are your thoughts on that?

100%. 100%. I think that's, that's absolutely true. And so, you know, these are just general recommendations. And, and, and so you want to, when you're making plans for yourself and your family, you want to be choosing, you know, the, the, the healthier choices as much as possible, the organic, the more, you know, the more closer to home choices. And if you live in a community where, where you have access to a regenerative farm or where you can get, you know, a farm share or get, you know, meat that's, that's grown on that, on, you know, meat or pork or chicken that's really local and organic and free range. I mean, that is— that's really the best way to go, right?

Yes, I completely agree. Okay. I'd love to switch gears and talk about mammograms. So mammograms, there's a lot of controversy around as well. With the gold standard being proactive screening, early detection with mammograms. So much language around how important that is for, you know, diagnosing breast cancer early and increasing chances of survivorship. But at the same time, many women— I'm seeing a growing concern over the radiation and even other healthcare practitioners that we know advocating against routine mammograms because of stating that the increased radiation, if you're getting them like once a year or once every other year, if you're high risk, that can increase risk of breast, breast cancer. How do you think about that?

So the general recommendation for mammography now is, is every other year between the ages of 45 and 75. And I think we wanna remember that mammograms are, do a better job on the, um, older, less breast, less dense breast tissue. So they are, um, a better screening test for that age group. And really the answer is we just need a better screening test, um, um, because that doesn't have radiation involved with it. Um, and so I think that, you know, there's a lot of ways and we wanna remember that screening is, can be helpful. It can save lives. It can help us find, uh, breast cancer early, but it's not really prevention. It's just early detection, right? So we wanna think about all these other things we can do for true prevention. And then at the same time, you know, get to know our own breast tissue. I found my own breast cancer because, you know, I was 30 and it was there all of a sudden. And that happens a lot, especially for younger women and also for more aggressive cancers. Most of the time when— I mean, so often women are finding it themselves. So you want to be paying attention to your own breast tissue, you know, know what your breasts look like, what they feel like. And when you feel something different, you know, you wanna get it checked, checked, checked out. And you know, there's a lot of other modalities. If you have dense breast tissue, you wanna be talking to your doctor about also getting an ultrasound along with your mammogram. And, and there's a lot of, you know, I'm really excited about is an, is a newer test called QT imaging, which is an ultrasound that does not use radiation and is, you just lay on a table and it's an ultrasound technology. And I think that's gonna be, hopeful that that's going to be a really great screening modality for, for especially for younger women. So, you know, mammography, the radiation is a concern. There has been studies, especially for high-risk women, BRCA. If you're a BRCA positive, you know, you're what the, what that gene variation is involved in is, is DNA repair. And so if there is any damage to a cell's DNA, you know, that people who have that BRCA variation don't fix it as easily. And so what, you know, they do show that when women with that BRCA variation start getting mammograms really early, that does unfortunately increase their risk. So that, you know, that's not necessarily the best route of screening for that population.

So the QT imaging, it seems like, like what is, what are the statements by, is it FDA approved? Are they stating that it's similar to— because it reminds me of like the Echolight out of Italy where, you know, like there's, it seems like really promising research that this could, you know, in some ways potentially replace a DEXA scan in the future since it's radiation-free and seems like the detection is, is very in-depth. Is that the same for QT imaging versus mammograms?

You know, I don't know off the top of my head how like the comparison of, of, um,, you know, the sensitivity and specificity and how the two compare, uh, exactly. But I do know that it's a great, you know, potential modality and I'm hopeful we'll get more and more research over time that will show, you know, that it's, that it's a great screening test for lots of women and definitely for those younger women with denser breast tissue.

And it seems like it's more, it has more like potential to be equivalent to a mammogram compared to thermo thermography. Is that right? Cuz there is controversy around using thermo, thermography.

Yeah, I think it, I think it's, it, it has, uh, more potential, you know, so hopefully.

Okay, great. Yeah. And then what are your thoughts on intermittent fasting or fasting in general? Because it's, you know, advertised as being helpful for decreasing risk of cancer, decreasing cancer cell growth once a person is diagnosed. What are your recommendations there?

You know, I think that there, that people feel really comfortable in terms of the research of the benefit of not eating for at least 12 hours at night. So there's a lot of research that shows, you know, for us to not eat for 12 or 13 hours at night, there's a lot of benefits in terms of, of cell turnover in the body, autophagy, improving the microbiome, improving our metabolism, and decreasing risk of cancer and cancer growth. So I think in general, what I'll recommend is the, you know, not, not eating for at least 12 or 13 hours at night, you know, trying not to eat after dinner. I think everybody sort of agrees that this is a good thing that, um, we wanna do to both improve insulin sensitivity and decrease cancer risk.

Great. And then what lab tests are you, are you recommending for, for women to, to be able to understand specific labs that can impact their risk of, of breast cancer?

Yeah, so, you know, I love checking a fasting insulin. Um, I look at fasting blood sugar and fasting insulin and hemoglobin A1C.. And I use those numbers in addition to somebody's waist-to-hip ratio. You know, if I do a, um, a BIA test of their body composition, where they're holding onto their weight to get a sense of their level of insulin resistance and what do we need to do in terms of improving their insulin sensitivity. So fasting insulin, you know, we know greater than 10 is a concern. I like it more around 5, but you know, that's something you can ask your doctor to do along with your, your fasting blood sugar and your hemoglobin A1c. And that gives you a good sense of, do you need to be focusing on, um, lowering your insulin resistance? The other—

another— can I— before we, we go on any more labs, can I just add that the BIA— you're talking about waist-to-hip circumference— can we mention that really quickly? And then the BIA is a bioimpedance analysis. So you're saying risk of insulin resistance because you're looking at where a person is holding on to more of body fat, knowing that if you're holding on to more visceral fat, that it increases risk of breast cancer. Is that where you were going with that?

That's exactly where I was going. Right. So we know BIA technology. So there's, there's some scales that will use BIA technology and that will tell us what is your percentage of body fat, what is your percentage of lean, you know, what, how much lean muscle do you have? And then what, how much visceral fat, fat that you have around the middle. Because, you know, we were talking about some of those risks for breast cancer early on. And one thing that was stated was obesity. And but it's way more than just the pounds on the scale. Like, it's, it's, it's way more than that. It's really where are you holding on to that weight and what is your percentage of body fat? So we're always so focused with pounds on the scale. But in terms of health, it really is, you know, how much body fat you have, but even more so, do you have enough lean muscle mass? So I like some of these, the, the BIA technology, the bioimpedance analysis, because it will tell me, does somebody have enough lean muscle mass? And so often women have a low level of lean muscle mass, and that's why their metabolism isn't as great as we want it to be. Or, um, and we know that's associated with increased risk of, of many different things in including having too much weight around the belly and breast cancer. So it's not just pounds on the scale, right? And so the waist-hip ratio is a great way that you can kind of get a sense of are you holding on to too much weight around the belly? And for women, you want that waist-hip ratio to be less than 0.8. And so, and if that's a little bit high, that's something you can monitor like once a month and, and, and it's almost a better monitor than pounds on the scale to get you, to give you a sense of, is your insulin sensitivity improving?

Agreed. A hundred percent.

We know that that insulin resistance is associated with breast cancer.

And it also, you know, I even just in thinking about women at 50 and older being at a higher risk and you saying that all cancer risk is higher as you age, insulin resistance risk also increases with age and with changes in your estrogen throughout menopause. And so it seems as though it's, it's all interconnected.

That's for sure.

Okay. So those blood sugar markers, waist to hip ratio, and to percent body fat. Um, and what else?

I always look at a C-reactive protein. So, um, you know, as high sensitivity C-reactive protein, it's a blood test that can look at the amount of inflammation in your body. And if it's high, then, then I need to, or we need to, or you need to figure out, well, why is it high? You know, why do I have more inflammation? Some people have inflammation in their body because of insulin resistance and having too much percentage of body fat. Some, some people have too much inflammation in their body because of imbalances in their microbiome, whether it's their microbiome in their gut or their oral microbiome. Right. And they have gingivitis or inflammation in their mouth and an imbalance there. So you really, if there is inflammation, then you want to ask that question why, and then think about what you can do to lower that. It's a time where a lot of times we'll do some sort of an elimination diet to see if that can help somebody's inflammation markers come down.

Yes, and, and adding more of those foods that you talked about that have those phytonutrient, you know, components that help to offset the underlying inflammation, I feel like ties in so well here.

Absolutely. And then all those foods that are rich in the omega-3 fats, also help bring down inflammation.

And then are you looking at omega-3 in, in blood?

Yeah, I love looking at the omega-3 index, which gives me a sense of the percentage of omega-3s within the red blood cell membrane. So I'd love that to be around 8. And it's a great thing that you can regularly recheck to make sure you're getting enough, whether it's from your diet or your supplements or both. And that's really a good thing to monitor. Vitamin D, I love looking at, of course, 25-hydroxy vitamin D. Vitamin D is really a great fat-soluble vitamin that's important for your immune system. And, and so we want that to be optimal. And then I'm also looking at things like a serum zinc to serum copper ratio. I'd like that to be around 1 to 1, making sure somebody is getting enough zinc because that's really an important mineral for your immune system function.

And that you're not getting too much that it's depleting copper or lowering copper, that ratio.

Exactly. I mean, you know, if, if, if a lot of times people will take extra zinc to prevent infection or if they've had cancer and I actually recommend a lot of zinc for people, but that is exactly right, Brigid Titgemeier. That, that's, that's the caveat. You don't want to just take it without monitoring it because if you're taking extra zinc every day, and you're not getting it checked every once in a while, you could take way too much. That could decrease the absorption of another mineral like copper. And so you don't want to kind of throw off your minerals there. And so that is something you kind of want to recheck if that's the case.

Amazing. And then what about stool testing? What markers are you looking for? You, you obviously run— I feel like just sitting here, I'm like so grateful to you because I'm the beneficiary of learning so much from you over the years and how much you and Mark have influenced my approach to nutrition. But hearing you speak, I'm like, I'm just so grateful for you. Can you talk about stool testing and how you think of that with certain markers that can tell us more about hormones in the microbiome?

Yeah. So, you know, there are some interesting markers within stool testing that I'm always looking at. So one of them is this marker called beta-glucuronidase. And it's an enzyme that will break apart estrogen that's bound to something called glucuronic acid or other toxins that are bound to this glucuronic acid. And so what we know happens is that after estrogen has done its job and it's in your body, it needs to get metabolized and then it needs to get escorted, escorted out of the body through your poop. Right. And so it's bound to this, this substance that helps it get— brought out of the body. If levels of this enzyme called beta-glucuronidase are high, that can cleave that estrogen bound to that glucuronic acid, allowing it to get reabsorbed. And that can, can actually increase— be one of the reasons that, that a woman will have higher estrogen levels, or, or some of the symptoms of higher estrogen levels in their body, some from PMS to breast cancer, or or, um, uterine, uterine cancer. For— so we will measure that in the stool, which is interesting. We can also measure a postbiotic, which is something that the good bacteria in the gut makes, called, um— and one of the ones we look at, one of the postbiotics we look at, is called butyrate. And, and that's actually been— low levels of butyrate have been associated with colon cancer, but they've also— low levels of butyrate have also been associated with breast cancer, which is fascinating. So there's this tie-in with, um, if you have enough, you know, having enough healthy bugs in the gut, really, really important for your overall immune system and inflammation in the body. And you can get some sense of that with stool testing.

And it's not the type of stool testing that your doc, your traditional doctor, is, is ordering where they're typically looking at like C. diff or something like that. This, we're talking about like functional medicine stool testing that tells you more about these specific markers in the health of your gut microbiome.

That's absolutely true. Yep.

And then let's talk about nutrigenomics testing, um, because you're using 3x4, is that right?

Yep. A lot of times, yes.

So we also use 3x4. I'd love for you to talk about genetic SNPs outside of the traditional, you know, people think of genetics and risk of breast cancer and they think of what you already talked about, the BRCA gene. Um, this is different. We're talking about your genes, but in relation to nutrition and how nutrition can alter the genes and your genes can alter your nutrition with nutrigenomics and nutrigenetics. Um, so can you talk about some of these SNPs that you look for when you do a nutrigenomics panel?

Yeah. So, you know, when we were talking about the BRCA gene earlier, and there's other genes that fall into this category of the high penetrance genes, and so that those are genes that are not very— these variants are not very common, but when they are there, they increase somebody's risk of a specific disease substantially. So BRCA would fall into that category. But, uh, Brigid Titgemeier, what we're, what you're speaking about and what we were talking about earlier is these low penetrance genes. These are genes that we all have variations in. It just makes us who we are. And, and, and those gene variations are really influenced by our lifestyle, that is for sure. So we will often look at some of these low penetrance low-penetrance genes that are gonna influence risk of many different diseases, including breast cancer. So they've done some research showing that when some of, when a few of these low-penetrance genes come together, that that can influence somebody's risk. So some of this, the variations in some of the glutathione recycling genes, COMT, which is a methylation gene, and those can influence risk as well. And so those are things where we are evaluating, and then that can sometimes help us determine, you know, maybe this person needs, you know, of course they want— we want them to eat more cruciferous vegetables, but maybe this is somebody who will actually give a supplement of sulforaphane too. We'll kind of take it to the next level to help them, their body, depending on what their genetic makeup is.

So, so helpful. You are such an amazing wealth of knowledge. Thank you so much for being here, Dr. Boham, and for being part of the Being Brigid Show. We're going to link to the ebook that you have for breast wellness. Can you share where else people can find you and benefit from your work?

Yes, Brigid. It's been great being with you and with all of your listeners. And you can— I'm on Instagram, Elizabeth Boham, M.D. It's the same at Facebook. And my website is drboham.com. And then I practice at the Ultra Wellness Center, so you can also find me at ultrawellnesscenter.com. So it's been great, great being with you.

You're the best. Thank you so much for tuning in to the Being Brigid Show, and we will see you next time.