Breast Cancer as a Patient and Physician with Dr. Liz Boham

Hi there, it's Dr. Jen. Welcome to the latest episode of Keeping Abreast. I am so delighted to have my friend and colleague Liz Boham here. Liz is a brilliant physician, a breast cancer survivor, a nutritionist. She, she is a instructor, a teacher for the Institute for Functional Medicine where she most recently was teaching in Columbia and rolling out their new program there. And the amount of accolades that this woman has is far too many for me to name, but I am so delighted to call her friend and to have her come on this show as she's also on my summit. And she brings with her just a breath of personal experience and professional experience. And she is really just making a huge difference in this world in how we practice medicine and in how we heal people. So, Liz, welcome. Thank you so much for being here.

Thank you, Dr. Jen. It is great to be with you and all of your listeners. It's always so much fun to have these conversations and about, you know, how we handle women, women's risk for breast cancer, breast cancer reduction, breast wellness, you know, which we can do to help ourselves.

And at the end of the day, breast health is health, right? And the same things that we're going to do to have healthy breasts are going to give us a healthy heart and a healthy brain and a healthy body and healthy gut and healthy bones and all those things that we really worry about 100%. Can you just start off by sharing your story? Because your story is so moving and I know so many people will be inspired by it.

Yeah, absolutely. So about 24 years ago, when I was 30, I was doing breast self exams. I was actually doing breast exams on myself because I was trying to learn how to do breast exams on women that were my patients. So I was in my residency training program. So I am board certified in family medicine. So I'm a physician practicing family medicine. But my undergraduate and graduate degree was in nutrition. So I was always interested in nutrition and wellness and prevention.

Did you practice as a nutritionist and then decide to go to medical school?

Yes, I did, actually. So I, I got my master's in nutrition education and exercise physiology and I'm a registered dietitian and I practiced in the field of nutrition. The biggest place, the longest place I practiced was at wic, actually in Brooklyn at sty. So WIC is a government funded program called Women, Infants and Children, and we would provide coupons for food. But when women would come in, whether they were pregnant or breastfeeding or had young children, they were required to get nutrition education. When they got the food Coupons. And so that's what I did. And I loved it. It was a wonderful job. But I decided, okay, I want to learn more about all the different systems in the body works, what more we can do for prevention. And I didn't come from a family of physicians. I came from a family of PhD doctors. And so I had no idea what it meant to be a physician. And I actually was at a conference, the American Dietetic association conference, and there was. Dr. Dean Ornish was lecturing on his research of how he showed you could reverse or stabilize heart disease with lifestyle. And I was blown away with what he was doing. And I wrote him a letter afterwards and I said, you know, Dr. Ornish, I'm so impressed with your work. I've been trying to decide if I should go to medical school or not. What do you think? And the coolest thing is he wrote me back. And he wrote me back and he said, yes, we need more physicians who are interested in nutrition. And so I was like, okay, I'm going to apply to medical school.

So. Wow. Did you realize at the time how huge that was?

No, I had no idea what I was doing.

Do you know that I have my own Dean Warner story? Did I ever share it with you?

No. Tell me.

So when I was, I don't know, 10 or 11 years old and I'm at summer camp and my grandmother comes to visit me for visiting day and she has this article with her, and it's an article about this doctor that did this study and he learned that by eating a plant based diet or by, I guess, being a vegetarian, that you can prevent and reverse heart disease. And she said to me, it's too late for me, but it's not too late for you. And she gave me this article to read and she told me that I should start being a vegetarian. And I started being a vegetarian at 11 because of Dean Ornish's article in the paper.

That's wild. Yes.

Isn't that funny?

Very. Has been very influential and so much of his research has been really exciting in terms of how they've changed reimbursement, insurance reimbursement, and incorporated more lifestyle into some insurance programs, which is phenomenal.

Yeah.

You know, so.

So you get an answer from Dean Ornish and he tells you that he thinks it's a great idea for you.

Exactly. Doctors who have a background in nutrition. And so I was like, okay. And so I go to medical school and I'm in the middle of medical school and I'm like, oh, my goodness, what Did I just get into, like. I had no idea about, like, all this stuff I had to learn about in terms of acute care medicine. And I'm, I'm in the ICU and I'm like, damn, Dean Ornish. I like work that are kind of intense and I'm like, you know, it's just like I'm in the ER and I'm like. I was all interested in wellness and prevention, and so it, you know, I, I really, I was kind of was amazing as so many people who go through medical school, training and residency realize. You know, it's. There's a lot, there's a lot to it. And it, and at times it was. I was frustrated with my decision. You know, actually, I think a big reason that I ended up getting breast cancer at that time was a lot of my. I mean, there were so many reasons, but one was I'm working nights, I'm, you know, not getting good sleep. I was angry with my decision. I was, you know, I wasn't managing stress well, you know, and I was like, what did I get myself into? And so I was, I was doing breast self exam on myself because I was trying to learn how to do it on my patients. Right. And so I. In August. No, sorry, In July of 1999, I do breast self exam. And to me everything felt normal. And then August of 1999, I do breast self exam and I find a mass and I, you know, I show it to my husband and he's like, you've got to get that checked out. I'm like, yeah, well, I don't know. And maybe it's just related to this infection I had. That's a whole long story. Well, it ends up that I had, you know, a lot of. I was around a lot of physicians, and so we, we ended up having a biopsy. The biopsy was inconclusive and I had surgery. And so in, you know, 24 years ago, I was diagnosed with this triple negative breast cancer. And, and, and then what sort of.

Stage were you at again? I don't mean stage of breast cancer. I mean, were you in medical school? Were you in residency?

I was in residency. Okay. Yep. So I was in my start of my second year of residency.

Okay. For internal medicine. So a three year. A three year residency.

Yep. Family medicine. Three year residency.

Okay.

So I then, you know, so I have.

That clearly didn't make things easier.

I have this aggressive, you know, you know, aggressive triple negative breast cancer. And I'm 30. And at that point, you know, at that point, being a 30 year old with breast cancer. We were very rare. And I went through treatment with a couple of other women who were also 30. But, you know, there weren't women who were in their twenties is what's phenomenal to me now, you know, unfortunately, is we're seeing more and more early, early cancers, including early breast cancer. So there are women in their 20s getting diagnosed, which is just. Yeah, is unfortunate and crazy and we can talk about that.

But in fact, when I trained, it was like unheard of. And now it's, it's quite commonplace.

Yes. Right, so, so, right. So here I was, I was this. I was all excited about prevention and wellness and I was, I thought I was practicing what I preached. I was all interested in nutrition. I was, I was, I was exercising, you know, and all of a sudden I get this aggressive triple negative breast cancer without a family history on top of it. Right. So I go through, you know, they did, at the time, they did surgery. I had sentinel, no biopsy, but they were just starting to do those. So I had eight nodes removed, which were thankfully all negative because of my age, the aggressiveness of the cancer. It was triple negative. I did chemotherapy and, and then radiation. And we were, my husband and I were married for about a year at the time, and we were interested in starting a family. But then this happened. And so my focus, my focus was so much on, I want to be able to have children and I want to be able to breastfeed, because as I just mentioned, I worked for wic and all we did was talk about the benefits of breastfeeding.

And I think you were handing out formula, right?

Yeah, but, you know, I, there was this, I think there was also this part of the denial piece, you know, when you're, when you're going through this kind of treatment where you're like, I don't really have cancer. You know, I had, I had somebody else look at the pathology, you know, all this sort of stuff. And it was very important for me to be able to get pregnant. And so I lost my period during chemotherapy, you know, as most people do. As most people do, period went away. I, you know, a lot of hot flashes, vaginal dryness, and all sorts of crazy stuff. All of a sudden trouble with sleep. And then a few months after chemotherapy, my period came back during radiation or toward the end of radiation, and I ended up getting pregnant with my daughter five months after I finished chemo.

Wow, that's fast.

My oncologist was not happy with me.

Yeah, but that's because they don't understand.

But, but it was so important to me. You know what I mean? It was very important to me. My daughter is now 22 and she's healthy. And you know, I ended up breastfeeding on the non radiated breast.

I tried track star or something. I feel like I. Yeah, she's.

Yeah, everything. Her ears are in the right place. She's smart.

Yeah.

Very accomplished. And then was able to breastfeed on the non radiated breast. We tried on the radiated breast. I don't know why I tried. I was crazy, Jen. I was crazy.

And then you were a mom.

Yep. And then I got pregnant with my son and he's. They're like 22 months apart. And so. But then it was after he was born, it started to sort of hit me that, oh my goodness, this really did happen to me. I just, I just had this aggressive breast cancer and I thought I was so healthy. And why, why did this happen? Like, what's, what's going on and what do I need to change, you know, in terms of myself and my health and how, how do I do things differently? And, and that was really important that I sort of delved into. And it was around that time that I learned about functional medicine. I.

How did you learn about functional medicine?

Yeah. So this is kind of a cool story. So my, after my last round of chemotherapy, my mom brought me to Canyon Ranch in Lenox, Massachusetts and she brought me for a mother daughter weekend. They had these mother daughter weekends and it was just a wonderful celebration of me finishing chemo. And my mom went to a lecture that Dr. Cindy Geier gave, who now works with us at the Ultra Wellness Center. And my mom went and then met her as a patient. Afterwards they did like an appointment regarding my mom's bone density. And so my mom, being just an amazing mom, says to Dr. Cindy Geier, she says, you know, I think my daughter would like to work here or do a rotation here. So I ended up doing a rotation, like a month long rotation. And in fact, Mark always, always like Mark Hyman, sorry, Dr. Mark Hyman was working there at the time. And he always tells the story of when we first met and how, because my hair was just starting to grow in, it was that really cute, curly blonde, you know, soft hair that was growing in. And so he always will tell people about when he's like a duckling. Yeah. And how I had that really cute short hair going in. But so I did a rotation at Canyon Ranch when, when, when I was in my residency training, which was phenomenal because it was A wonderful.

I can't even imagine what that experience must have been like.

Oh, it was so, so great for me. And then a few years later, they had an opening and I got a job there. And so it was in 2004 that I started working at Canyon Ranch and in Lenox. And they sent us. They sent me and Dr. Todd Lapine, who also works with us now, they sent us to afmcp, preliminary week long program in functional medicine. And they sent us to that. And I remember I was blown away. I was like, this is so cool. This is how I want to practice medicine. This gives me the tools, this gives me the roadmap to bring together my belief in prevention and wellness, but also recognizing the fact that sometimes we get sick and systems in the body get out of balance. And just a different way of thinking about was so exciting to me to say, okay, we have the tools to help our patients, help their bodies get into better balance and not just say, okay, this is the disease, this is the medication, and that's it. And so it was just this, it was so. It just blew me away. And it was wonderful first week. And I was hooked at that point from then on. And it also really helped me with myself. Like, it helped me recognize what I needed to work on in terms of helping my body get into better balance, you know, areas that were out of balance for me. And it helped me make sense of that concept of like, you know, how important personalization is. Because for some of our patients, it may be that we've got to really work on their diet and their insulin resistance and their blood sugar, but for other people, it may be more. We've got to really work on their body's detoxification systems and how their microbiome is in their gut and how they manage stress. I'm just talking about myself there for a second, you know, and so we're all different. And I think that's really what's great about the concept of functional medicine and looking for those that, you know, treating us each as an individual and finding the imbalances in that individual and helping their body get into better balance.

Yeah. So I'm curious, when you, when you learned about functional medicine, were you already in practice and were you. Were you practicing family medicine in a kind of, you know, general way that, that we typically think about family medicine practitioners working, like, giving out a lot of scripts for cholesterol and depression and high blood pressure and things like that?

Yeah, so I had finished my residency, so I kind of had, you know, I was at that stage. So I was doing family medicine. I also had a sort of a different type of a, of a practice that was very nutrition based, which was, you know, I've worked with a group of physicians who had a background in nutrition who, who were managing patients that needed gastric bypass surgery or were getting gastric bypass surgery or had high, high cholesterol diabetes. So I was in, I was in a slightly different type of a practice, but it was very conventional.

And that's really interesting though, because most practices that I think about that are, you know, kind of conventional medicine with a nutrition focus is mostly for weight loss, like for getting people ready for gastric bypass surgery. And oftentimes the, the path to weight loss for those people isn't nutrition centered. So thinking about what you know now and what you, what you were doing then, is it the same? Like, were these really forward thinking people?

No, we were, I mean, the practice was very conventional. We also did, I mean, we definitely used medication to get people ready for surgery. We did a lot of support for gastric bypass surgery, which I have a lot of opinions on, but that would be a whole nother podcast. We also did a lot of enteral feeding TPN in hospital, tpn. And so it was a very conventional practice, but we also did have a nutritionist on board. So, you know, I guess I think that what was exciting to me when I got involved in functional medicine was I was just like, okay, I need to do this differently. I really struggled with the, with just the knee jerk response in conventional medicine of, okay, this is, this is the diagnosis, this is the treatment, this is the way you've got to go and you've got, you know, 10 minutes to do it. And it just didn't make any sense to me. And, you know, just getting in the world of functional medicine opened up this whole door for me and a whole world for me to say, okay, we can treat patients differently and we can treat them better and we can have better outcomes when we do that. And it's not that everything in communication, conventional medicine is, is, is wrong. There's a lot of good things in conventional medicine, but we need to bring these two together. And because we're, we're, we are. You know, there's so many physicians that are unhappy in the way we're practicing conventional medicine because we're not giving them time to get to know patients. And we've got all these restrictions and then we've got patients who are not happy because they're not getting their questions answered. And they're kind of.

And they're not getting what they need. Right, right. Why do you think that marriage is so hard? Why is it taking so long? And why is that divide still there?

I think part of it is just that as physicians, we have. I don't want to blame physicians because I think we're overworked and there's no time to. To say we need to do it differently. But we kind of get into this process of training and then practicing, and there's no time to say we need to do it differently. But I think that we have allowed pharmaceutical companies and the insurance companies to take over.

I think so, too. And I don't blame physicians at all because I think that they are completely victims of a system.

Yes.

And what I think about most is the educational system. And I don't know why that hasn't changed. And I certainly think as a physician who really believes that we are not serving people nearly as well as we could and should I really believe that it's our educational system that has to.

Serve that has to change 100%. I remember. I mean, it's just one example. I can remember. You know, when I went through training, it was the opioid medication are not concerning. They're not addictive, and we need to be checking every patient about their level of pain and not controlling it. With these opioid medications, you were doing something wrong. And that was in medical school training. That was not a pharmaceutical rep coming by and telling us.

Yeah.

And so those ties are very deep, and it's upsetting. I think you think back to our training and the limitations that our training put on us. Right. I mean, good parts of our training, but there were a lot of things that were that. That limited our thought process. And then we are in this system where you have to see so many patients, you have to write up these notes that have all these things included. So you get this insurance reimbursement. Reimbursement. So you never have time to get to know the patient. And then. So doctors are completely exhausted and they don't have time to say, this is just wrong. You know, this is not care.

Yeah, it's not. And I completely sympathize with that whole pain narrative. Right. Because I was in. I was in surgical residency at the time. And we. We were. We were given those charts.

Right.

It's the, like, frowny face transitioning to a smiley face and asking each patient, like, where you are on the scale. And if they didn't, they didn't have a smiley face. We were told to give them more oxycontin.

Yeah.

And like, I, I think back to my surgical residency days in horror of how many oxycontin addicts I probably created, because as a surgical resident, we would see them when they were in the hospital and prescribe for them while they were in the hospital, and we would give them their prescript when they were being discharged, and we never saw them again. Like, they followed up with the attending in, in the office, and we never saw them again. So, like, I have no idea how many people ask for another script and another script and another script, but we know statistically by the numbers that that was horrendously addictive.

Yeah.

And so I have no idea. But that, that haunts me. Absolutely haunts me. And it's just, it's. It's exactly what you were talking about. Like, what, what we were trained to do. And a lot of that was not driven by anything but the pharmaceutical companies.

100% in your. @ that point, you're not in a position to question. And again, you're overworked and you're. And you're. You don't have a time. You, you don't have the time to step back and really look at the big picture. Yeah. Or really understand the big picture of what are we doing.

Yeah.

Right.

And it sounds like you eventually, with your diagnosis, got to the space where you were asking, you know, what do I need to change? What do I need to do differently? Because we know without change, we can't expect change. And unless we change the way we live our lives after our diagnosis, from the way that we live our lives before our diagnosis, we can't really expect anything to change. So I wonder if you can share with us, like, what. What message do you think your body was sending you when you had your breast cancer, when you got your diagnosis? Because our diagnoses are often messages saying, like, this is not working for me.

Yeah. It said, it was saying, listen to me, pay attention. And you know, it's not uncommon for physicians to be in this situation. And there's a lot of other different, different jobs and people in different positions that are in this, this situation. But so often we get, we just push through. Right. And, and I think medical school and residency training, especially for surgeons. Right. You know, you are told not to listen to your body. Right?

Absolutely.

You're last sleep when you. Exactly. Yeah. And my body was like, you have got to be. Listen. You have got to listen to me. You have got to stop when I say I need to stop. You have got to take more time for resting. You've got to, you've got to listen to what I'm, what I'm saying. I honestly, I think that's the biggest thing that my body was, was saying. And it's not always easy for me to listen to my body and, but it's so much easier now than before this happened to me. And it was definitely, you know, you know, this, this, it just was like, okay, balance, you've got to have a better balance in life and you need to have time for rest and you need to have time to sleep and you need to have time to nourish yourself and you need to learn how to do that. And I started doing this journal when I was going through treatment and it was, it, it was just phenomenal because it, it helped me sort of understand all of the things that were, that, that I was feeling and, and kind of make sense of it all. And I also kept within that a gratitude journal because I was listening to Oprah one day. So I, I did take three months off of residency when I was going through treatment. And during all that treatment I had time to watch Oprah, which was so much fun because that's back when she was on TV every day. I think it was at three o', clock, maybe four, I don't remember which. And she had this episode on gratitude and the Gratitude Journal. And so I listened to it. I'm like, well, that's very interesting. And so I started keeping a gratitude journal. And because on the show we were told, write down three things you're grateful for every day. And honestly, for me, it was very hard. At first I was pissed off, Jen. I was like, I am a healthy 30 year old. People are telling me I have this aggressive cancer. This is just wrong. I don't have history. I was just, I was angry. I was not in a place of gratitude. And what I realized is I was, had probably never been in a place of gratitude. Honestly. I was always more of like, push, push, push, glass half full kind of personality. And so I kept, I started this gratitude journal and I would write down three things every day. It was part of my overall journal. And at first I would be like, food, sun, you know, I was, I had such a hard time finding things.

Yeah. But I think this really speaks to people because I think a ton of people who are in this situation who are given this diagnosis struggle with this exact thing.

Yeah. And, and also it taught me that I was struggling with that even before this diagnosis. And the issue with that the issue with struggling with finding gratitude is, you know, it's. You realize that you're more. Always in a more sad place or a more stressed place or a more angry place or. Right? And what. What ended up happening while I was keeping this gratitude journal is over time, I started to. It started to just come more easily to me. And I can remember, you know, all of a sudden looking at a tree and going, oh, my gosh, those leaves are so beautiful. And, oh, my goodness, you know, I'm so lucky to have my husband who just made me this soup. And, you know, it was just. It would just come naturally, right? And that happened because every day I forced myself to come up with three things, right? And then over time, it just became more natural. And my gratitude journal really helped me change the way that I interacted with the world around me. Like, it changed how I viewed my medical school training. Like, I was fighting it. I was, like, angry. I was pissed off. And I just started to have a different outlook on the whole thing. It changed. It changed how I went to work every day. It changed how. It changed how I went to the doctor's appointments because I had so much fear and anxiety. And. And that started to shift with my gratitude journal. And it just. I find it. It really changed me in a way I can't even explain, but it was just. It was. It was very. That is the one thing I'm grateful for in terms of the breast cancer, because it did help me shift to a life that is just naturally more fun and joyful, and just because of having that gratitude, you know, how long did that take?

How long did that shift take?

So I think it happened in layers. I feel like after a couple of months, I had. I had one layer of improvement where I had a little less fear, and I had a little bit more joy. Right. And then. And then a few months after that, at six months, it shifted again. And then I feel like after two years, it shifted even more. And then, you know, so I feel like. I feel like it. I started to notice some improvements right away, but I also would have to say that this. This whole transition probably was more years in the making, you know?

Yeah. Yeah. So I know you've. We've spent most of the time with you sharing from a survivor standpoint, and I'd like to shift a little bit to your provider standpoint. And I wonder if you. If we could start to tackle what we. What we mentioned in the beginning, which is that we're seeing breast cancer in younger and younger women. So what do you think is going on there?

I think it's a combination. I think it's a combination. I think that it is because of shifts in lifestyle, we see that in general our food supply is, is, is worse and worse. I think that there is, we have a food supply that is, is full of refined carbohydrates and sugars and chemicals and antibiotics. Right. In, in our, in our, in our meats.

Can you just explain why that is an issue? Because I think that people still in their mind think like, like, well, what's wrong with that? Like, what's the problem with that?

Yeah, I mean non organic or conventionally grown animal proteins, especially beef, Right. A lot of times they're given antibiotics to help them get bigger, faster.

It's growth hormone.

Yeah. And what, what happens then to us is, is crazy, right. First of all, it produces a meat that's more pro inflammatory and then the meat has a shift in bug in the bacteria in it, in the microbiome, which then impacts our microbiome. And we know that when our microbiome is out of balance, that can influence how we metabolize our own estrogen, how we handle toxins from the environment, how we, how we, how we have, you know, how our digestive system works, how.

We produce, how our immune system is functioning.

Absolutely. So it's like, it's so multifold and we've just created this really toxic food, food supply that we are like, oh, it's normal. Right. And then, and then we're eating so many processed foods that have so much packaging on it and a lot of that packaging has these endocrine disrupting chemicals in it. Right. Like BPA or phthalates or plastics. Right. So, so there's so many layers to our food supply that I think is one of the issues. I think that the other is, is, you know, kind of folds in with that. But it's just like the toxin exposure in our environment. We have, we are exposed to so many, so many toxins now, none of which have been properly or very few have been properly studied and evaluated. And you know, many of us are really impacted from those toxins. Whether they're heavy metal toxins, pesticides or herbicides, or these endocrine disrupting chemicals which include like the bpa, the phthalates, the parabens, triclosan, herbicides, pesticides, ddt. You know, there's so many. And you know, we are not studying to make sure that they're safe for human consumption. There's just, it's really, I think that that's probably the biggest reason we are seeing so many more young women with breast cancer.

Yeah, I mean, you know, we, I think we delude ourselves in thinking that we're growing up on the same earth that our ancestors did, but we're not. Like, we're not living on our mother's earth, we're not living on our grandmother's earth, we're not living on anything like that. And, and the amount of toxins that we have to process on a daily basis is exponentially more than even 10 years ago.

Yes, yes.

And so we are definitely living in this like, ever increasingly more toxic world.

Help. And we have this, like, our body has this ability to detoxify. You know, it does. You know, we sweat and we, we, we urinate, we have, we pass stools, you know, we've got our liver, we've got a lot of things that help us detoxify, but it can only do so much. Right. And so, you know, if that, if our bucket overflows, then, you know, it's really, it's impacting, it's really concerning. You know, it's impacting just our overall health and well being. And I think that that's why we're seeing an increased risk of breast cancer. But we're also seeing an increased increased risk of colon cancer in young people, which is significant. It's a significant shift in change. Just, I mean, just the fact that they've lowered the recommendation to start screening people from 50 to 45 in terms of colon cancer. Same thing, you know, younger and younger people. And, and so we've, you know, we can, there are things we can do that can support our body's detoxification system, but we also have to work on a, on a more global, larger scale to work to lower these toxins we are getting exposed to.

Yeah, absolutely. I agree. And I think that just taking colon cancer as an example, that is definitely a direct indication of our diet because we know that, you know, that colon cancers are due to direct exposure to toxins from the diet.

Yes.

And you know, that is local chronic inflammation that is there time after time. And we see it with a number of disease states. Like, you know, we can predict someone with, with uncontrolled ulcerative colitis. We can predict that they are going to develop colon cancer after a certain interval of time because that chronic inflammation is just there over time.

Yeah. Cancer likes to grow in the face of inflammation. Right. So, you know, one of the things when, as a clinician. Right. One of the things we look at when I'm looking at a patient is, I'm saying, what are their levels of inflammation? Are there signs that they have inflammation in their body? Because if there is, that's an area I really need to focus because if I can lower that inflammation, I can help create a terrain where cancer is less likely to grow. So there's a lot.

What kinds of things are you looking for?

So, you know, I'll do blood tests. So we'll look at things like high sensitivity C reactive protein and the ESR or SED rate. We'll look at situations where the patient has symptoms of inflammation which could be anything from eczema to acne to digestive issues. You know, we will look at things that measure levels of nutrients that help lower inflammation. So things like Omega 3 levels, which Omega 3s are such a great anti inflammatory food. And when people don't get enough of that, they're more pro inflammatory in their body. And so we balance and improve omega 3 levels. We can look at things like markers of dysbiosis, which can be, you can have markers of dysbiosis, which just means an imbalance in the good and bad bacteria that could be in the mouth. Right. That's a place where people can get a lot of inflammation, but it can also be the digestive tract or the urinary tract. Right. They've even looked at breast tissue and they know that there can be dysbiosis in breast tissue that has been associated with, you know that we see that when women have breast cancer, the, the microbiome in that breast tissue looks different than when breast tissue is removed. Let's say if somebody has a breast reduction surgery and there's no cancer there, we see shifts in the microbiome. So those are, those are all sources of potential inflammation in the body. Yeah.

What about, are there any physical signs that you look for?

Yeah.

Like do you look for truncal obesity or anything like that?

Absolutely. Right. So when you, when you do one of the things, when everybody comes in to see me, we get a waist to hip ratio. So a waist hip ratio looks at the amount of weight somebody has around their midsection. And one of the things that gives us a sense of, of if somebody is carrying too much weight around their midsection is that waist hip ratio. For women, you want your waist hip ratio to be less than 0.8. And so if you have too much weight around the belly, around that waist, then that can indicate that you have too much visceral adiposity. And what that means is just too much Fat in the abdomen area. Right. And that fat in the abdominal area around the organs is very inflammatory. It's associated with insulin resistance or metabolic syndrome or pre diabetes. All of those words are used to describe the same thing. But that, but that, that fat around the belly, it's just sitting there like we think, oh, we've got fat, it's just sort of hanging out. We could just liposuction it away.

Yeah.

But know that that fat is actually very metabolically active. It's doing all sorts of things and it's actually creating inflammation so it can, it can cause higher levels. That fat can secrete these pro inflammatory markers that can increase inflammation in the body. And so it's not just sort of, of just hanging out, it's actually producing inflammation in the body. And one of the, one of the ways we work to lower inflammation is lowering that waist hip ratio. Right. And so lowering insulin resistance and lowering that waist to hip ratio because, because that really will lower inflammation. And we can see, sometimes people see reactive proteins will go down, sometimes their blood sugar and insulin will go down when they lose that weight around the belly. And that is that like, you know, how you started at the beginning. You know, breast health is heart health, is, is, is brain health. Right. Lowering your waist up ratio is one of the best things you can do to lower your risk of breast cancer, breast cancer reoccurrence, as well as lower your risk of heart disease and stroke and diabetes. And so it's just such a great, you know, great thing to measure on yourself and kind of get a sense of where you're at and, and how are you doing.

So I want to, because you started to talk about insulin resistance and, and lowering your insulin resistance when you, when you lose that visceral adiposity. Well, what does that mean? Why, why is insulin relevant? Why do we talk about insulin resistance?

Yeah, so insulin is a hormone that the body makes that, that when, after your, after you eat your blood sugar goes up, up and the body produces insulin. And insulin is a hormone that helps take the, you know, take the blood sugar and get it out of the, of the blood and into the cells for processing. What can happen in states of inflammation and excessive calorie intake and under exercise and toxins is we can develop what's called insulin resistance. And that means we don't, our body, our cells don't listen to the insulin as well as it used to. And so what ends up happening first is we start to get higher and higher insulin levels. And so I'm always checking Insulin to see how insulin resistant somebody is. But you get higher and higher insulin and what that Insulin is a growth hormone. Insulin causes us to gain weight, Insulin causes us to gain weight around the belly, but it has also been associated with the growth of cancers. Insulin resistance is, is definitely tied in. It's a major cause of breast cancer, also uterine cancer, lung cancer and other cancers as well. But high levels of insulin is a real concern and that's why we talk about it so much, because you can really control that with lifestyle. You can improve your insulin sensitivity, you can lower your insulin levels when you choose a diet that is lower in refined carbohydrates, that's lower in simple sugars, that is more of a balance of healthy fats and protein and fiber to balance your blood sugar. You can also improve your insulin sensitivity by exercise, improving your lean muscle mass and getting in both strength training and cardiovascular exercise. You can improve your insulin sensitivity by getting enough sleep, by getting those seven to nine hours of sleep a night. You can improve your insulin sensitivity by getting rest and doing stress reduction techniques. And so there's a lot of things you can do to improve your insulin sensitivity that is critical when you're working on reversing breast cancer, lowering your risk of breast cancer, lowering your risk of reoccurrence.

Yeah. And I think at this moment in time we have to be talking about what everyone is using, whether they're admitting it or not are the semiglutide inhibitors. So what I, I, I'm curious, what are your thoughts on those? I think that we probably don't have enough long term data for the non diabetic population, but that hasn't stopped people from using it.

You know, as I mentioned earlier, I've been in this field of weight loss for a lot of years, like working with people to help them with weight loss. And so, you know, I practiced when fen phen was around and then I practiced and we did that Fen phen was bad where we were, we were, you know, getting people ready for gastric bypass surgery. And you know, I mean, so I think that, you know, the Ozempic and these medications are now the new thing that everybody's excited about. And yeah, you know, for some situations they, they work, people do lose weight. But I have, I have a lot of concerns. I think my first big concern is what happens long term. And we just don't have enough data on that. And anything that you're going to say, okay, this person has to be on forever is a, is a big concern to me. Or if they, if they stop it, they start to gain the weight again. You know, that's not really helping us at all. My other big concern is the amount of lean muscle mass that people may lose with these medications, which then just sets them up for a worse metabolism afterwards. And so, you know, every, we always want a quick fix. And this is just another one of them. It doesn't mean that I don't have any. I mean, I do have patients that are on it. I have situations where you go, okay, let's, let's use this as part of a comprehensive approach. But it's the minority because I think we have to think about this differently because you really want to have long term, sustained, healthier weight management.

Yeah. And I think that's the biggest problem is that it's not being used as part of a comprehensive approach. It's being used as a single solution. And so people are not making lifestyle changes around it. They're not using the opportunity to learn how to nourish themselves properly. And it's basically like a starvation diet. And I mean, I, I don't have patients on it, or if I do, they're not telling me. But I don't think that that's the case. But I do know a lot of people in my community that are on it and it is, is very effective at weight loss. But I, I'm certain that there's going to be big ramifications because people are not changing the way that they eat. They're just not eating.

And if you lose a lot of weight quickly and you lose a lot of lean muscle mass, then what happens? Right. Then your metabolism slows down completely.

Oh yeah, it tanks.

And then to maintain that weight loss, what do you need to do? Right. And that's the biggest question that, you know, how are we going to help people maintain this weight loss long term? I don't know. I don't know how that's going to all play out. But I do think there are a lot of concerns. You know, there's been concerns about the amount of lean muscle mass that people lose. There's concerns about changes in, you know, increased risk of depression. And I'm sure there's changes in the microbiome that we don't appreciate.

Yeah. And I, I mean, I think that, that they're also coming out with pancreatic concerns because it, it basically stagnates the, the pancreatic secretions. And there are real and genuine issues with it because it is having profound effects on physiology and they're not all positive, right?

That is for sure. Yeah.

So I want to transition a little bit to talk about detoxification because you mentioned that there are lots of things that we can do to detoxify. And there is a lot of talk about hormone positive cancer and whether or not that is an issue with estrogen dominance and whether or not estrogen is actually driving the cancer or if estrogen is just, you know, a part of the picture, just like estrogen is a part of the picture with normal breast tissue. So can you talk a little bit about our hormone synthesis, our hormone metabolism, how we're breaking them down, what methylation has to do with all of this? I know it's a big question, but let's try to tackle a little of it.

So, you know, we do know that there are some variations in our genetics that influence how we break down estrogen. Right. And the, what forms of estrogen that, you know, how, you know, how our estrogen gets broken down and into what forms. And, and there may be some forms that are more carcinogenic potentially than others. And so the process of, of how your body handles estrogen is multifold. Right? It's, you know, what, how your liver processes it, how you then get rid of it in the digestive system. And that is what's also important there to recognize is that it's not just the body's estrogen that we're talking about, it's all of these xenoestrogens from the environment that we have to get rid of as well. Right. So we were talking earlier about xenoestrogens or toxins. So xenoestrogens are toxins from the environment that can impact the estrogen receptor, that can impact how our hormones get metabolized, that can impact all sorts of things regarding estrogen. And so I don't think we have a clear, I don't think we have a clear understanding of how those are interlayed with our own estrogen and impacting risk of cancer. Of course, I think the toxins are huge, are a huge issue, and I think that's really where we should focus. And when I, when I really look at most women who come to see me, I do think there's a, there's a chunk where I'm really focusing on insulin sensitivity and lifestyle and weight loss and lowering their percentage of body fat because that helps with decreasing aromatase activity. And I mean, there is definitely a group of women, but I think an even larger group of women that I'm working with, I'm focusing on how do we help their body detoxify, and part of that is how we metabolize our own estrogen. But I think an even larger part of that is how do we handle all of these toxins from the environment that are also impacting estrogen receptors.

And being metabolized down the same pathway? Yeah. So we're really, like, increasing the burden on our detoxification system significantly, 100%.

Right. And so we. We work with women to talk about decreased exposure. Right. So how do you have a lower exposure? You know, you read. You know, you can read labels on your personal care products and make sure they don't have parabens in it. You can avoid using plastic, and you definitely don't want to store your food in plastic. And you don't want to heat in plastic.

Right.

You want to store in glass. You know, use glass water bottles or stainless steel water bottles. Right. I really work with women on that. But then I also think about, okay, what can we do to support the body's natural detoxification systems? Because. Because a lot of women who are struggling with cancer is. We are seeing issues with how they're detoxifying. And so we work like, let's support the diet with getting in enough fiber, because fiber helps with binding toxins in the gut. Let's support the diet with getting in a lot of cruciferous vegetables, because they're rich in sulforaphane, which then helps the body with production of glutathione, which helps the body with detoxification. Glutathione is this master antioxidant detoxifier. And you get a lot of that, the sulforaphane, from things like broccoli and broccoli sprouts and Brussels sprouts and kale and cauliflower. And we know that the sulforaphane in here is just phenomenal. It's so potent to help the body with production of glutathione, but also can help us. Us epigenetically, which just means, you know, the way that our genes express themselves and can help with improving tumor suppressor gene production, which helps suppress tumors. Right. So we really work with people to get in more of these very powerful detoxifying vegetables. For some, like, every day, a cup or two every day. Broccoli sprouts are really fun because they are even higher in the glucosinolates, which go on to make sulforaphane. They're even higher than actual broccoli. And you can grow them at home.

And in two weeks on your windowsill.

Exactly. And you can throw them in a salad. And it's really a fun, fun thing to start to incorporate. And for some women, this is where we'll supplement, right? We might supplement with extra sulforaphane, but that I think is a very critical to help with. We are learning so much about how phytonutrients, these components in our plant foods, really support so many aspects of our health by lowering inflammation and supporting detoxification. And so, you know, working with people to say, okay, how can I get in more organic plant foods? You know, organic. I'm going to say it again, right? Plant foods that are really rich in all these phytonutrients, really helping people reach for age 8 to 12 servings of phytonutrients a day. So think about all the colorful foods, your vegetables, your fruits, your spices, your teas, your coffees. They're rich in these phytonutrients that are really powerful. They've even shown that these phytonutrients can block the negative impact of plastics on cancer cells. So they can show that plastics can cause cancer cells to grow and metastasize. Right. So that bpa, but that actually these phytonutrients can block that action from occurring. So they're really powerful. And that's where we'll focus a lot. Fiber, vegetables, phytonutrients, sweating, sauna use, exercise, massage, lymphatic drainage, Epsom, salt baths, all these things to support the body's natural detox detoxification system.

Just out of curiosity, what do you recommend people do for water?

Yes, so I recommend filtered water and then care, you know, carrying it in glass. But I, you know, I, I like the Berkey filters that are on the countertop if you need one on the countertop, because it's a, it's, it's, it's a stainless steel filter. Or people put a filter on either their, you know, their sink or a whole house filter.

And you're talking about reverse osmosis.

I am just talking about regular filters, like a filter. My only, my one concern with reverse osmosis is the amount of minerals we're pulling out. And so I know that some people will replace them. But, but that is my one concern in that area.

I was going to ask you what you recommend for mineral replacement because there are a lot of people who have install, installed RO filters either underneath their sink and using that for, for drinking and cooking, or they've put it through their whole house. So for those people, they do need to replete Mineral minerals, they do need to replete minerals.

And I am not sure on what is the best way to do that. Like, I don't. I'm not up on like, are they. But that is, I think, a very important consideration. And why I always. That's not always my first line of recommendation. Because of the recent mineral content.

Yeah, makes sense. So in, in wrapping up, I, I'm curious as to two things. First, what do you think the big needle movers are for people, like, for someone who has, you know, just got a diagnosis and knows that they have a lot of things to change? Where are they going to get the most bang for their buck when they're just starting out? Where's their big win?

So I think that one of the largest, again, we have to take a personalized approach. So this might not be true for everyone, but if you look at our population, probably the biggest thing that people can work on is insulin sensitivity. And so lowering blood sugar and lowering insulin, lowering that waist to hip ratio, getting in daily movement and exercise and cutting out sugars, sweets, refined carbohydrates, cutting way back on alcohol. You know, anything you can do to lower blood sugar and insulin. I think, you know, that's not true for every patient that I see that is dealing with a new breast cancer diagnosis. But there is a lot of people that, that's where we really have to focus on.

You know, I have to say, even the women who are not overweight, they're not, they're not. No one would ever consider them fat. I am seeing insulin resistance in those with, with new diagnoses, women who I would never expect to see this. And yet I get their first screening labs and, you know, their fasting glucose is, is 116 and or even 99, and their fasting insulin is 10 or 12 or 15. And you would never know by looking at them and by knowing their height and weight that they had insulin resistance. But it's there.

And that's because the height and weight and BMI is missing a lot of important information. And so as we spoke about earlier, you can get more information with the waist hip ratio. And you want that, that to be less than 0.8. You know, to get a waist circumference, you go between your lowest rib and the top of your hip, and that's where you put the tape measure. That's your waist. Your hip is in general, you can just kind of get the biggest circumference around your hip area, but you want that to be less than 0.8 and that can help us, but sometimes even that misses women. And so we are seeing more with, you know, more. More of us that are even thin on the outside, but fat on the inside. Right, so. So guinea fat.

Yeah.

Right. And so, you know, BIA technology or a DEXA body composition, where you look at somebody's percentage of body fat, where they're holding onto that fat, can be another layer. But I also, I agree with you. I check a fasting insulin on everybody. I would like that to be around 5. I get concerned when it's 10 or above, but I sometimes get even a little concerned when it's like 7, 8, 9. Like, sometimes we need to do a glucose tolerance test with insulin levels to get a sense of how insulin resistant somebody is. And a fasting blood sugar, you want to be definitely less than 100, but 90 or less probably depending on the person. But you really, you know, I think you're absolutely correct. We do see a lot of insulin resistance out there, and it's a major driver of all sorts of diseases, including. Including breast cancer. And I think you're right. I think that saying, okay, this is where for so many people, we can focus. And so when you look at your meal, what that means is, you know, not choosing. I always. I used to call this meal, you know, we used to call it pancake headache in college. Right. So, like, we'd go out on a Sunday morning and you'd get pancakes and orange juice and syrup. Right. You know, that is like the worst thing you can do because it just causes such a spike in blood sugar and such a spike in insulin. Right. Of course. That's really not good. So you look at your plate and you want to have half your plate be full of vegetables and then have some protein and healthy fat. So then you'll get healthy fat, fiber, protein, and that will slow the digestion of your food. They'll slow the rise in blood sugar, it'll slow the rise in insulin. And then we need to be working to increase our lean muscle mass because that's one of the reasons you're saying that you're seeing women who you might. Might. You're looking at them like they should be fine, but then you do tests and they're not. A huge reason that is, is because they don't have enough lean muscle mass. Mass. You know, they are just. We need to improve. We need to do strength training and exercise and increase our lean muscle mass so we stay. We stay sensitive to that insulin. If you still have insulin resistance and you're doing everything Right. Regarding exercise and diet and sleep and stress management. And you still have insulin resistance, then it's toxins or the microbiome. Right. Then you have to go, okay, what am I missing? There's some toxin that could be doing this. There are toxins that BPA has been shown to cause insulin resistance. Not only breast cancer, but insulin resistance. And we know that when the microbiome is out of balance, it can drive insulin resistance. So, you know, there's sometimes other reasons that's going on, but, but so many of it, you know, people can really start to, okay, I gotta pull in. I gotta cut way back on the alcohol, you know, way back on the sugars that are just in every food product out there.

How do you feel about CGMs?

So continuous glucose monitors, I think, can be really helpful for a lot of people. They are, you know, they, they help people say, oh, yeah, I thought I was doing a good job, but then I ate this meal and I got this really big spike in blood sugar. So I think, I think for a lot of patients, they're really, they give, they are very helpful. They give them some good feedback and they help remind them that, okay, that meal didn't have enough fat and protein per carbohydrate. It helps people learn how to get things under better balance because so many of us are still under those pyramid recommendations and think we need, you know, all of those whole grain goodness. We need all that grain and bread and pasta and oh, my goodness. So, so I think, I think that the CGMs can be helpful, but they're not giving us all the information. I do have some patients that are very insecure, insulin resistant, and their CGM is not bad, but when we look, they're actually producing so much insulin to keep their blood sugar normal. And so it's, it's not perfect for everyone. For some people, it's, it's missing all. Some. It's all that information. So it, it can be helpful, but it's not giving us all the information we want. We would need it to have also insulin levels for it to be a perfect.

Yeah. Is that coming?

Not that I know of, but I hope it does.

Yeah, me too.

Yeah.

Okay, so let's finish up with what labs do you order universally on everyone that has breast cancer? And what labs, what are the labs that you think everyone should know about themselves?

Okay, so let's think. Definitely get a 25 hydroxy vitamin D, everybody. You know, you want that at, you know, probably 50 to 75. Maybe, you know, you could even you know, some people are arguing a little higher or. But somewhere in there you want your 25 hydroxy vitamin D level, you want your C reactive protein. So high sensitivity crp. That's very important to look for signs of inflammation though. Don't. I don't want people to think just because they have a normal CRP they have no inflammation. So it's sometimes it doesn't always pick it up. You want to know your fasting blood sugar, your fasting insulin, we kind of get, went through some numbers there. I often will get a hemoglobin A1C because that will tell me their blood sugar over the last three months. I like looking at zinc and copper ratios because some people are not getting enough zinc in their diet or not absorbing it well enough. And that's really important for their, their immune system. So I'd like that to be around one to one if possible.

It's also important for blood sugar balance, isn't it?

Yes.

Yeah.

I look at homocysteine when I'm trying to get a sense of people's B vitamin levels. So you know, I love homocysteine to be around 8. Homocysteine will increase if somebody's not getting enough B vitamins. And the B vitamins that most people need are the methylated B vitamins. So like methylfolate.

So we're talking about B9, B12, which is found in mostly animal foods. So if you are a, if you are mostly plant based, you often have to supplement with B12. And we can talk a little bit about how you prefer to supplement people because I know sometimes you want to use a methylated form of B12 and sometimes you, you don't. Some people can't respond to that. And then of course you're talking about B6 as well, all being involved in the, in the methylations.

Like I think that in general, like for folate I always want it to be methylfolate in general because that it's easier for people, every person to utilize and it's better for us. And most food is in the methylfolate form anyway. All your.

So when you're, when you're eating your leafy greens, that's methylfolate.

It's pretty much, it's most of it's methyl folate and the synthetic folate is folic acid. And that's one that we're concerned about because not everybody can utilize it. And there is some concerns in the whole cancer realm regarding that. Yeah, you were asking about curiously, I.

Don'T know why it Is that we universally give that to pregnant women. But that's a, that's a talk for another time. Cheap.

It was cheap and you know. Cheap.

Yeah.

Yes.

Okay, so B12. Tell me, tell me what you, what your thoughts are around B12 supplementation.

There are some people that get more anxious with methyl B12 and so we have to watch that. If they need more B12 but they get anxious with the methylated form, then we'll use like a hydroxy B12 or an adenosyl B12. So a different form. You can sort of get a sense of that with some genetic SNP testing if you do it. But also the person will tell you, they'll, you know, you have them try it and they feel more anxious.

It's amazing. And almost immediate.

Yes, yeah. And, and, and also dose dependent. So sometimes people can get away with like a B complex with B12 and they're fine. But if you have to give them much more because of their homocysteine or whatever, then, and you're giving a higher dose, then they'll be like ah, yeah, yeah, yeah.

They just get terribly anxious. So are you, are you?

I do like looking at genetic testing. So those low penetrance genes, so like the high penetrance genes are like the BRCA genes. But I will also do a genetic panel that looks at things like methylation genes, comt mthfr, glutathione producing genes, vitamin D receptor genes. So I like looking at a genetic panel. I like looking at natural killer cell activity, oxidative stress markers like 8 hydroxy deoxyguanosine and other markers of oxidative stress. And then I sometimes will do markers that look at dysbiosis because we were talking about how that can influence inflammation and, and, and estrogen metabolism and that sort of thing.

And so out of curiosity, is there a panel that you're looking at SNPs on? Is there one in particular that you use?

Lately I've been doing a, a 3x4. It's a genetic panel that's very good and very comprehensive. Yeah, DNA Health is also a very good panel as well.

And so for the person that is out there, recently diagnosed and you know, I, I feel like they get put on the, that, that conventional medicine pathway so fast. Right. And they're, they're basically, you know, given a diagnosis and signed up for surgery. And what advice do you have for them?

You know, I think it's important to get, get other opinions, you know, get a second opinion, get a third opinion, really learn about what the recommendations are and, you know, ask a lot of questions like, how much is this going to decrease my risk? And, you know, so they can get a better understanding of how necessary the treatment recommendations are.

Are.

It's sometimes it's tricky when there are so many different recommendations coming at you. So, you know, taking some time, doing some reading, reading your new book, which is coming out, which I'm so excited about, which has so much good information in it. I've been so lucky to have the opportunity to read it to, to read it already. And so, you know, it's really exciting to see all of that great information out there so people can get a, a better comprehensive understanding of what they're being told. Because it can be so overwhelming.

It can be. It can be. And yeah, I mean, that's my message to most everyone is, though, breast cancer certainly feels like an emergency and it is certainly an emotional emergency, but it is rarely a physical emergency. And I do talk about when those exceptions are. I mean, if you have inflammatory breast cancer, that is something that needs to be dealt with right away. If you have metastatic disease and you have an impending fracture or you already have a fracture, that's certainly something that wants to be dealt with right away. And if you have metastatic disease to your brain, because the brain is a fixed space, you know, our skull is a fixed space, so it does not tolerate a lot of swelling there, that. That is an emergency. And outside of those three circumstances, you have time, you have time to investigate, you have time to understand, and you deserve to understand, and you deserve the time and the space to ask questions. You deserve answers to your questions. And, and this is really the time to build your team and to think about what's right for you, because this is a different disease for everyone, and everyone arrives at it for a different reason. And there are lots of things like the, all the stuff we talked about today, there are lots of things to contemplate that are not part of that conventional medical paradigm. And it's not that. That, that those doctors don't care or are not interested in doing the right thing for you, but that they've been trained to think down their tunnel, and their tunnel doesn't include a lot of things.

Yeah. And you know, I think like you were mentioning taking that time and asking questions and then finding the right approach for you is really important. Is really important. And if you're not getting the answers to your questions, ask somebody else.

Right? Yeah. Yeah, I think that's a really good point, is that, you know, your relationship with your doctor is going to be a very long term relationship. The vast majority of women will survive their breast cancer. And you, you want to make sure that that relationship is beneficial for you, is meaningful for you. It's, it's positive for you because you don't want to invite more negativity. Life, certainly not around the time when you have a breast cancer diagnosis or any other time for that matter. So, Dr. Boham, thank you so much for being here for, for so vulnerably and beautifully sharing your story and your experience with us. I know that the women are going to be so grateful to hear it and relate to it so much and for sharing your experience as a physician and the wealth of knowledge that you bring.

Well, Dr. Jen, it has been great to be with you and all of your listeners as always. So thank you so much for having me.

Where can people find you?

So I am at the Ultra Wellness center in Lenox, Massachusetts. That's where I practice. So ultrawellnesscenter.com you can get more information. I have my own website, drboham.com and on Facebook and Instagram, it's Elizabeth Bohammdash.

Awesome. And we'll make sure to put all of that in the notes. I thank you again for being here today, for sharing the time with us and I'll see you next time. It's Dr. Jen.

Thank you.

Bye for now.