73: What Happens after Cancer Treatment? A Guide to Life After Survivorship with Dr. Megan Bernard

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Hello and welcome. I'm Dr. Jen Simmons, a breast cancer surgeon turned integrative oncologist on a groundbreaking mission to transform the conversation around breast health. If you're seeking to redefine the way that you think about breast health, you're in the right place. Breast health isn't just an aspect of well being. It is health, integral and indispensable. Here on the Keeping Abreast podcast, we delve deep into the innovative ways to diagnose, treat, screen for, and prevent breast cancer. But it's more than that. It's about having the crucial conversations that empower, enlighten, and drive us all to a healthier place. As someone who has navigated the front lines of breast cancer treatment and now champions an integrative approach, I bring a unique perspective to these discussions, blending rigorous science with holistic health principles. Health is a journey, not a destination, and I am truly honored to accompany you on this path. Each episode aims to provide you with actionable insights and cutting edge strategies to take charge of your breast health and.

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So many women as they go on their cancer journey. It starts off very loud, noisy, busy, where you are thrown into appointment after appointment after appointment, and then you're thrown into treatment and there's a lot of. Of activity and whirlwind and the world is there for you and to support you. And then you send us treatment and you go into what we call survivorship and the world gets really quiet. And this is actually the time for everyone where the healing starts, because it does not start in treatment. And there is no real opportunity for healing and treatment. And the opportunity comes when treatment finishes. But there are so few people involved in that part of the cancer journey. There are so few people involved in the part that I would argue is the most important. It's what happens after and how do you avoid a recurrence and how do you avoid being in that spot again? How do you avoid metastatic disease? And it's all in what happens afterwards. So I am so delighted to have Dr. Megan Bernard here today to talk about what happens afterwards and to talk about how her role as a board certified naturopathic doctor has led her to helping people as they complete their cancer Treatment, prepare them for the rest of their lives, and prepare them for survivorship. So, Dr. Bernard, welcome. I'm so delighted to have you here today.

No better place to be right now. Love it.

Well, I don't know about that, because I think that you're on a vacation at the moment, so.

I'd still rather be here, yeah. Oh, well, wow. Well, then I'm so happy to have you.

And this is a pretty important conversation to have. Not many people are looking to own the space that you're in. So tell me a little bit about how you arrived there. I mean, why did you choose this population and this part of that population to work with?

Yeah, absolutely. So this has been a passion of mine for several decades now. It kind of started in high school. I don't know what exactly it was. What class just kind of triggered my interest in cancer biology and how we know so little about so many different processes that can lead to cancer starting. I've also had a lot of family members who have gone through cancer themselves and just kind of watching their stories as they go through the treatment and navigating the process and then figuring out, so I still have all these symptoms. What do I do next? That led me to doing my master's in cancer research. So I did breast cancer cell research, and I researched a natural product. And then whenever I was doing my research during my master's, I stumbled across naturopathic medicine. I had never heard of it before. It's not like it's not available where I grew up, but it was just something I'd never crossed path with, crossed paths with. That is just because I was searching a natural product. Naturopathic medicine school happened to pop up in my Google searches. And I'm like, that looks really cool. And at the time, I was kind of considering medical school, like, conventional medical school after doing my master's, and it just didn't sit right with me, where the schedules were ridiculous. And at the same time, you still never really got more than 10 minutes with a person to kind of navigate their case and understand them and, like, push them in the right direction. So I looked into this more. I'm like, wow, like, an average visit is an hour long with a naturopathic doctor. Like, and that's, like, pretty much minimum most of the time. Wow. We actually get to talk about, like, where did they come from? Like, what are their. What are their taste preferences? What are their schedules? Like, like, what kind of built them as they are? And can we start picking a way to make something better for Them when it comes to their health. And then because I did my research and my master's on cancer, it kind of brought me into more of like, oh, my gosh, there's a whole other world in naturopathic medicine when it comes to oncology. And then that's kind of where I started to spread my wings even more and going into the support of people during cancer treatment. And then I went into clinic, I ran my own clinic for some time and was really enjoying supporting women and men throughout cancer treatment, whether it was chemo, radiation, surgery, whatever it might be, with the side effect management, with improving the treatment outcomes, with helping them to receive treatment better, with whenever treatment wasn't working as good, what else could we do? And then it was like, post treatment, like, we finished our last visit. And then they'd be like, what now? I don't have any treatment anymore. And I know that you support people through treatment, like, what the heck do we do now? And I'm like, you know what? I don't really know. Let's figure that out. And then here we are, the flourish program. And just basically I stepped away from seeing people during treatment, mostly to working with people post treatment, just because I just enjoyed the deep dive into what we can support people with to prevent a recurrence. Cancer coming back. Yeah.

And I actually call this the quiet after the storm. And I think that this is the most terrifying spot and the place where, like most, most practitioners, they have no idea what to do and how to support people in this space. And so I think it's pretty amazing that you. That you took that challenge. Right. And decided to specialize in the what now. So for all those people that are arriving in this place, or they've arrived in this place years ago, but still are wondering, what now?

What now? What do you.

What do you do for people?

How to do it? Yeah. Good. Yeah. No, that's awesome. So, yeah, looking into this world, there's so much out there that we can do for people who have finished cancer treatment. Whenever you think about it, like, for anyone who's gone through a heart attack, there's rehabilitation programs where they teach people how to recover using the nutrition and exercise. Like, two simple things. If someone's experienced an injury, whether it's like a sports injury or whatever it might be, there are rehabilitation programs where you see a physiotherapist, you rebuild your muscle, Sometimes they throw in some nutrition and stuff like that. But for cancer survivors, there's nothing like, it's very. I mean, there's some Things, but it's not very good potentially in a lot of settings where it's just basic nutrition, basic exercise guidelines. But people need more than that in order to make such drastic change. Whenever it comes to unlearning what you've done for 20, 30, 40 years and changing the way that you eat and exercise and think and feel all those kind of things. So what we kind of came across, myself, my team, is developing these six pillars of cancer prevention, and it just kind of encompasses all the different things that we can go really in depth with, depending on what the person is requiring. When it comes to nutrition, mindset, movement and exercise, talk about digestion, detoxification, environmental contaminants, and then epigenetics and specialty testing as well, to see more unique changes that can be done for the person.

So let's start off from the beginning, because you started off talking about nutrition, and this is an area which is so underappreciated. And there are still. The majority of medical oncologists are still saying to people, what you eat doesn't matter. And they're saying to. That. That to them during treatment, they're saying that that food and diet did not contribute to their diagnosis, nor will it save them for their diagnosis going forward. Then there is an absolute lack of knowledge, a lack of appreciation. And for the most part, I think that most people are getting very, very bad advice. And it's confusing, right? It's confusing to people. So how do you help them unlearn, and what do you help them learn?

Yes. So it's definitely the confusing part is the biggest kind of concern that we hear quite often from the women we work with, the women who kind of come into our world. It's like, I've been told this by one person and this by another person, like, what do I actually believe? Like, what do I actually follow? And it's confusing because nutrition is confusing. Um, nutrition on, like, medications interacts differently with everyone's bodies, the way that they're made up, everything from, like, their gut health and their microflora to their ability to absorb nutrients, to certain immune reactions. And, like, there's just so many different factors involved when it comes to choosing nutrition. And it's. It can be very unique to the individual. So that's why there's a lot of confusion there, for sure. And then whenever the doctors are then saying, it doesn't matter, eat whatever you want. I think it's also because of the confusion in the research. A lot of the time that they're seeing mixed results and Just kind of giving up and just saying, really we don't. Basically they're kind of saying, we don't know. So let's just kind of, you just do what you need to do. But whenever we are working with people on nutrition, one of the first places that we will start with is macronutrients. That's pretty basic for everyone. That in order to get good energy, heal tissues post treatment, we need these macronutrients, which are your protein, healthy fats and carbohydrates.

And I think that most people kind of know that and have that. Where the confusion comes up and where it's hard for people is first of all, as people go through treatment, things change, right? They don't. They, their tastes change, what they, what they want, what they tolerate. All of that, all of that changes. And a lot of it is due to some damage from treatment. A lot of it is due to changes in the microbiome during treatment. So how do you help people to kind of remake that microbiome, realign their taste buds with things that are healthy for them? How do you make them make that transition?

Even taste buds from treatment are one thing, but taste buds from the way you grew up as well could be a different thing. Like you start to adapt to certain foods and that's kind of what you know and that's what you enjoy. So just so many things like the, the thing is we need to rebuild the body first. So micronutrients such as zinc can sometimes help with taste, Taste changes that have been done due to treatment or just, just practice, just kind of cheat slowly initiating some nutrition changes that are a little bit more healthy. Not necessarily looking at it from an approach of, oh, we need to take everything out. You can't have any of that. Let's actually look at kind of adding some things in. And then overall, when it comes to the microflora, like there's, there's always some great foods for the gut, gut, microflora, fermented foods, things like that. But we, we basically want to start with quality foods of the gut so that we're removing some of the burden so that it's not constantly being hit by processed foods and seed oils and things like that that might be a little bit more pro inflammatory. Looking more at an anti inflammatory, lots of olive oil, lots of leafy greens and fiber, depending on the person, how much they can kind of tolerate that from vegetables, of course, would help with the gut. Microflora.

Yeah. Amazing. Are there any foods for you that are an absolute. No.

I mean, like if we, there's. There's always this balance of looking at the research and what does the research say? And like there are certain limits that we know with like processed foods, a certain amount leads to this much percentage increased risk in like colorectal cancer. So I mostly look at limiting because I think avoiding automatically puts a road, like a wall up for people. So it's more like limiting. I don't believe we ever 100% need to give up everything. And I feel like, to be honest, like, that's a lot of a mix of societal values in how we have gone through the world and what we see is available even a lot of the time for us to consume. It's kind of hard to find a lot of foods that are perfect in the realm of functional cancer prevention. But I feel like our people, when we work with them, like they do so good at just including things and limiting things as opposed to ever worrying about 100% giving up everything.

Yeah. And I agree with you. I think when you tell people like you absolutely can't, they, they feel uncomfortable with that. Like it's too hard. Right?

Yeah.

And I do find that as people start to make positive changes, their desire to, their desire to have more of the things that don't serve them diminishes. And um, and what happens is that the more things that they do to nourish them, the more that their body craves that nourishment. And as they start to make those changes, I think that they start to feel what their diet does to them and for them. Right. Like the cleaner you get, the more in touch you are with how what you're eating affects you.

I think the extreme dieting advice that a lot of people are given post cancer treatment as well is kind of the reasons why it's being so shunned by the conventional medical setting is because they're seeing what people are trying to do. Maybe their patients are trying to ask them certain questions or they're seeing the marketing and the social media saying you need to be fully plant based or opposite, you need to go carnivore or something like that. And the doctors are just like, don't listen to any of that. You don't need to do any of that. And then the information is kind of being misconstrued to the patient thinking, oh, they're telling me not to do anything. So yeah, if you kind of find the happy ground that's going to work for everyone as a unique person and slowly and surely over several years start to change their Diet up, you're going to see like huge differences in everything from their, their risk of recurrence coming down to cholesterol to blood sugar to bone health. All these things are all linked and definitely major from cancer treatment too.

Yeah, absolutely. So as, as you move past the micronutrient part and help them to make dietary transitions, what about supplementation? Where do you, where does that fall in for you?

I feel like if people were to like read my emails and social media, they would think I'm kind of anti supplement, but I'm not. I'm kind of more anti general supplementation where I do believe there are certain supplements that help support the body's ability to protect itself and to be anti inflammatory and to block cancer pathways. But again, I find there's a lot of misinformation out there that people are coming across that they need to take this, that and the other thing in order to kill cancer cells. Whenever it comes down to taking supplements, I advise people not to take them based on their like any supplements, cancer killing properties. Like I would never look at an antioxidant supplement or a plant or whatever it is and it's being, it's being said to it kills cancer cells. That's just not really helpful information. That information is often coming from cell studies or animal studies that are, yes, they kill cancer cells, but they're looking at the mechanism of action is the purpose of those studies. Instead, when we're looking at applying supplements for someone's case, we want to look at what is their body needs. So, so do they need to fix their gut and maybe it would look like a probiotic, for example, because their microflora is off, do they need to top up their vitamin D? Do they need something, some support with stress, maybe some lavender capsules or something like that would be beneficial. So it's more of finding any potential vulnerabilities or holes in the person's body than it is about applying something to kill cancer cells. Because then we build up the body's own innate defenses and strengths and it just helps to build those defenses against cancer as well as helps them to feel a lot better too, which is also super important.

I do think that there were some things that they don't necessarily have cancer killing properties, but they can do things to your own inherent immune system to make it more responsible, to make it more reactive, to better aid your own inherent systems. Absolutely. And so you know, we know that there are things that increase natural killer cells and natural killer cells are part of our tumor defense system. And certainly our immune system is part of our tumor defense system. And so when we are walking around with immune systems that are really taxed and overworked and not doing what they're supposed to do or what they're capable of doing, when we do the things to enable them and to support them, it has that same effect. But I agree with you, like, there is no magic bullet. There is no one supplement that is going to do it. And that's why when people say like, oh, I need to be on so and so, you know, whatever the, the supplement du jour is, I'm always like, why? Right. Like, what do you think that's going to do for you? What, where's that magic, you know, Better. Better. Let's dial in and, and give you things that we know that you're deficient in. Right. Like if you're B12 deficient, let's deal with that.

My favorite question is, what can I take to lower my estrogen levels? Like, they just want to supplement to lower estrogen. Like, this is like such a great question because there's so many things we can do to manage estrogen in like a year of positive breast cancer or a hormone positive cancer. But it's not necessarily to just take the right supplement. It always comes down to like, are you removing estrogen? So looking at like bowel movements and gut health and detox processes and then you actually want to support those processes. You don't just take an estrogen anti, estrogen supplement kind of thing.

Yeah. And I think what most people don't understand, because we've given this whole estrogen oversimplified explanation, that it's easy for people to kind of imagine that landscape of estrogen stimulates growth of hormone positive breast cancer. So if you take away estrogen, it will take away the growth of breast cancer. And it's a logical theory, it just doesn't happen to be true. And as we see, most breast cancers happen in the postmenopausal population where women barely have any circulating estrogen. And taking away their estrogen at that point is not making a critical contribution to the anti cancer picture. But what you talked about are the detoxification part of it, and that is estrogen metabolite, the breakdown products of estrogen. And we know that many of the breakdown products, if not most of the breakdown product of estrogen, they are really toxic and they are responsible for the development of at least some of the disease.

Yeah.

And so I would love for you to talk about estrogen detoxification and how you help people with that process?

Yeah, for sure. I think one of the things we dive into whenever we're working with someone who's gone through an ER positive breast cancer diagnosis is all the other factors, of course, like nutrition, stress reduction, of course nutrition can play a role. If there's things like ground flax and green tea and soy, like, we tend to encourage organic soy products and in certain people that can help to influence someone's risk of cancer patients playing back over time, also just optimizing vitamin D. But whenever we look at estrogen in particular, we like to look at someone's epigenetics. I'm not sure if that has been talked about in a little while here on your program, but epigenetics are kind of like things that we can influence with our day to day. So in our environment, our nutrition, our supplements, our thought processes, even medication, things like that. So I always say your genes, we're born with them, we can't change them. We also can't change our epigenetics, but we can change how our epigenetics are influenced and how they influence whether we get disease or are healthy too. And there are parts of your epigenetics that have to do with the breakdown of estrogen. So everyone's a little bit different. And it can tell us like, do you tend to, whenever we do this test, saliva test, it tells us about like, do you tend to create more of the, like less help, less harmful, more helpful types of estrogen in basically kind of like what ratios are there, are they being produced in? And it tells us even like how do you protect against these harmful estrogens sometimes as well about like looks at your glutathione, your ability to create glutathione or to create antioxidants. And whenever we're creating these like catechol estrogens for example, they are going to kind of act like the damaged cells act, kind of like reactive oxygen species. And the more glutathione, more antioxidant support we have in the body, the easier able your body is to protect against these chemical estrogens. Easier able it is to heal any damage that may have already happened. So it's way more than just blocking estrogen pathways or just taking something to stop estrogen. It's about how well are we protecting against any harmful estrogens that are produced. Can we convert certain types of estrogen a little bit more effectively with certain foods and nutrient and supplements? And can we eliminate whatever excess estrogen that might be a little Bit more harmful from the body through things like bowel movements, better detoxification processes, which kind of plays into the conversion of the estrogen, things like that.

Yeah, yeah. And so just for people who, you know, aren't necessarily familiar with these pathways, when we break down our estrogens, it's actually a three step process and two of them are happening in the liver. And those breakdown products are taking something that is fat soluble because our hormones are fat soluble, and changing them, converting them into something that's water soluble. And when they are, when they arrive in that water soluble state, they're then secreted into our gut, into our stool. And if you're, if you're moving your bowels regularly, then the breakdown products of estrogen are leaving your body. But if you are not moving your bowels regularly, then these, these changes, this conversion from that fat soluble molecule to the water soluble molecule, it's not a permanent change. And there are also enzymes in our gut that facilitate that reversion back. And then these toxic estrogen products get reabsorbed into our system and they, they are responsible for doing a lot of damage. So that's where constipation, like people don't even associate constipation with a risk factor for breast cancer or a risk factor for recurrence, but it's actually both and something that's not discussed and not talked about at all. Mostly because I don't think that most of mainstream medicine even realizes that connection.

I agree. And I'm just thinking, like, I wonder if I've looked into recently the, if they've ever done studies between women who are constipated and the risk of breast cancer over time. I can't think about, I've looked into that before, but wouldn't that be kind of cool information to take a look at is?

Yeah.

Like for all the women who got breast cancer, what was their, what was their, what were their bowel habits like throughout life? Because I tell you, a majority of the women we work with come to us and they're like, yeah, I just, I have a bowel movement every third or fourth day, maybe once a week sometimes. It's just normal for me.

Yeah, absolutely. And I mean, obviously I'm just giving you anecdotal information, but about half of my breast cancer patients are legitimately constipated. And you ask them if they're regular. And this is part of Soul to. One of the problems with our society is like, it's not considered nice or, you know, proper conversation. Right. And so we don't talk about it. And you ask these women how often they move their vows and they're like, oh no, no, I'm regular. And you ask them what does that mean to you? Like, what does regular mean to you? And they're like, yeah, I go every week. Right. Like and, and, and there's no and how they got to be, you know, 56 years old and they think that that is normal and then that is okay. And people are not appreciating the impact that that has on your overall health. And it's not insignificant. Right?

For sure. Like there's so much research on the strabolome and cancer and all those kind of things, even not just breast cancer, but other types of cancer as well, that. How is it not more known in the. Whenever you go to a medical appointment, for example, that it's important to discuss healthy bowel habits and what regular should actually mean.

Yeah, but do you want to talk about what the estrobolome is? Because I don't know that that is a very commonly understood term.

There's, there's basically a, like a kind of subset of microflora in the gut. So bacteria in the gut that are very important for processing certain types of estrogen. They turn them from good to bad or just in general just churn them from one type to another of the estrogen in your body. And there's research from not even just er, positive breast cancer where we call the estrelone because it influences, it's influenced by estrogen, but there's also research on like triple negative, so like er, negative cancers, showing that women who have a better microflora potentially leading to better establish have decreased risk of cancer coming back over time. So they've done really nice research on gut health and microflora and how it can influence one's risk of breast cancer over time.

Yeah, and that is, I mean it's absolutely logical because we know that the immune system is so, is like the cornerstone of, of whether or not you develop breast cancer or not. And our immune system is so intimately tied to the health of our microbiome. Right. They are in near constant contact with one another. And so it's nearly impossible to have a healthy immune system if you don't have a healthy microbiome and vice versa. Right. And so, you know, making sure that that is something that we are paying attention to is of the utmost importance.

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Back to our show. So you talked about constipation as part of the detoxification system. What else are you thinking about?

It's so comprehensive and a lot of women come to us or we just, we hear from them and they're more concerned over taking like specific detox supplements like mouth thistle and glutathione and NAC and things like that.

And liver cleanses. Everyone wants to know how to do a liver cleanse.

Yeah, juice cleanses, liver cleanses. Like basically they just make you poop, which is good. A lot of people do need that, but we want to go above and beyond that. A lot of these cleanses definitely get things flowing, but it's usually because of the herbs that they're using or potentially extra fiber or whatever it might be. Or maybe they're part. Part of it is getting to drink more water. That's why people find that they feel like it's working is because they're, they're actually going to the bathroom and flushing things out. But when it comes to doing a good, like detox, honestly, your body does a lot of the work for, for you whenever you give it what it needs to function properly. So whenever we're just doing something as simple as changing up someone's nutrition to include more greens and to give them healthy Fats and to get the nice balance of protein that they need to, to kind of look, all these enzymes are made of proteins in your body. They require protein to function. You're a lot of protein. So we need to make sure people are getting their protein, their greens, their adequate amounts of carb cells because that's going to help the liver to do its function more readily. And then of course, water, movement, exercise gets the blood and circulatory systems or the lymphatic systems moving. Because what we see is whenever you have your, your blood running, for example, you're going to eat food, it's going to digest in your gut, it's going to. All the nutrients are going to go into the bloodstream, the bloodstream is going to pick that up, deliver it to all your organ systems and other parts of your body, give you like your vitamin D and your zinc and your magnesium. All those kind of things get moved from the food in the gut to the rest of your body, including your liver. And then your circulatory system is going to pick up all that junk as well as the lymphatic system is going to pick up all the junk that the liver is like, I use this up, I don't want it anymore. And then circulate, circulate that back to get removed through kidneys, valens, things like too. So by eating well, you're going to support a lot of these systems anyway, your liver, your intestines, by removing things out of the body or moving burdens off of your, your liver as well. I do love green juices, I do love glutathione. Like we do recommend things like that often. But I find we need to make sure that we're not bypassing the most incredible step of like the lifestyle changes, the nutrition, the sleep, the exercise, all these kind of things need to be done really, really well on a consistent basis. Or supplements are just going to do crap basically. Not in a good crap.

Yeah, no, I completely agree with you. And we hear it said time and time again and I wish people had a greater understanding for this, but you can't supplement your way out of a bad diet. You can't supplement your way out of, of not not moving properly. You can't supplement your way out of poor sleep, you just can't. There's no substitute for any of these things. And unless these things and we have amazing, amazing, excellent data to show the value of sleep, the value of exercise in terms of cancer recurrence. So for the person that kind of is at ground zero and is just finishing treatment. And you know what is in that now? What space? How do you take them through this process?

If whenever possible, we basically start everyone, if they can, with a blood panel to go way more in depth than the typical liver, kidney, white blood cell count, like those kind of things are, they're important. But there's way more that can be done. And it's kind of like it's, it's hard to say, we just want to test everything, but we do. A lot of doctors don't like that approach, but whenever someone's gone through the rigamaroo of chemotherapy or radiation or the stress of a diagnosis and surgery, whenever cancer is in the body, we definitely want to see what can we do to strengthen those defenses. And it comes from better nutrient levels, lower inflammatory levels, better glucose regulation. So we want to test of course the liver, kidney functions, the CBC with the white blood cells and the red blood cells. But we also want to look at your B12, your ferritin and we want that above 50, for example, not just around 20, which is what most women are hanging out at. An iron panel, of course, Vitamin D, fasting insulin, fasting glucose, IGF1, cholesterol panel. Because cholesterol is likely to change over time. With many people have gone through cancer treatment, treatments can influence that. Whether it's a hormone change or whatever it might be. Just kind of starting there, getting a good feel of these things that are circulating in your blood and that can guide you a little bit better on what's proper nutrition. Anything from like where do we need to focus our attention when it comes to supplementation. That's kind of like a good concrete step. Start when it comes to fresh out of the gate when it, when treatment's done.

So you're looking at people's white counts, you're looking at nutrient levels like vitamin D and B12 and folate and B6 and, and that kind of thing. Zinc, selenium. I'm assuming you're looking at blood sugar regulation that ends up being a pretty important part of it, right?

Yeah, super big key.

So. And I, I'm assuming that metabolic health is a place where a lot of people who have a cancer diagnosis are struggling. Is that, is that, are you finding that?

Yeah, it's very interesting that even recently we've been finding that people have been on the edge, like even they've been in pre diabetes and nothing's been done about it. They're not even being told to do proper screen like follow up screening or anything like that. So I think whenever people go through cancer, it's just assumed that a lot of stuff is due to their cancer. But if someone's pre diabetic, we definitely want to start changing that so they don't eventually become diabetic over time, which is a known. Like you're at a known increased risk for that after going through cancer treatment. And there's so much we can do with nutrition, and it doesn't mean you can never have, like, chocolate again. Like, I would never tell someone they could never chocolate. I couldn't imagine living like that. But there are certain techniques that we can do when it comes to your food choices and how you pair your foods together and even the order of food that you, the order that you eat your foods in, not to be super extreme all the time, but on a regular basis, we can make changes with something as simple as nutrition, of course, exercise, to draw someone out of that pre diabetes or diabetes, and also influence their glucose and inflammatory markers in ways that are less harmful to increasing one's risk of cancer starting, growing, coming back.

Do you generally recommend that people wear CGMs, continuous glucose monitors?

With my particular population, I haven't found it too, too helpful. In fact, it seems to be just more confusion. I do. And certain in some people we have, but not too often. Mostly we're looking at really regular blood work throughout the year. Not just once a year, not just one. One time. And we're monitoring their HbA1C, they're fasting insulin, fasting glucose and IGF1. There are some people who come to us and they're like, kind of like next level advanced. They really want to learn a little bit more about how does their. How does each meal kind of influence their blood sugar? And we can totally support them with that, but I don't find it's necessary for a lot of what we're. What we're doing. When people are learning how to pair their foods together, whenever they're watching their blood levels go down, they're getting done maybe at minimum of twice a year. Then we know that it's on the right track for the most part.

You mentioned food order, and I think it's interesting to look at the data on. People can eat the same meals with the foods in a different order and have a far different glucose response. So can you talk about that a little bit? Mm.

I like to describe this as if you're in a. You're in a high school hallway and you've got your jocks who are the big bulky guys, and then You've got your little scrawny cheerleaders walking down the hallway. So your jocks are going to be your proteins and your healthy fats, and your cheerleaders are going to be the. The carbs. So if you can picture a bunch of jocks and a couple cheerleaders walking down, you got your healthy fats and your proteins in the hallway. It's really hard for the cheerleaders to get through. So their, their movement is much more slow getting through that hallway because there's just not enough room. There's very little room for them to get through there. So this kind of relates to how whenever people have their healthy fats and their protein first, they kind of put the jocks in the hallway first. Then they're going to make it a lot slower for the carbohydrate cheerleaders to be pushed through and broken down and processed through that hallway. So it's going to basically slow down your breakdown of glucose whenever you have more healthy fat and protein first.

There's a lot of chatter now about not eating naked carbs.

Yeah, naked carbs.

So, yeah. Right. And so, you know, instead of having an apple, having an apple with some nut butter on it or something like that to try to slow down the rapid release of glucose into the bloodstream. And what you're saying is that our body will preferentially go to break down the harder things first if they're consumed together or first, but if you're eating your fruit first or something like that, there's no barrier. Right. It just has the opportunity to the.

Cheese, run through the hallway, spike the glucose. Yeah, yeah, yeah.

Okay, so you're starting everyone off with a blood panel, and you're using that blood panel to help them dial in to nutrition, to help them know what nutrients they need or, or you know, how to. How to formulate based on what their needs are. And then where do you go with them?

We'll also do epigenetics testing, too, and kind of leading back to how we learn a little bit more about their estrogen metabolism pathways, how they interact with glucose and cholesterol. Could it be a potential risk for them over time? If we're not careful with how they're eating or exercising, we can see how well do they protect against any reactive option species. That would be another test we often do. And then just based on a really thorough health history, we want to learn more about pretty much their health from head to toe, because again, for us, it's not about killing cancer cells so much as it Is about building the body up super nice and strong, like achieving ultimate health as best as possible. And we want to look at their nutrition, stress, sleep digestion, past medical history, family medical history, even like where have they worked in the. Like what could be some potential exposures they come into contact with, with their jobs or church. Like maybe it's moldy and stuff like that. Just kind of a big questioning process to get a big overarching picture of. All right, so these things look great. Let's not worry about that. Keep doing whatever you're doing. But here are some things that could use our attention the most. Here's our focus. Let's start working on this. And whether it's gut health or stress or vitamin D or whatever's popping up between testing and questions, we want to go there, tackle that and then step by step start pulling away all the other pieces too to make sure that things are running smoothly.

Now stress is a huge issue and it is very, very difficult to heal if you are in that kind of stress. Dominant cortisol dominant state. Right. So what advice do you give people? How do you help them to mitigate the stress? Because the stress, quite frankly isn't going anywhere. Right.

Like I think often it comes down to what are your main causes of stress. And sometimes it can be just the cancer. Like you might have been a super stress free person for the diagnosis. For sure, it's very rare that that is the case. But what are some underlying causes of the stress? Whether it's family, whether it's friends or job or whatever it might be. What can we do to start picking away at that? And we often refer people out for the cognitive behavioral therapy or mindfulness based stress reduction or whatever it kind of takes for some sort of counseling to do that. We also do emotional freedom technique and tapping with all of our clients as well. And I would say one big general thing that I wish more people would listen to me about is to just kind of cut off social media a lot of the time or at least to stop, stop stopping on cancer supplement marketing things or just this, this piece of machine is really helpful with cancer. Like that kind of stuff can be super stressful. For example, I have an Instagram that's mainly geared towards training and teaching and like a kind of showing my clinic side of things. I will never go on there for, from a personal perspective because it's. Because I do more cancer stuff, I get more cancer advertisements. And I just can only imagine what all of our clients and what a. Whatever anyone's listening to who has gone through cancer is coming into contact with. Whenever it comes to the social media, like, barrage of things. And I have like a TikTok account that just shows me dogs and jiu jitsu moves and things that I actually enjoy learning about. So root cause counseling and also just looking at where is all your sources of confusion overwhelm information coming from and can we start blocking a lot of that? And often it's a lot of social media, blog posts, emails, that kind of stuff.

Yeah. Well, I think that social media is damaging on a lot of levels. First of all, I think that it portrays kind of this ideal that is unattainable and it's actually not even real. Right. Because what, what people put out there is not even them. It's them in that, in that moment of time. And a dear friend of mine and a mentor, Kellyanne Petrucci, she was that. She's the bone broth lady. And she says that, you know, for every post that you see out there where that person is winning, there's hours and hours and hours and hours of loss and failure and grit behind that. Right. To get to that one moment of, of a win. And it is, it's very deceiving when you're on social media because it just looks like everyone is winning all the time and all you can be left with is like, why am I a loser? Right? And, and also people are just so frustrated, free to criticize. You know, I get, I get told.

A thousand times a day that you should, you should, you should do this.

And you should do that. Why aren't you doing this? And, you know, it's hard and you have to, you have to be one of those people if you're going to engage there that lets it roll right off or abstain. And I think everyone is better off from abstinence. You know, you and I are kind of forced to be out there and put things out there because that's the way that we are educating and that is the way that people are learning these days. Right. But that, but it's a really toxic place where when people don't agree with you, they're. They're quite evil.

I even say a lot of. It's just often general advice. Like I can only give general advice on my Instagram or my Facebook or whatever it might be because I don't know you. Yeah, I don't know what's best for you. In fact, what I'm saying sometimes might actually not work for you because it's not important. You've already Done it. There's something else going now that needs to be fixed before we work on that. It's all about the right strategy at the right time as well. So sometimes it works at one time, sometimes it doesn't work at another. And that's very confusing for a person who doesn't have any sort of medical background for sure, or health background. And I find it confusing.

Let's just put it out there. Like, don't ask for personal, highly detailed medical advice from a stranger over social media, no matter how qualified that stranger is. I mean, like, people write me pages and pages every single day. I have. What should I do?

Yeah, I don't know.

Because I don't know you and I'm not a social media doctor and we shouldn't have any social media doctors. Right? Like, that shouldn't even be a thing. But yeah, I mean, you just, you just can't. You want to. Of course. I mean, I want to help everyone. That's why I wrote my book. That's why I wrote the Smart Woman's Guide to Breast Cancer, because I want people to have access to valuable information. But. But you know, me telling you what you need.

How would I know?

How would I know? Or will this work for me? I don't know.

How would I know? Because I don't know. You gotta love everyone. I know they're just trying to get answers for sure, because it's just there's no avenues for it. For the most part, they're having trouble finding those avenues. But I just want to say you do not want my information. If you message me on social media to figure out what pill or supplement or whatever you should take, you don't want my information, you don't want my answer. Yeah, that way for sure.

Yeah, agreed. And also, I think that the. That kind of black hole that people get sucked into with social media and a total under appreciation of the fact that someone else is now in charge of your brain and controlling your narrative. And, and I mean, like this scary, scary, scary stuff. Like I could be having a conversation with my husband and all of a sudden an ad for what I was looking for, even though I didn't search for it yet, pops up on my feed and it's like, okay, that's super scary. Like they're just.

It's like, what are the chances? Yeah, yeah, yeah.

Simply so. You know, getting out of. Getting out of that control that, you know, that master that you never wanted to work for, and also getting away from the blue light. I mean, that is itself a Toxin and the emf, it is itself a toxin and I think we're going to start seeing some really serious ramifications of people being on these devices all the time. Yeah.

Not only if just from like the messages that get shared, but perhaps the way that the messages are shared through the technology.

Yeah. Okay. So by the way, what epigenetics testing are you using?

Like which company? Yeah, yeah, we use DNA labs.

It's pretty.

And it's a, there's a pro version. They might have changed it recently, but it's a pro version that covers more of the estrogen stuff, whereas the non pro version, whenever I, when it's like a couple years ago it didn't, but then they added this in. So. Yeah, we've also used nutrition genome before. It's good as well. I just find we didn't need the additional information.

Yeah, I'm, I'm actually using the nutrition genome and the report is a little daunting for everyone, right?

Yeah.

Because it's like an 80 page report. But I have found that spoiler alert. If you just feed it through chat GPT, it can give you a really, really, really good summary that kind of boils down to here are your touch points. Right. Here are the things that you need to be mindful of for you and it's. And it's pretty nice from that perspective. And you know, most people we know, if they have breast cancer, we have to be mindful of their hormone detoxification pathways anyway. But this is a confirmation, a nice combination. And then what about, I'm curious, what do you, how do you help people to make these lifestyle changes? Because the exercise, the movement, the sleep, that, that ends up being a big factor for people.

Yeah, it's just repetition and clear steps and just having someone to guide you along the way. Like a lot of the research, let's just use weight loss. Because a lot of research has been done on nutrition, exercise and weight loss. When they're researching weight loss, the touch points are weekly. Like they have nurses calling their patients weekly to say how much did you exercise this week? What did you typically eat? So as human beings we require multiple touch points. So we meet with people many, many times. We're constantly. There's many different touch points as well between like group calls or I don't just there's a community and stuff like that. So I think the more tough points you have, the easier it is to kind of motivate people to make change and answer their questions and just clarify because like if you have so Many questions, you don't know what to do, you get stuck like a deer in the headlights. So just being able to answer those questions and then also go into detail, not just say, you just, you really shouldn't eat ice cream or you shouldn't have cheese as much, let's actually, instead, let's actually focus on what should you have for breakfast, lunch and dinner? What do you typically eat? How can we kind of tweak that a little bit? So basically comes down to getting the focus. So not trying to do everything. So do that testing and do the questioning to get an idea of what's really important for them to do. Meet with them multiple times in order to assess. Is what we're advising them to do working for them, whether it's their schedule, their taste buds, their day to day, and if not, can we troubleshoot and make sure that does work? Also consistency and not going too extreme and changing things up all the time, just trying to get people to form these habits as well is very important. Yeah. And just nice, simple steps.

Yeah. And I think community here is really important because it helps people to stay on track and be motivated. And I, I think one thing that is so underappreciated is kind of the less you do, the less you can do. And when people are tired, they think the last thing that they can and should do is exercise. But so much of that fatigue that they're feeling is a lack of exercise.

Yeah.

And so I think that that's the, the place where it's the most important and you don't need that much. I mean, I'm not discouraging people from doing more exercise, but the truth is that the data shows that even, you know, walking as little as a mile a day significantly reduces the chances of breast cancer recurrence.

Yeah. And makes you feel good, too, a lot of the time.

Yeah, yeah, yeah, for sure. And I mean, I think that the studies are pretty clear that exercise is as good as any of the other medicines that we have out there for depression.

Yeah.

Right. That's really impressive.

You know, it even works as good sometimes as certain. Like, I would never. This is not, not saying that this is a replacement for conventional treatment, but whenever you look at how well, like how well exercise works to reduce the risk of occurrence over time compared to certain drugs like hormone beds even, we can see like a 40 to 50 decreased risk of recurrence in something like exercise, whereas sometimes you might only see like a 20, 30% reduction in risk with hormone medications. Like exercise is so underrated and like you were saying, it doesn't mean that you have to start out being a crossfitter or bodybuilder or whatever it might be. If you just go for a nice walk every day, that's a good start. And then you can consider, once you get that under your belt, once you kind of get that into your habits, then we look at what can we do next? And then the research kind of says strength training and also helps with bones and it helps with blood sugar regulation. So there's just so many benefits to exercise that can be kind of comparable to medications a lot of time, which is fantastic.

Yeah. So I would just like to wrap up with talking about, you know, people are so overwhelmed. They're so overwhelmed when they. When they are kind of embarking out on this healing journey. What, what are the small wins? What are the things that. That people. That you can help people to do to get started and to keep them on that path, to put them on and keep them on that path?

I think innately, a lot of people know what they already need to do, but they've got so many other things coming at them that they are like, is it even enough so they know people, you know, you got to change your nutrition. If you're probably listening to this podcast right now, people probably already know they need to change their nutrition. You might even know what it is that you need to do already. And it's probably going to be something like just eating more vegetables. So just start there. If you're kind of stuck, you probably already know you need to exercise, so just start walking. You don't need to do it every day for hours. You don't need to get into the weightlifting just yet. I would love to see everyone doing some weightlifting, but you just start there, get going, and make that a habit. And if that's all you do for the next couple of months, that is fantastic. Like, don't. Don't forget to give yourself some credit for that. If you're at a. Maybe a more complex level where you already are eating well and exercising, then maybe you want to look at getting more comprehensive blood work done. And although I do recommend people get their blood work done with a practitioner, just because there's so much information that practitioner will see in someone's numbers that someone might not have that background can do. You can even get your blood work done yourself at most labs without a doctor's requisition, which is pretty cool. It is paid out of pocket. But if you're just looking, for example, like a vitamin D or inflammatory markers or whatever it might be. You can get that done yourself if you're kind of at that next level. And then I guess the last thing I would say is kind of what we were talking about is just block out all the extra noise. You shouldn't be following everyone. You don't need to do everything. I don't want you to be looking at these supplements that you should be doing if you're not already doing the concrete foundations we've talked about already. I want you to cut out the noise, start with the foundations, and just do that for the next couple of weeks to months. Whatever it takes to get those consistent.

Yeah. And we know that positivity begets more positivity. And like begets like. And as you continue to go down this, this path and make small changes, small changes over time add up to really, really big results.

Absolutely. Like, whenever we work with people, it's step by step because you can't do it all at once. And we see these little small steps making such big differences. And you guys can do that, too.

Amazing. Where can people find you?

I am on Instagram @MeganBernard nd so natural. Dr. Maryland. I'm also on Facebook. Same thing. Megan Bernard, nd and I do have a website, flourishaftercancer.com amazing.

It was such a pleasure to have you today. And I think that the work that you're doing is so necessary and so needed and so important. And I'm just really delighted that you are setting this example for people during what I think is probably the most important time in their cancer journey. Because the truth is that that is where the healing starts and where the healing happens.

Yep. We absolutely love doing it too. Thank you for having me.

Of course, of course. So if you enjoyed this episode, please like it. Please share it with someone who needs to hear it and know that I will be back next week, same time, same place. Dr. Jen. Bye for.

Thank you for joining me on this.

Episode of the Keeping a breast podcast with Dr. Chen. I hope you found the discussion informative and empowering. Remember, breast health is health. So by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube at Dr. Jen Simmons and remember, my Jen has two N's, so until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.