Episode 95: Integrative Approaches to Breast Implant Complications with Dr. Nasha Winters

Foreign Dr. Rob Whitfield, the board certified plastic surgeon specializing in explant surgery Breast implant illness is a topic that is not often talked enough about, especially in medical community, but is something that affects many women. In this podcast I'll be discussing the latest research, treatment options and personal stories of women who have undergone explant surgery in an effort to heal breast implant illness. In this podcast, we'll explore the symptoms of breast implant illness and delve into the latest surgical techniques for explantation and the recovery process. Whether you are currently experiencing breast implant illness or are considering explant surgery, this podcast is a valuable resource for anyone looking to take control of their health and wellness. So let's dive in. Today I have on the show Dr. Naysha Winters, a naturopathic physician, is a pioneer and expert in metabolic health with a specialized focus on oncology. Renowned for her innovative approach to integrative cancer management, she is committed to transforming the landscape of chronic health disorders through research and education, advocacy and innovation. Transitioning from clinician to educator, Dr. Winters has built a reputation for expertise in integrative metabolic oncology and evidence based metabolic therapies, making her a highly sought after speaker. She has developed clinical educational programs that connect hundreds of clinicians, equipping them with the knowledge to effectively implement vetted integrative therapies in cancer management, thereby extending patients lifespans and significant improving outcomes. As the co founder and visionary behind the nonprofit Metabolic Terrain Institute of Health, Dr. Winters shaped its mission, drives research priorities and spearheads fundraising initiatives to support patient treatment. Her goal is to make the metabolic approach to cancer accessible to all, ensuring that more individuals benefit from this groundbreaking perspective. Thank you and welcome to our show, Dr. Winters. All right, I have Dr. Naysha Winters with me today. Everybody who has followed the show for a period of time knows that I did oncology for the better part of 20 years of my career. And so everybody listening. We took care of patients with head and neck cancer, sarcomas, which are tumors of the bone, muscle, tendons, fat and then of course the most dominant form of cancer I cared for was breast cancer, of which my sister passed away this year from and so I had a very traditional training in both oncology and reconstructive oncology surgery. And then I met someone like Dr. Winters who has, you know, flipped the pyramid, so to speak, on that and really has unique insights and a very, you know, transformative approach. So I want her to share with us, you know, what her viewpoints are and what her programs are regarding holistic.

Oncology care first of all, thank you. I mean, Dr. Rob, you are such a gift to so many people in my community, the clinicians and allied health professionals that we train globally as well as to the patients they serve. I mean, you have been a call to prayer for so many, and it's really great to meet someone with your expertise. Very unique, very unique expertise that can. You and I were talking before the recording that basically I often have patients who jump into the frying pan of the cancer space only to jump from one into another of oftentimes dealing with implants from either, you know, surgical devices to rods and whatnot that can have some reactions, reactions in their body or clips in the breast from areas that they could have reactions in the body to actual implants, you know, breast implants. And so I've had a lot of patients who then end up with some form of medical implant illness, only to say to me, boy, this is even more challenging than the cancer was. And so to have a resource and to have someone who first of all believes them is really, really, really huge. And so I'm really grateful for that. And then someone who has something to do about it, really, really powerful. So I want to acknowledge you before jumping into my own story. So extreme gratit.

Yeah, well, thank you. You said something that we got to clarify for the audience because most will not understand this. We live in a huge country, not a little country. So I live in Texas, of which you can play Spain inside. So it's a very complicated equation to get taken care of here in this country. Once you leave a city that's, we'll say a million plus people. So at that level infrastructure, you typically would have a tertiary care center. Now, for everybody listening, that's a place that has a higher level of care. When I say tertiary, they'll have icu, they'll have different integrated forms of care. Maybe multidisciplinary cancer care. Not always, but typically they'll have a cancer center associated with it. But that's a very, very small number of cities in the United States. So rapidly, once you get outside of that, you have a much, much lower level of care. Not a bad level of care, but the lack of infrastructure, it becomes apparent very quickly. And so if you're in a rural area, when I was in medical training, I had to work in a rural area as part of my training. And if someone came in sick, someone came in with a bleed or some kind of sepsis or preceptsis picture or something like that, they immediately called for a helicopter to get that person away from them because they didn't have the infrastructure to support that patient. So for everybody listening, if you get diagnosed with breast cancer and we'll just say you, you don't go into the lumpectomy situation, you opt to have a mastectomy. The most dominant form of reconstruction, if you choose to do that in the United States, is going to be an implant based reconstruction, because that can be carried out at your local hospital and that is a function of the level of care provided in your area. You never would have met something like me, something nice. You never would. Sometimes they call me something. You never would have met someone like me unless you went to a tertiary care center or a cancer center for a opinion, a second opinion, a referral. Because what I did, I performed microsurgery. That was my, you know, I spent my entire. We joked about it last night because I had a bunch of college kids over as a pre Thanksgiving thing, you know, last night. We're doing this right before Thanksgiving and I always have to think like, I spent 13 years training after college.

Incredible.

Wow.

Yeah. Yeah.

So all that time really sets you up to do things that small number of people around the world will do in terms of microsurgery, but even smaller amounts of people will ever know of or engage with someone like me because it's just not going to be that easy to find. It's a numbers game. So we always worked in bigger centers. And when I came to Austin, basically at that point, I had done so much microsurgery, it was more about the instrumentation, which you need obviously, and the microscope, obviously you need a good microscope. And then it was level of care. And you could do it with different levels of care versus having to be where I was at a big center. Like it can be done in different size cities. If you have the people that have experience like I'm talking about, then go to that smaller place and make it happen.

Right. And so basically the majority of folks that you and I see started out in those smaller environments and may and were just given the options of what was available to carry out in those environments. And so not a surprise that you and I work with folks who might have not done the most state of the art or the most innovative or the most. What's the word I'm looking for sort of the most start small before going big, you know, like start, start with something. Like you talked about the micro surgeries or whatnot that are much more finite and more detailed than going in with like kind of the big sledgehammer. If you will, of the. The tools that we had. So that's a really big clarification. I'm glad that you brought that up, because folks, if they're. If they're only in their own community and they see that this is how everybody is getting their care, they just assume that is the standard. They don't even know to ask what else could be, or could there be some harm or some side effects of this. And so when they end up meeting somebody like me, and I'm questioning that initial approach, it's not that I'm dissing the community they were in. I'm just saying, hey, might not have understood that there were other ways to think about this or approach this, or there's certain level of risk potentially involved. And we're all very individual. And no one can know ahead of time how you're going to respond to any one of these things. But certainly if you are responding, you should do something about it. And that's where you and I are. Worlds kind of collide, and that becomes really clear in my world when someone has done the best of the tools they had available to them and then end up with problems coming from that. This is where even you and I, and what you wanted to talk about is just even how our philosophies may be different than our colleagues.

Yeah, the number of cases. First of all, you know, it doesn't matter what type of implant. If you can name an implant, I've been called by the surgeon who put it in to help them when it either got nearly exposed or it got infected or they had to replace something or whatever. You can come up with a thousand explanations of why I got called. And, you know, then it becomes what, you know, can I do to help basically reconstruct an area. And obviously, one thing I did for a long time was just move tissue, almost like an organ transplant from your own body from one place to another. And so the last person to win a Nobel Prize who was A surgeon was Dr. Joseph Murray. He performed the first kidney transplant on Siamese twins, which was not a. I mean, for that time, it's a feat, but in reality, it's a technical exercise for a surgeon to do three things. So a ureter, an artery, and a vein in. Because the immune system is exactly the same. So anytime you're doing an autologous, which is obviously what they were doing in Siamese twins. Transfer, no problem. So transplant as a specialty then becomes a thing, because if they can do it with that, we can do cadaver.

Oh, my God, yeah.

So then tolerance, which you're gonna probably touch on tolerance is obviously the problem here with any implant because we're not tolerant, lack of a better word of any implant. So you get problems.

Yeah. And it's interesting, you know, first of all, I mean, I'm ask you back a question because there's kind of a level of common sense around this, of anything foreign that you place into your body. Your body should have sort of the three R's of immune response. So this moment your body goes, hey, I recognize what are you to the number two, then respond to that recognition. And then number three, remember, you know, it's like, oh, I remember that you're now part of me. Or I still perceive you as a threat or a foreigner or what have you. Those are what should naturally happen anytime something outside of you enters you, right. And your body has that moment of. Well, and again, the way we respond is going to be unique to each of us. So I've always been curious as to the rationale and as someone in your work with breast cancer, I always wanted to understand about the rationale of placing a clip after a known area of interest where there could have been a cancer or a perceived cancer or an area of concern for a future cancer. And we end up placing this foreign metal clip into the breast tissue so we can easily identify it on future imaging and see if something shows up. And as a clinician, it's causation correlation for me has been that routinely if there's going to be a recurrence or a progression, it's happening around that site. Which just intuitively as a clinician I'm thinking, well, is there just a local wound or a local immune reaction or a local inflammatory process that is making that site more vulnerable? Am I the only person who questions that? Because I just wonder, you know, because I see it all the time in dental implants. I see it all the time in, you know, hip implants and whatnot, or rods in bones that were broken or fell apart because of a cancer process or a post radiation process. I see the body will have at some point in time a reaction to that new material. So how do you clinicians. Because it's often life saving, we need those types of materials. But how do we work with or navigate that almost inevitable immune reaction?

I think it's a two porter because clips have been used extensively in surgery for long periods of time. And when I was taught I kind of straddle a very specific timeline in surgery. So I trained from 1996 and till 2002. So six years I trained in general surgery. During that time, surgery changed forever. So surgery for your gallbladder went from being open where you made a big incision under the right costal margin to being done with a camera also as it pertained to breast. I was taught how to do a ratify a radical modified radical mastectomy with a knife, an axillary dissection with a knife only. And in the time I got done training, we had done a trial for sentinel lymph, no biopsy. So everything changed basically while I was in training from one way to another way. Now everybody before us learned the old way, everybody after us learned the new way. We're the generation that everything changed in mid training. So, you know, there were. And there were other things that kept changing. You know, the. Unfortunately the pandemic, it was super frightening to me. I lost my dad in the pandemic. But during the pandemic, I would watch doctors post images of chest X rays that looked like adult respiratory distress syndrome, but they weren't able to treat it. Now, during the time I trained, a drug came to market from Eli Lilly called Zygris, which is a TNF alpha blocker. We trialed it at our place. So I knew, like I'm telling you, things changed in training for me that where somebody would just die with adult respiratory distress syndrome to by the time I finished training, you could stop it. It's progression because it's a cytokine storm and zygous is a monoclonal antibody to TNF alpha. I'm just going to tell you all to everybody, listening changes quick in medicine and then some things don't change at all and mostly their attitudes. So, you know, from a technical standpoint, I just span a very different time. Like things just changed on me from one generation to another generation. I'm super fortunate. I had great teachers. They were not easy people to greatest teachers rarely are.

Yeah.

But I appreciate them all. They've unfortunately passed for the most part. My general surgery mentors have all passed. So. But they taught me about the importance of nutrition, surgical nutrition to keep patients alive. They were the people who when they were trained, that was invented.

Wow.

So I had a very interesting training background that and also most people under you will, you'll understand this. So the day I finished general surgery was the day they started the 80 hour work week.

Oh my gosh.

So for six years I trained in an environment where I was on call every other night or every third night and that was it. There Was no. Every fourth night, every fifth night, go home after call. No way did you have any adrenals.

Left at that time.

The thing is, people trained after that time, not only did they learn all the new stuff, they're not as well trained because there's not enough repetitions to replace what I had. Yeah, so surgery is a discipline that with time, you get better at. Because it's a repetition. It's not a cognitive thing as much as it is a repetition. So much like an athlete gets better by practicing, surgeons get better by repetition or practice.

Suddenly, hours were drastically cut that repetition went with it.

Some people are super gifted. Like, you know, people ask. I'm sure they ask you this, dude, oh, would you go back and do anything differently? No.

Right.

I was meant to be a surgeon, period. End of story. There was no go back and do something different. Now. I would never do anything different. That's. You know, this is what I did. I've transitioned to different things now. Like, we'll discuss in a minute. From oncology and reconstruction and microsurgery for 20 years to now looking at these patients who are having difficulty with implants, specifically in this instance, breast implants, and suffering from what I consider is a chronic inflammatory process of which the implants, you know, part of. I don't get into. And I'm not going to sit and debate what we should call it or. That's not for me to worry about. I got to take care of people. Not. Not debates, diagnoses.

Yeah, yeah, I love it.

However we want to term it, breast implantolis, to me, is just a chronic inflammatory process of which a device is playing a part.

And that's just. I think that's the piece here, is there's just like a level of common sense around that, that of course there's going to be a role of some chronic inflammatory or chronic immune response to anything foreign put into the body, no matter where it is, no matter what it is, just is. And instead of fighting it, our medical system tries to deny it, or ghost patients or gaslight patients or their experience with it. We should be aware that that's just an obvious side effect of what happens. So how do we then support it? How do we then move into saying, well, this is now part of you. Can we work with it? Or do we need to look at getting it out of you? You know, and that's like. To me, those are. It's like a crossroad. Because I've had lots of patients, we've been able to get them to stop Having that hyper reactivity of inflammatory process or immune process and be able to live a long, happy, healthy life with whatever external devices and bits and pieces are in their body. But I've also had patients who we've taken it as far as we possibly can, and the only way to overcome it really is to remove it and then to watch their health really come back on track is something to behold when that happens. And so I'm just curious, doc, why that is such a difficult thing for the medical establishment to recognize and own and be willing to support their patients throughout, whether they can find a way to work with it or to lead to removing it.

Well, when I think of how I kind of got down this path, first of all, anybody who places an implant, especially in a cancer patient, as I did, and then has to deal with them getting radiated and extrusion or chemotherapy and infection, et cetera, anybody who places a device knows there's a heightened risk for an infection and ultimately an explant. We just didn't sit there and I had to go through a long informed consent process when I was doing oncologic reconstruction. And of course we explained implant infection.

At the time. They're sitting in front of you having that conversation, I'm sure.

Right. So I would say, and I have the same discussions whether you are a patient getting a reconstruction or a cosmetic patient getting a augmentation and lift or whatever, because I didn't have, and it wasn't of two mindsets. A device goes in, a device has a lifetime. Sometimes it's shorter, sometimes it's longer, depending on your treatments, exposures, lifestyle. There's all sorts of factors that will affect how that device interacts with your body. And I'm not even talking about genetics because I'm old enough and you're old enough to know. There was no genome project when I was in school. The Internet wasn't a thing and they still had books in libraries.

Yeah. Really, Imagine that.

Yeah, yeah.

Decimal system back in my day.

Yeah. So, you know, for us, I mean, and of course it was a cancer patient who enlightened me in 2016 by showing me what I don't know, like always will be humbled by the things that you just can't figure out routinely by all the methods and all the tricks and all the experience and things you have. But especially came to me in 2016, wanted to go flat, had a implant based reconstruction from Atlanta, nothing wrong with it on physical exam, no caps or contracture, no redness, no swelling. Labs were all fine. And she's like, I just want, I'm done with this. I'm like, okay, she had fatigue. A lot of people who have, you know, cancer related treatment have bone marrow suppression. Leaves of fatigue, you know, that's nothing new. Did her explant and I sent everything off for path as I normally did, all the capsule material, the mastectomy scar, all the basic things I did for 20 years for oncology. And it came back, no evidence of any recurrent cancer. First and foremost, most important thing. And second thing was she had an E. Coli infection. So for everybody listening, this is a super old way to look at an infection. It's called how many bacteria per high power field are visualized. And hers is 10 to the 6. So that's greater than 100,000 per high power field which is an infection. And that was done at a hospital because she had a underlying medical condition and she had to be kept overnight. So Dr. Winters knows what that means. That means I, with 20 plus years of experience under my belt missed a breast implant infection. And my sister at that point was a breast cancer survivor. I would have been, you know, she passed away this year, but I would have been supremely agitated had somebody missed the infection. So how does that really happen? Well, we published a paper recently that shows in almost 700 samples that on PCR testing, which is a much more specific and sensitive technique, that 29% have bacterial contamination. Staph epi, Ketobacterium acnes are the dominant species, all of which produce a biofilm. Paper was published earlier this year that shows that that interaction between the bacterial biofilm and the oleic acid in the breast creates oxylipin 10 home, which actually can lead to symptoms. So, you know, we have a cause effect relationship. Is it going to be the answer in every single patient? No.

Is it 30% of them? It could be, yeah.

And of course now I get asked, is it available as a commercial test? No, it's not. But I've introduced the scientist to the company that can help hopefully bring it to market. And so there really is very little for a opposing viewpoint to stand on with any credibility to me.

Got it.

So I don't, I don't listen to patients to figure out and assign a diagnosis. I listen to patients honestly to hear how they detox, what level of symptomology they have. And they've already decided to have an explant with me. I'm not telling anybody to get explant. I never would do that. You know, they're asking for an opinion, but Nobody sits in front of me because nobody wants to come see me, right?

No, they're not like, this is an exciting person to go visit. No, they. You're kind of a last resort for folks.

That's right. It's no different than the cancer population. They didn't want to come see me. In fact, I was the last person a cancer patient had to see. I would see them on Friday afternoons routinely after they'd been bombarded all week with visiting med on and radonk and getting PET scans and, you know, whatever, done bone scans and, you know, all this stuff. And then I'd have some really, really dressed out person sit in front of me and have to listen to me for an hour talk about reconstructive surgery and what all the, you know, risks and benefits were to give them the best information to make an informed decision. So I look at it always this way, Dr. Winters. Like, I'm not here to do anything but educate people in the best way possible to make an informed decision. I don't decide whether or not you should have surgery if you're in front of me. That's basically been your decision. Because nobody wants to sit in front of me in Austin or online and talk about anything related to explain, which.

I so appreciate that you're willing to have those conversations, those hard conversations that by the time that person has to reach out to you, they don't want it either. But they may realize or may feel that it could be their only hope. And so I think that's a place where we have a lot of resonance, too. Like, no one really wants to be talking to somebody like me as well. But I'm like you. And I think people assume that because I'm a naturopathic doctor that I'm just going to be totally pro alternative medicine. And that's the only thing I'm interested in having a conversation about. I think people are often really surprised when they meet with me that whatever is right for that person, first of all, they come in with an idea of what they want to do. I have to listen very carefully and help them determine if that's truly a good fit, despite my opinion about it. Right. That's my job is the methodology I use of test and assess, never guess is really important to me. Like to say, well, hey, you're being told to do this treatment, or you're being called to do this treatment. Is that a fit? And do we have ability to measure whether that's a fit or not? And then what can we do to support you? For whatever treatment you're doing. That's the philosophy in which I come from. Instead of, it's not about a protocol, it's not about my beliefs of what the patient should do or not do. And then to help educate and inform and empower them to make the right choice for themselves based on really good, sound data, as well as their own intuition and as well as their own mindset of where they are in that time. And so, you know, for someone who's gone through my own journey over, oh my God, we just hit over 33 years ago, a terminal cancer diagnosis where standard of care did not have anything to offer for me. I was too far gone. It was too missed, understandably. You know, in fairness, what 19 year old in 1991 were you expecting to see a terminal ovarian cancer diagnosis like that? Talk about the unicorn. We talk about that in medicine all the time, right? I mean, that would have been an absolute zebra unicorn of that time and era. Unfortunately, today it's a lot. It's still not normal, but it's a heck of a lot more common to see younger and younger women with that same diagnosis, which has pulled so many gynecological oncologists out of retirement. One, in fact, that I work with very closely who's come through my training. He got back into the game because he had four girls under the age of 10 with stage 4 ovarian cancer. How do you leave on a high note in your career when it's just getting worse and you're one of the few people in your entire profession wanting to understand why before you can rest your head on a pillow at night, you are curious to say, I want to do something differently. I want to understand why and I want to do something about it that is not easy to do, especially when you've committed an entire career to something that's no longer making sense. Some will continue in this concept of kind of cognitive dissonance because it's just way too painful to consider something else because it kind of invalidates everything you'd ever known or learned or applied. But it's also like, oh, crap, I have to learn an entire new language or an entire new skill set. And you know, folks like that, like me, like you, we learned in our. I mean, I've now been in my career for over 30 years as well, of we learned something new. You don't know what you don't know until you know. And once you know, you have to do better. Pretty, pretty simple law that I abide by. And I Wish that all clinicians and allied health professionals abide by. But it's sometimes not as easy. Can you speak to that? Because you're likely perceived as an outlier or somebody rogue or someone alternative, despite the fact that you're just following good data yourself. Can you, can you tell me how you deal with those impasses from mostly from colleagues or from industry over patients?

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Exactly.

And coupled with just the mutations, not just BRCA but CHEK and all the other mutations. But then I looked and more interested in somebody's exposures. Like what you eat air, you breathe fluid, you drink food, you put in, you know, your system and that coupled to your genetics and how you detoxify those, I think you know, the way we feel and and approach it now is much more in line with not how I was taught, but more of what we should be talking about with functional genomics. And I don't quite understand the lack of mainstream acceptance of that in medicine.

Yeah, yeah. Basically it's interesting because you and I would have been. I started medical school in six and you know that process. So you were a couple years, I think ahead of me in that time frame. Maybe you're right around the same time. But we watched a lot of changes. I mean, even for me in 96, I was one of the first, first people tested for the BRCA gene because of my previous diagnosis in 1991. And we didn't know then we still are learning things. In fact, just so your listeners have a sense, you know, a lot of people might know the BRCA gene is like the Angelina Jolie gene. And some people hear they have BRCA and they freak out. And you know, there's definitely a higher incidence type of pattern. But what people don't understand is a BRCA mutation is just simply a mutation of how our body repairs our DNA. It doesn't repair it as well as the average show, but it impacts less than 5% of all breast cancer or other cancers in general. It's less than 5% of the population have that particular genetic hiccup. And the other side is that genetic hiccup has zero impact on the overall survival. And so people have this assumption that it's somehow way more dangerous and way more life taking and yet it isn't. And so this is one of those opportunities of where I start to teach and educate about. My philosophical understanding is that there's a lot of things we can do to support our body's ability to protect and, and clean up its DNA, you know, and support the repair which you just alluded to. A lot of that comes from our dietary lifestyle choices. And you know, maybe not living right underneath a phone tower or walking through lots of, you know, going to have a lot. Which ironically, those patients are also the ones told to have a mammogram every six months despite the evidence saying, you know, this is a very fragile genetics to ionizing radiation. So my rocket patients, I'm always telling them like, please know it's time to, to other imaging. Thank God one of our colleagues, Jen Simmons, has brought a really powerful one to the market and a couple of really high powered ultrasound devices and other early diagnostics, non, non radiation imaging that is very sensitive and specific is out there today, which is like a gift for all of us in this industry of understanding and then also helping patients understand, like, well, let's support your DNA. Let's protect it. The other part is that we've had for from 1914 on to today, still, the driving force of cancer is that it is just a genetic mutation, that it's just the genes gone amok and it's simply bad luck and there's nothing you can do. Well, it's not to say the genes don't have a role, but it's not where the process starts. And a few years after Dr. Bovary's understanding of cancer as a genetic disease, a few years later, Dr. Otto Warburg. If anybody wants a really interesting read, read the book Ravenous by Sam Apple, which gives a lot of the history about what was happening in medicine at that time and specifically with this kind of controversial character, Otto Warburg, at that time, and how his theory of cancer as a metabolic mitochondrial disease actually foreshadowed Dr. Bovary's work up until the 1950s. So from early 20s until the mid-50s, until a woman who Watson and Crick took credit for discovered the helix of the DNA, that's when all of our energy swung back, the pendulum swung all the way back to, say, genetics, genetics, genetics. So when Dr. Rob here is saying, hey, the genome was being mapped while we were in our residencies, right. It was coming out. We were so expecting and hopeful that we'd find, here's the one gene, here's the one treatment, and cancer is gone.

I just tell like, I'm glad you said that. Go ahead, finish. I have a funny story about that.

Well, take it now because I can jump back on there.

Well, unfortunately, like a lot of great people that you and I worked with, they passed away too soon. Judah Folkman is. And I try to tell my team the stories about people that I encountered. And my chairman of surgery was Dr. Jay Grossfeld. He's a pediatric surgeon. He started the Riley Children's Hospital in Indianapolis, Indiana, very famous in pediatric surgery. So when we were in training, you know, the visiting professors would come and we had a special surgical conference room that they would give their presentation in. And all the surgeons of the disciplines interested would show up. Not for Dr. Folkman. They rented a hotel across the street and we're like, who the heck is Dr. Folkman? And so Dr. Folkman, everybody, anytime you take a drug that has MAB at the end of it, it's because of Dr. Folkman. So all the people that show up telling me they their radiation, oncology or not, they're, I'm, sorry. Their medical doctor gave them XYZ mab. I'm like, yeah, that all came from Judah Folkman's lab. And he was a pediatric surgeon at Boston Children's Hospital, and he came and presented his work. And it was crazy. Dr. Winters. It was absolutely effing crazy. He would show these little rodents. They would give them injections and give them cancer. They would get the tumor the size of a walnut on this little rodent, and then they'd give them the drug to block it and stop it and shrink it and go away. And everybody's like, is that real?

Yeah.

And so those are all of the antio angiogenesis drugs. And we're all like, this is some crazy stuff. Are we ever going to have jobs? Because, wow, if you're sitting there, going to be an oncologic surgeon, you're like, well, if this actually does work, then we won't be doing much in the future. And everybody showed up for this talk. All the pocket protectors, all the oncology people, all of everybody who was on campus came to this. We didn't even have places to sit as surgical residents. We had. We were told to stand along the side of this huge auditorium. Not auditorium, what do you call it? Ballroom thing at the hotel while he presented. And then he had a separate thing for just surgery residents after he gave his big talk. And he unfortunately passed away before he could be awarded the Nobel Prize. So for everybody listening, Dr. Folkman should be the last or most recent surgeon to have won a Nobel Prize, but he died before it could be awarded, and they don't award the Nobel Prize posthumously. So I was like, you know, it always makes me go back and think of that presentation one, because every drug commercial has a MAB in it, basically. And to your point, there is no one answer for anything in your body because your body is super clever.

Very. Work around, work around, work around all the time.

Right. And that's what happened with those drugs. They came out and everybody's like, they don't work. Yeah, they work for a hot second.

And then it gets smart and works around.

Yeah, correct. But you can have people have complete clinical responses on those drugs. And to their point, the oncology providers do this, and they're right to do this. They say, I don't know how long this will last. It may be forever. It may be for a few months or a few years. You don't know. But to have complete clinical regression of a tumor is pretty amazing.

It is, yeah. And it's interesting because there have been a Lot of various therapies, a lot from both the standard of care environment as well as what would be perceived as the alternative care environment that have very robust, complete, or extremely positive responses to a therapy that just blow your mind on imaging, on dropping of tumor markers. And it looks really good for a short period of time, and then it doesn't. And that's the part we always say it's like, it's actually easy to treat tumors. It's not easy to treat patients with tumors. And that's the part of getting creative. And that's actually where we started to understand through Warburg's work, as well as people like Tom Seyfried and others have brought it back to light. And Dr. People like Dr. Mina Bissell in the 1980s started talking about the. Basically the tumor microenvironment and the extracellular matrix. And Dr. Seyfried dusted off the idea that maybe mitochondria were the starting point instead of the genes and started looking at this again. And that's when we could actually look back at science and go, okay, for the past 70, 80 years, we've done these, what are called cell nuclear transfer studies. So basically taking the DNA hard drive, so the genetic hard drive out of a cell and replacing the genetic hard drive in another cell, whether if it was cancerous or not cancerous, you would theoretically, if this was truly a genetic disease, turn that either into a cancer cell or. Or into a healthy cell. And unfortunately, those tests, those research projects never panned out, which started to say, maybe there's something above the genetic expression. And so we still are continuing to put all of our eggs in the basket of genes, despite it not really panning out as much as we'd hope. And yes, you can easily find a target and find a treatment, go after it and get a robust response, but it's never enough. In fact, when you and I were in our probably residency zone in 2002 was the first time we actually articulated this idea, the Hallmar. And these are some of the common features. At that time. There were six of them that were the common features of all cancer types, which were things around, you know, cell death, cell proliferation, signaling pathways. And we got really excited and we started coming up with a lot of drugs to target those hallmarks. And then about a decade later, in 2011, same team brought in four more hallmarks, and we got pretty excited about that. Okay, well, those six didn't quite pan out, but maybe these four, what we were missing, now we know better. And we brought in the Concept of the energy sources that the cancer cells use. That's when we actually really started talking about metabolomics of the cancer process. We started looking at other immune pathways in the hallmarks that were not working. And we went to town on that. Flash forward to January 2022. The same team came back and added four more features, four more hallmarks. And what's interesting is we've now had these hallmarks to our disposal that are very common in all the cancers that are 22 years later. We've barely made a dent. In fact, many. You can see the stats were pretty much flatlined in our overall survival rate of cancer, because we can easily see the target and find the treatment and attack it, but we can't hit all Those, you know, 14 targets at once, or we take out the host with it. Right. And so that's what's really fascinating to me is my question and where my philosophy changes is what makes those hallmarks express. Let's go even upstream from that. And you already alluded to this. This is when I can start to explore the chronology, the biology, the biography of the patient, to come together to understand what led to a particular moment in time, how it's expressing, how we can measure that, and then apply a particular therapeutic approach to that, Whatever that may be. Could be a combination of things. But finding that right dose duration combination is really critical because protocols will fail our patients time and again because we're not all having the same experience. So giving someone the same treatment and expecting the same outcome Is just ludicrous. And we still keep approaching medicine that way, Whether you're in standard of care or even functional medicine or alternative care. And so finding those nuances, which takes a lot of work, not very scalable, Is really challenging for doctors to do their job well, because we don't have the luxury of time, right? And we're trying to help a lot of people. And so we fall default to protocols and whatnot. And yet part of what we're developing Are strategies and data platforms that take in large amounts of data to and, you know, do translational evaluation of it to understand potential patterns that are unique to that individual that then tell us potential treatments to that particular pattern for that individual that may be an earlier starting point of treatment versus jumping right into protocols or. And it really oversimplifies and evaluates that volume of data In a way that does make this scalable in practice. So we're excited to keep developing, you know, our skill set and learning and adding into the. What do we call it? There's, I'm not a tech person, but there's like this rules based engine and this sort of AI aspect that's that medicine is now taking another leap from where you and I had started in our training that will make it look very different from five or ten years from now. I think to take a lot of these complexities and translate them more in a real time to scale that individualized, personalized approach in a way we've never been able to do. We just didn't have enough hours of the day or people trained enough to have the patience to do what it takes to actually know what's best for every single individual patient that we come in contact with. So my hope is that where you and I are going in medicine is that it'll even all the things you explore will start to be scalable in some of these newer technologies and approaches. But what I have learned is that there isn't one, one target, there isn't one treatment. That every person is unique, absolutely unique, and their needs are unique at different times. And that even in every. Any tumor has multiple cancers, multiple personalities. It's called hetero genicity. So it's like multiple pathways and processes happening at once. You can't possibly target them all at once. So instead of focusing and treating cancer, we focus on treating the person to make them and their environment as inhospitable as possible to those hallmarks taking off and expressing. And so that's where, even where I look at your world, you coming in as the expert that you are, helps remove some of the obstacles or helps address some of the obstacles that actually may be driving forces to some of those hallmarks that really helps my patients when they've kind of addressed all these other entry points. You have one that unfortunately, more, more that is probably, you know, than people are even aware of, might face that need to have that particular thing addressed in their own improvement in their own terrain to have much better outcomes over time.

Yeah, I get asked routinely about the, is AI good or bad? And you know, what are we going to do with testing? And I don't want anybody to perceive this the wrong way, but the way I look at it for, for medicine, just like Dr. Nate, Dr. Winters just describes it as very complex. Like there's too much data for her and I to understand. So we need as much help understanding that to be able to provide a solution to whatever problem, you know, we're faced with. So I don't ever look the gift horse in the mouth, like if it's going to help analyze large amounts of data, to provide a overview, maybe a specific answer, maybe just give us the rough draft, so to speak, of what's going on. Yeah, yeah, that's totally fine because I had a lot of mentors, but I have this axiom. I don't know if honestly I came up with it or somebody else told me, but, you know, if you have a huge problem, obviously like you are describing, you have to break it up into a series of smaller ones to attack and make progress. If you don't, it becomes an insurmountable quest. And so when you start knocking off, you know, parts of it or taking advantage where, oh, I can help here. So, you know, we just like your patients, like people constantly are critical of supplements as they should be because it's one of the most farcical industries you'll ever find that skincare.

So transparency. Yeah.

Right. And I'll let Dr. Naish describe what she thinks about this. But I know that everybody individually absorbs things differently, 100%. So I don't try to give you 50 pills to think I've changed most of my supplementation to liquid on purpose. I'm just treating you like a baby.

Nice. I love that.

So that you'll absorb and I know that you're getting it and it's not difficult. Compliance is very, from a behavior standpoint, it's one of the hardest things we deal with.

It's the biggest limiting factor. Right. In any of our patients journey. Yeah.

So if you're just trying to upgrade their nutrient, not overall nutrition, just nutrients, that's what I found works the best for our patient population. So I have got this thing where I'm like, I don't want you to throw away anybody's supplements. I know you spent good money on them. I'm just going to tell you this. I don't trust them. So you're not going to use them when you're working with me? Because I don't stop supplementation to operate on patients. And I'll say it again, I don't stop supplementation to operate on patients. Which was a dictum, a dogma in surgery forever.

That still is, by the way.

Yeah, yeah, we balanced them out on purpose. So you can't. I guess you haven't said this. You can't approach things from fear or scarcity or whatever. Right. You either know what you're doing or you don't. You either say, hey, I don't want you to take anything because I don't trust it. Which is fair, Right?

Absolutely. Very fair. I wish people would say that. That's a very honest answer. And patients are like, I get that and I appreciate that. And I'll follow your advice. Yeah, yeah.

The only thing I ask is that you take ours and you don't do turmeric, ginger, ginkgo biloba, all these other herbs and roots and berries and things because those are not controlled. And they'll my table.

That would be a problem.

Yeah.

They'll make you believe reaction with the interactions.

And yeah, I didn't mention this happen in residency while I was training in my six years. A lot of things came to market, a lot of things were problematic. Ginkgo biloba came to market and killed several people.

Learned a lot of things about that. Barry works with a 3, 4 a pathway and interfaces with a lot of things and then has a bleed issue with surgery. So you must have seen a lot of nightmares. Yep, yep.

Yeah, yeah. And that all happened to us. And we'd have to explain how somebody, you know, bled to death in an operating room, which is obviously not normal for us. That's not something that happens. And we did complicated pancreatic surgery every day of the week, liver surgeries, all the stuff. And we're like trying to explain this. And then the FDA came out with a warning and said, you should not be taking ginkgo biloba prior to surgery. But back then we didn't even know ginka biloba was a thing.

Kind of snuck in your radar.

Yeah, yeah, we didn't know. But just like a lot of things, you have to. To your point, it is impossible to keep up with all the data. It's not even a fair fight. So someone will ask me, do I know about this? Yeah, supplement brand or drink or shake or whatever. And I'm like, no, I'll look at it for you and tell you what I think of it. Right. But I don't know it. I didn't make it. And you know, I can tell you if it has five ingredients or more. I don't trust it if that helps you because those things add fillers and all sorts of stuff to it. And as soon as I flip it over and I see it, oh, sunflower powder. Oh, no, that's a hard. No. Any powder outside of like ground up pea powder or whatever. Something basic. Like the more ingredients, the more suspicious I become. It's just a habit. So I got a little tangential.

But I love it. It's good.

But you have to rein in folks because they just get information and Your point about bio individuality is spot on because I tell everybody the same things like I know all of this, the only thing that keeps changing is the person in front of me.

Exactly. You're my only variable and there's a lot of them there. Yeah, yeah, yeah, yeah.

They're like why, why didn't I, you know, respond like Susie Smith on your Instagram? I'm like because you're not Susie Smith. It's pretty simple.

Yeah. And that's the, you know, at the time my diagnosis in 91 there was no Dr. Google, there were no Facebook forums, there were no functional medicine practices or people out there. This was going it alone really in a time and in some ways I tell folks it was probably easier because I didn't have the well meaning advice of so many people who cared about me shouting, you know you should do this and this and talk to this person and go to this influencer and read this book and take this supplement. And that didn't exist and so there was not as much noise and so I had to go inside a lot and I had to use my intellect and make critical thinking pathways and bring things in that made sense for me in that moment in a way that I've continued to develop that obviously for myself but also for the tens of thousands of patients I had direct contact with and the hundreds of thousands of patients the indirect through their clinicians contact with to learn. So our data platform that we're building is very much about this rules based engine through my filter but also through the filter of colleagues. So it's still getting real time input. It's not just a computer making the decisions, it's our life experience all coming together and the variables of that inn of one coming together into a data platform that is helping us make these decisions. Because if you've been in practice long enough you will have seen patterns, right? You will def and suddenly you start to know like you taught me some of these things about things around mthfr like who are going to be the more challenging folks to do explant like you start to know who are going to be your easier patients who are going to be more challenging and who are going to be easier to support and who are going to be more difficult. You as a clinician, if you've been in practice for longer than 10 years you start to see patterns and if you've been it for 30 years for sure, you know, and then you bring in the voices and the expertise of hundreds of who see these patterns and suddenly we have something that starts to make sense of a lot of information and starts to create opportunities to create more of an n. Of one approach in healthcare in general and in cancer care in particular. So I feel hopeful, like you and I have been at this long enough that maybe in our lifetime we'll see some bigger developments. You talked about the pivotal moment of your training career being the fulcrum between the old way and the new way. I think there's probably been a few moments where that fulcrum has happened over the past 30 years, and I think there's many more to come. So I feel hopeful, even if I sometimes feel very frustrated that it is such this. Like you said, at one moment it's a snail's pace and the other it's exponential. And it's both simultaneously happening. You know, that this is never going to change. And then suddenly you wake up and it's a totally different paradigm. It's a really interesting place to be in the, in the field of healthcare.

Now the. To your point like that whatever those platforms become, whether you know, your specific platform or another platform that utilizes the data to help the clinicians better respond to the individuality that, you know, that is a big step forward.

Massive. Massive.

Because it just seems like it's a very. And I'd have to say I would not want to be trying to teach a medical student today how they should be interpreting the data, the physical signs, the symptoms, the exam. And it sounds like challenge that I, you know, not up for anymore. I just, I just think of like, man, anything that would help, obviously it's great. And then does that replace experience if it augments them to help them make better decisions for, for clients? I think clients just, you know, they're looking for help.

And I don't care how you get the information as long as you're helping them.

And then a lot of times they're never seeing, you know, a, A physician. And that's not to say that the. I'm not discrediting any provider at all. Being a provider is not easy. Doesn't matter what your credentials.

Exactly, exactly.

And if the tools are available to help at any level, help the patients. That's what we're talking about. I, I'm not talking about a specific.

Right.

Because I get people coming from all over the place, from multi levels of training and disciplines and thought processes. And you like every program under the sun. And I was like, and you know, they're always going to ask, oh, doctor, Dr. Winters, are you familiar with Dr. Smith's program?

And you're like a million out there. But I'll do my homework and let you know.

No, I. Probably not. But yeah, that's what it is. So. Well, I mean, I hope, just like you hope, that the data and the artificial intelligence and all the things that, you know, seem to hold so much promise for us actually do fulfill some of the expectations and make it simpler for us to care for patients. But I want to thank you for coming on and sharing your insights and let everybody know she is an expert in holistic oncologic care. So if you're looking for or want to learn more about that, she's going to tell you where to find her. And then we'll share it in the show notes, of course.

Thank you. Well, again, thank you. I mean, you are I feel like you're one of my extension of our team. So it's really beautiful to have resources in our world. So thank you for that. You can learn more about what I do and my philosophy in my book the Metabolic Approach to Cancer. And another book came out a few years ago, also called Mistletoe and the Future of Integrative Oncology. So it focuses on one of the most studied integrative therapies in the world. But it also really fleshes out where integrative oncology is going, where we are now and where we're going. You can also learn more about our nonprofit raising grants for patients who don't have resources to pay for alternative care, for instance. That's one of the things we do. But we also have a lab. And so we're doing evaluations in R and D and discovery as well as cell line studies and cell respiration studies and metabolomics. We want to look at all things. We want to see if that supplement is actually doing what it says that it's doing. We want to see if this particular intervention is actually moving the needle for this patient or not. Those are the types of things we want because we want that data. No one else seems to be willing to fund these type of studies, so we're just going to start the process ourselves. And we're an agnostic lab and research institute that are helping answer these questions for other people as well, not just our needs. And then moving into the realm of mtih.org metabolictrainstituteofhealth.org is where all of our nonprofit lives. And then under Dr. Naysha D R N A S H A dot com is where you can find more about my speaking engagements. My podcast, Metabolic Matters, which I'm going to have this Lovely. MAN on Very soon. Can't wait to have this conversation as well as others in really innovators in the healthcare space and beyond. Just our wellness space in general. But there's a lot of ways to follow us. So Dr. Naysha.commtih.org follow me there and see what we're up to. We're, we're linking arms with people like Dr. Rob in Changing patient experiences and patient outcomes. So thank you for this precious time.

You're welcome. And we'll have all that in our show notes so everybody be able to link. And then when we put our show up, we'll do collaborations with Dr. Naysha's team so that everybody can see everything that we've, we've talked about. We know it's hard, you know, in the very cluttered environment to get the information. So thank you again for coming on. Thanks for joining me today. I hope you found the information and stories shared on this podcast helpful and informative. Remember, taking control of your health and wellness is key to recovery from breast implant illness. If you're looking for additional resources and support, be sure to visit our online store, Dr. Rob's Solutions at DrRobSolutions myshopify.com you'll find a wide range of wellness products and supplements to support your journey to recovery. From specially formulated detox supplements to personalized skincare products, we have everything you need to aid your recovery. Visit Dr. Rob's Solutions today at drrobssolutions.myshopify.com thank you for listening and we'll be back with another episode soon. Remember, you're not alone in this journey and together we can overcome breast implant illness. Take care.