Toral Shah |Ep #25 | Understanding Breast Cancer Risk with Nutritional Science & Functional Medicine

and a functional medicine practitioner and also the founder of the urban kitchen and she specializes in nutritional science she’s based in london in the uk and we are super excited to have her today on our show dodge of the podcast welcome taro thank you so much for having me it’s a pleasure to be here well welcome tora we’d like to discuss uh about the modifiable and non-modifiable wrist risk uh to get breast cancer because i think there’s a lot of kind of unknown around this and so to kind of open up the conversation um i’d like to read off like a research from the american cancer society in 2019 where they say that about five to ten percent of breast cancer cases are thought to be hereditary which means that they are a result from gene changes uh mutation uh passed on from parents so usually there’s this common misunderstanding between okay what’s the difference between hereditary versus predisposition of breast cancer i think that’s such a great question and and i’m going to explain that with kind of go through a case study this case is actually my family so just to really clarify hereditary breast cancer is one where there’s a particular gene mutation so things like bracha one or two check two tp53 pal b2 and then these are the common mutations in breast cancer and there could be one mutation that can just cause breast cancer and that means often more than one person in the family will have breast cancer and at a younger age often not always but often um with percent advocated it’s completely unrelated to your family and it’s kind of random you know our body is making new cells every day and copying the dna in our bodies over and over again like millions of times a day so it’s natural that there would be uh kind of mistakes or things that can change and that can cause normal mutations dna damage and that can cause not just breast cancer any type of cancer and in between there’s these people in the middle who’ve got some sort of familial link but not any of the genes that we know about but they have a family predisposition and that’s different from the modifiable risk but this is about you know family predisposition and i’m going to talk about home family because i think it’s a great description of what familial breast cancer looks like so in our case none of us have got any of these gene mutations but my mum my mom’s sister myself and then about 10 of my mom’s cousins have had breast cancer we’ve all had the same type of breast cancer uh ductal carcinoma in the right breast and what’s also interesting is that nearly everyone has moved apart from me who was born in the uk everyone’s moving from in kenya or india or wherever they are were born to the uk us canada so there’s that that part too but anyway in this instance we don’t have these but we’re all just predispos you know we have a predisposition to breast cancer and we don’t know how our genes are interacting with that environment but something in there and it’s probably many different things is predisposing us to breast cancer and one of the things i’ve considered is vitamin d we know that vitamin d deficiency is linked to increase in risk of breast cancer so obviously if you’re genetically you be you know born to live in a country where there’s more sunshine and more likely to be deemed into darker skin then obviously when you come to the uk or us or canada there’s less and like already from now in the uk until the end of march we’re not making it’s beautiful sunny day in london but we’re not making vitamin d and we have higher requirements so that’s one part of it and the second part there’s a lot of other family things we don’t have the our food and our lifestyles and all of those things are interacting with environment but something’s happening where we’re just more likely to have breast cancer would you would you mind to give a bit more um details about the link between vitamin d and breast cancer because as a person of color and especially darker for brown uh girl i guess that vitamin d has always been something that’s like be careful you have to take your supplements et cetera but i i actually knew there was like a link between breast cancer would you mind like sharing more light on it so actually there’s a link between vitamin d deficiency and all cancers so for a start not just breast cancer um but importing in the context of breast cancer we know that people who are diagnosed often have a deficiency whatever ethnicity they’re from and we know that this deficiency increases our risk why exactly there’s so many different mechanisms and thought processes one is when you have lower levels or you’re more deficient or insufficient in vitamin d your immune system’s not working quite as well and our immune system is so important for surveillance so basically our immune system helps us to catch cancer cells before they grow out of control so it goes around surveying all the time like kind of close circuit television to see if there’s any cells growing up control and if it has it kind of gobbles them all up and obviously if our vitamin if our vitamin d levels are low our immune system is not optimized doesn’t potentially not work as well there’s definitely other mechanisms and i have to say there’s still not like a definitive answer there’s so many things we could go into but hopefully that gives a good overview of why it’s important and why we should be supplementing and actually we’re still in a covered period and we also know that vitamin d deficiency can impact your coverage uh risk too so just please compliment everybody that’s a good point um so you’re saying that those you were touching on like the non-modifiable and modifiable uh factors right um so the non-modifiable would be kind of your genetics that a genetic predisposition would that be no your non-modifiable risks are things like things that you can’t change so things like you can’t change your age you are the age you are all right more likely to have breast cancer if you’re older you can’t change your gender you’re more likely to have breast cancer if you’re female or have ex-wife you know ex exchange rather than a male although men do get breast cancer you’re more like you know um if you’re taller which you can’t change yeah it’s more more of a discriminatory it is it’s because you’ve had more likely to have more growth factor the same as if you’re at a bigger birth weight you know if you’re just a bigger baby again more factors um what else is obviously your genes you can’t do anything about that and these are all things that you can’t change there’s nothing you do about them it’s just there right because there are other aspects that we can kind of look at but i mean even like the other things which are not modified are things of our age of menarche which is the age that we start our periods so if you’re start your peers between kind of 12 or under you’re more likely to have breast cancer both me and my mom start our parents at 11. but i’m not saying it’s going to make jeopardy of course it’s not but it’s a it’s a risk factor right ages menopause just to touch on that right you were saying so is that the link when you say before if you get your period before the age of 12 um you are more likely to have breast cancer because is that linked to estrogen yeah and having more cycles you’re just having more cycles so there’s more chance of things going wrong so again the same with menopause if you have a later menopause you’re having more cycles you know the period cycle so you’re having more hormones uh cycle you’re having more estrogen cycles so that’s why um and obviously if you have your periods later you’ve had less cycles and same way if you have menopause earlier you have less cycles so that can be part of you know changing reducing your risk what would be like one key thing that you think a mum should like tell her her younger daughter who’s like you know about to get her her periods about understanding you know the estrogen part and and understanding the the link between having your your cycle and potentially you know uh doing those regular checks uh for that gene the braca for example gene so you can’t i mean you don’t regularly check for the packaging not yet it’s not something that’s done unless you’ve got a family history um it’s a genetic test and that costs money and you know we don’t do that not in the uk um but one thing i would say is i think the more we talk about our bodies the more aware we are of tracking our period cycle like checking our breasts at least once a month you know knowing what’s normal what’s not normal and what’s not for you will be different to what’s normal for somebody else and just right the more we have those sorts of conversations because for me and you know and i’m sure we’ll talk about this more i’ve had breast cancer three times and all three times it’s come from me knowing my own body so well that i can pick things up before conventional medicine say look something’s not right please check this out please check this out please check this out i mean to be really honest all three times no one’s believed me um and that’s a whole other topic of conversation you know despite my family history despite you know already having breast cancer you know the second two times so i think it’s been your own advocate and knowing your own body but if you don’t know your own body because you never touch it talk about it look at it what can you do right it’s awareness right okay cool yeah so i guess we can they can now move on modifiable factors so these are things that we can change and i’m not saying that necessarily easy to change but there are things we can change so firstly like smoking so smoking can increase the risk of lots of cancers but breast cancer being one of them particularly smoking in your teenage years which is whether women do smoke for various reasons and i think that’s something that you know in your last question what could mothers tell their daughters maybe that’s something don’t smoke because it can help increase your risk of breast cancer when you’re like a teenager you know i have a very sad story about that one of my really good school friends like high school friends we were friends from the age of 11 she also had breast cancer and she was a dentist so she knew about health but she had smoked from very very young and i’m not saying that’s the cause of a cancer because obviously it’s a multifactorial disease but sadly she died um it’s been a while now actually but and i keep thinking about it and i know it’s not necessarily the answer but it’s just like i keep thinking okay well i’m still alive and i’m still here she was fit and healthy in every other way so the smoking you know it it doesn’t remember because i know she smoked from when we were very very young at least 13. so something to be aware of you’re smoking when you start your periods it can really increase your risk um um alcohol consumption so look we all you know many people drink many people don’t drink um but increasing if you have increased alcohol consumption that can you know increase your risk of breast cancer and a few other cancers too uh can i interject at someone who likes the wine and you know anyways uh what is it about the consumption um that you know will affect potentially your risk because it’s one say it’s like it’s one thing to say okay don’t smoke don’t drink but what is it exactly about that that you know is going to put you at risk great question so when we drink alcohol it’s metabolized by body but it can be metabolized to something that is a carcinogen which can increase our risk of breast cancer and this particularly works in our breast tissue anywhere where there’s like estrogen and things like that so that’s why drinking i’m not saying don’t drink i drink um i think also we’ve got remember the health benefits from a cardiovascular perspective if you know red wine and heart health we know that there’s evidence and if you look at the blue zone literature which is areas in the world where people live to over 100 they’re all drinking so it’s about balance right um i think it’s like not been drinking having like at least three days alcohol free keeping to the government guidelines yeah it’s those things and part of it it’s like sometimes people drink they eat they don’t eat as well and that can increase obesity which takes us to the next factor so that’s why alcohol is particularly interesting um and we could really go into the mechanism but you know i think it gets more complicated but that’s why it’s particularly metabolized which can be passed in a particular breast cancer i think we just need to remember that yeah and i think that’s a great point to to park and it’s just that also for men especially coming from um in the uk or um not especially for men it’s because i was going to say men to link to south asian but then in the uk that’s a very big drinking kind of culture and um and giving a bit of background i think sometimes can be helpful and in the uk we are probably under the unhealthiest nation in europe if if we were part of europe now um geography yeah because our the way we drink is more like social bingeing where it’s like in other countries that eat with me drink with meals and things like that so it basically our cultural and how it’s impacted our metabolic health and actually that’s you know part of our why our covered and apart from our government being used but like the probate outcomes be important because we do have poorer metabolic health compared to some of the other european countries that makes a lot of sense okay um and then you would talk about obesity um which could be uh a factor yeah so being overweight or obesity is um an increased risk of breast cancer it’s really weird because if you’re slightly overweight um when you’re pre-menopausal it actually reduces your risk and that’s probably because you’re more likely to have less periods because you might have pcos or something like that a polycystic ovary syndrome or something like that now let’s most people have breast cancer when they’re postmenopausal and being even just overweight or obese increases your risk the reason being there’s loads of mechanisms and i i’m going to go into this in more detail in other places but what we need to understand is that it can be a function of insulin resistance um and if our body is not metabolizing uh our food so well when we need we’re less sensitive to insulin um then we’re going to store more body fat and that you know and all of this is linked back to breast cancer so for example if you think about having diabetes which is so prevalent in our south asian community having type 2 breast diabetes can increase your risk of breast cancer by 20 which is you know really important and there’s other mechanisms that we’re trying to understand with being overweight and obese and these are the things that we’re trying to get to bottom why is it so important and does it get can you exercise and eat your weight can you be a little bit overweight and still eat well and exercise well to reduce your risk for breast cancer that’s what we all want to know is how do we reduce our personal risk because some of us are prone to it’s being bigger and some of us may be smaller so i think it’s a really interesting area of research and i think understanding more about this is really important given that certainly in the uk and us and can you well uk and us we have a really increasing risk of people you know of people being overweight or obese and our cancer risks are increased i mean breast cancer has now overtaken as a most common cancer globally well in the developed world um for the first time ever it’s surpassed lung cancer and i think that’s something to remember and yet in the developed world we are larger than ever before and our eating patterns have really changed and it’s not just when we even what we all of these things put together i think that’s something um i’m just curious like as you were saying insulin resistance the first thing that kind of popped into my mind it’s also like inflammation and gut health and can you can you talk a bit more about that and link to breast cancer yeah so again i hadn’t got to inflammation but what we also know is that when you have carrying more fat cells you’re more likely to have inflammation about the body and chronic inflammation can lead to more dna damage which can increase the rate of cancers and there’s like 13 different cancers where obesity and being overweight can increase the risk and breast cancer being one of them so i think this is the interesting part because if doctors and oncologists are saying oh what you eat doesn’t matter yet we know a that what you eat you know changes how your insulin resistance and how your body responds to food number two by eating ultra processed sugary high carb foods we know that that can also lead to chronic inflammation especially in conjunction with our westernized busy modern lifestyle that can be part of it and then secondly if we’re all eating fewer fruits and vegetables plant-based foods like legumes beans not seeds that’s affecting our gut microbiome now gut bacteria is the beneficial bacteria in our bodies and we really need those they’ve performed so many roles that our bodies can’t perform themselves so for example they make vitamins like vitamin k our body can’t do that by itself um it’s a massive part of the immune system so we talked a little bit about vitamin d and the immune surveillance if your immune system is optimized because your gut health isn’t working is not optimized and that’s going to impact your immune system it’s not going to impact like how your surveillance habit or cancer cells or or other pathogens as well you know whatever they might be viruses or you know whatever so i think this is where actually diet and nutrition become so interesting and i don’t want to overstep when we were going back to obesity being overweight so this is how some of the mechanisms and there’s going to be a lot more medicine we’re still all kind of doing more research into this is how being overweight and obese can increase your risk of having breast cancer and there’s a lot more the world cancer research fund website if anyone really wants to delve deep into the science they’ve got the whole report which explains all the mechanisms that we know so far yeah so if you so is it a fair assumption to say that say you are naturally bigger because of hereditary factors meaning like it’s it’s kind of like the structure of the family it’s in your dna et cetera you could be that could be kind of an added factor of you being predisposed for breast cancer so what’s interesting with being overweight and obese is what we think of hereditary can we kind of present to you one is lifestyle everybody if you’re eating the same way as everyone in your family you’re likely to all be the same whether it’s you’re exercising or not exercising if you’re eating healthy or not you know so that’s the familial part and that could be and then there’s also like we all have gene mutations and we have a lot of things called single nucleotide polymorphisms which have tiny tiny gene mutations so some people might have a mutation something called fto which is to do with fat metabolism and if you are then you’re more likely to be bigger and it’s really interesting um and there’s other gene mutations which can predispose to having diabetes or to being overweight so i think there’s so many elements yeah in london i mean you we have a living environment where some people pass as many between work and home or work at home and school they can pass up to 150 fast food outlets so they’re everywhere the social i mean and that’s the poorer areas often which have these places so the socio-economic it’s not always your fault in fact they say that very little about less than 30 of it being overweight obesity is really in your control a lot of it’s out of your control social not factors all sorts of other different things so it’s really hard i mean i remember when the shops were shut on a saturday evening at six and nothing opened on sunday apart from like maybe the corner shop and then it opened on monday morning now you can be sitting on your sofa and your food comes to your house or to the door like you get over uber meets deliveries literally and i’ve never had raise and this is the first time in my life in lockdown i’ve had takeaways like that because obviously all the rest of the shop so you couldn’t go out and if you didn’t want to cook then you know it was gonna go out which is a different experience so i think it’s not easy we have to take away the blame we have to like look at how we can as governmental or health organizations what are we doing about preventative health right and even in nutrition and the options that you have now see because we’re having this discussion it’s like for you to be vegetarian or so say you want to adopt a certain diet a healthy diet buying you know organic stuff so say you know you want to shop consciously it’s very expensive yeah and so somebody who is a bit in a modest uh from a modest background will not be able to afford these you know unprocessed or refined foods that are slightly more expensive so i think that yeah it’s definitely harder with all the temptation of having you know those fast food not only delivery but also you know just being it at low price yeah i mean that’s a no brainer yeah the mcdonald’s is like one pound or something i can’t remember but like i think i think we have to remember it was also really about to do a socio-economic and you can eat healthily for a cheap when you can afford to bulk buy or there’s a local fruit and veg market which you know like the local market like croydon has a local market so that we have a local market where they sell big gold food and vegetables and stuff like that but then you have to go there you have the cooking skills you have to have the money to go to cook you have to have the gas electricity or whatever it is you have to have pots and pans you’ve got to build you might need to have a freezer to batch cook free these things so all of these things are socioeconomic and let’s let’s not forget like the knowledge of it like that the gap because you’re already in that conditioner environment you’re going to be missing that how to do that so if you have all the tools like how are you going to bridge that gap who’s going to help you get there right so it’s such a it’s such a intertwined system that is it feels very like you’re really like walking up an uphill battle right so you really have to have all of them in place at the right amount in the right time um and i guess when you’re saying all of this i my question uh to you or like that comes up to my mind is like can these can these factors of like these lifestyle changes affect our dna like can they change our dna so there’s something called epigenetics where genes get switched on and off in response to our diet lifestyle and environment so genes get switched on and off all the time and when genes are switched on and off that means they can reduce your risk of certain diseases or cancers or whatever it might be so and then lots of foods which are uh are known to be kind of adapted chickens things which can switch our genes on and off so things like some of these amazing mushrooms like reishi and shiitake and maitake or things like green tea or the polyphenols in berries um turmeric you know there’s loads of compounds that we know can help switch our genes on and off so how we eat can quite literally change not our dna but it can affect which genes are expressed and which genes are switched onto which genes are so short so we we talked about we talked about food how it could affect um what about exercise so just going back to the food one of the things that we know modify our risk is if we eat a diet that’s really high in non-starchy fruits and vegetables that can reduce my risk having a diet high in calcium reduce our risk having a diet um that’s um kind of rich in fiber can help reduce our risk so all of these things are important plus one of the things that we’re starting to learn about is maybe having a low lower glycemic index diet which means the food they eat doesn’t release insulin glucose or insulin quite as quickly and so that’s where that link between the insulin resistance comes in so i wanted to just kind of round that part off yeah sure would you have examples of that for example like a typical so like if you’re having um you’re having when you’re thinking about foods let’s say you’re having carbohydrates you’re having the most unprocessed version so you’re having whole grain brown bread as opposed to white bread and those sorts of things same with pasta right like wild you know brown rice as opposed to white rice so those are the kind of you know things and obviously then having a lot of fruit and vegetables is just beneficial in every way um and like having an anti-inflammatory diet i mean that’s the thing where people keep saying oh does that work if you look at the mechanisms of it well yes because we know that reducing inflammation can help reduce dna damage which can help reduce our risk of cancer so things like that that’s a really good point no sorry um but yeah that’s a really good point because it makes me think about like like the keto diet and like you know going fully vegan like you know at a drop of a hat like i don’t think it’s necessarily like the best way to do that um but more maybe like taking steps i guess um to close like bridge that gap and then improve your vegetables and foods i guess and that’s improved i’ve got microbiome and we need to eat 30 different plant-based foods a week and we’re not there’s something vegetables fruits herbs nuts seeds you know salads uh even things like spices and stuff so right now we need to be really doing that a lot of people only have like between eight to ten and i think that’s where we need to change things and you know we’re relying on four main crops in the world so we have to start diversifying um our diets and that will help to improve our gut microbiota to support our immune system and it’ll help with making sure we’re getting all the nutrients we need to reduce our risk of lots of diseases not just cancer in terms of like physical activity or exercise is there a link there with breast cancer so what we know that for pre-menopausal women doing vigorous exercise can help reduce your risk and when i say vigorous i mean being like super alphabet so like running uh singles tennis heavy yard work heavy house work you know all of those things that get you really upright lifting really heavy weights all of that stuff um ever post menopausal it’s moderate and vigorous so everyone’s like oh but i walk i’m like no that doesn’t do anything so we need to be up a hill fast kind of know so i think this is where we really need to in particular south asian community we exercise so little as women and that having those role models and i’m really lucky because my mom is a full-on exerciser and a very active person who you know made me play a lot of sports i was not very sporty but i was active and so i think this is where people need to understand there’s so many women are so concerned with weight loss and fat loss they don’t forget like exercise is not for that exercises for a billion other reasons it’s for your metabolic health your heart health for your reducing your cancerous for your mental health for you to feel good there’s endorphin rush all of those things and you need to be doing things that you enjoy but you also need to incorporate certain aspects so mobility uh flexibility that is resistance training and that is really important and that takes us back to what is resistance rate using some sort of weight it could be body weight to do things that that can increase your muscle mass and break your kind of muscle fibers and help you build more muscle so even things like climbing and you know other things that kind of where you’re using your body weight pole dancing i don’t know whatever you know all of these things could help you yes that’s great but partly because muscle is an amazing way of using up extra glucose and to help with your insulin sensitivity the more muscle you have the more insulin sensitive you have so it’s a sensitivity how so this is why it’s so important i think it’s something that people don’t talk about enough and when i think about my own self um i had breast cancer at 29 and i did i did have reoccurrence but not till i was in my 40s and my body started to change and you know all the usual things but um i was very vig i was exercising vigorously all the time before that and when i say vigorous like i mean an hour or more a day of being quite out of breath and that’s important and whether it was a spin class or am i like classes or tennis or dancing or lifting weights or whatever it might be i did triathlons in the past um yeah all of those things swimming fast yeah all of those things are really important you need to have a variety but you also need to be able to enjoy it stick to it because the exercise you do is that what’s worked the exercise that you think you want to do doesn’t work right and i think that uh for touching on the like the bam community where um looking back’s like oh you know you’re a girl you shouldn’t be doing too much of like you know exercise or weights because it might you know i don’t know what i i don’t really know but with the it’s a sign of masculinity i think they think of it as masculine but yeah which makes if you lift weights it makes you lean at the moment i’m not doing really that much my diet i’m kind of just eating which i know i need to reign in a bit because like i need to be really careful my diet but like just by being very consistent on weight training every other day my body shapes changed in two months and i’ve lost body fat so and i’m not looking bigger i’m looking smaller so you know i think these are all myths again you know and like for you and i think paul nabel writes about this beautifully but if you want to put on muscle as a woman hey we have low testosterone less levels so unless you’re having testosterone you know as a supplement you’re not going to be bulky for a star and you really need to be consistent for a long period of time a few years plus eat the right amount of protein the right amount of calories and to to really bulk up it’s not as easy i mean it’s easy to one body fat but not really to bulk up with muscle right and i think there’s like a stigma with like the south asian community where like women i mean i think definitely the older generation maybe not so much for the younger generation but like the the embarrassment or the like the shy factor of like having to work out and wear workout clothes there’s a strange like association with that which i come to see in my family as well and i guess it’s a it’s i guess knowledge a knowledge gap right um too but it’s also you know how many brands make modest um fitness wear and there are brands now but they really need to think about it because some of the bigger brands aren’t doing it but if you have a little slit at the back of your neck that’s not going to be modest then people aren’t going to wear it people are like yeah where he jumped or cover up and like i think we have to we haven’t been catered for you know it’s only now that we’ve got like these modest swimming suits that nike brought out whoever’s brought you know so if if we’re not in like in countries like france they’re banned kind of these things it’s just crazy like bikinis and stuff so i think it’s not easy yeah that’s very true so exercise and one another aspect that i heard you say with regards to even like kind of byproducts of exercises mental health um can you touch upon upon that so one of the really interesting things about when we particularly resistance training will do that kind of training is that our our muscles release something called brain derived neurotropic factor and it basically goes into our brain and kind of hoovers up all the crap essentially and like we and we and that can help our brain health and then from a mental health perspective you know releases a lot of endorphins and feel good molecules you know neurotransmitters which make us feel better and i went to a spin class today and i give you this example openly literally cried so upset about something that happened i was talking to one of my best male friends who’s south asian and i was telling him blah blah blah and i went in and i was so upset and i came out feeling like woohoo life is okay it is okay so i think we underestimate how important exercise is and it has to be the right type of exercise for you like it might be just dancing in your living room it may be i don’t know slightly it might be rare it might be like going for a really long run with your dog i don’t know but you have to find the right thing for you um but i think the exercise exercise of aesthetics is really going to be not keep you motivated exercising for all the health benefits will keep you regulated exactly but then after some people don’t really care about you know having that motivation of like saying health benefits because like one of the thing is that well at the end of the day because i have some of the aunties that do tell me like well we’re all gonna die some at some point and it’s like what is the the point but anyways these are just a bit more uh how to say optical i i’m with you my mom is with you my mom’s 72 and she’s a crazy exerciser and she says i’m just tired of telling all these ladies that they need to exercise and she’s understand i’m like i don’t know so i think i think you’re in you know i think there is a frustration from all of us who who don’t you know and then when people complain it’s their karma or their fate or whatever i just feel like oh no i’m like yeah it’s sort of like yeah no this is no this is not the conversation and you know people have taken responsibility for their own but we also have to make it easy and encourage people to have their social economic and their structural things in place to make it easy you know exercise needs to be fun and it needs to be inclusive and if you know if it’s not inclusive it’s not going to encourage people so people have had bad experience which is so many people have particularly women of color then they’re not going to want to i know you’re not blaming them but then you’re like you know so then you sort of think okay can we do more like pogba parties or go abroad or whatever it might be that they might actually enjoy which gets them moving yeah maybe um and so when you say exercise right like can you kind of share um what the impact is on reducing your risk of breast cancer uh by doing it so we we just know it reduces your risk by being vigorously active um in pre-menopausally and being moderate to vigorous active post memory can reduce your risk what the mechanisms are again it’s for all these different things changing insulin resistance you know um you know not just not just changing your weight but there’s so many metabolic health aspects of exercise and all of these things fit in and do we understand all of them not yet probably but they’re again it’s it’s to understand that it changed our metabolic health it changes how our body works what we do know is that exercise releases many kind of immune system molecules that can help optimize our immune system so if our immune system is working better again as i shared before it can go along and gobble up any sort of pre-cancerous cells or any cells inside to grab control so these are the different ways in which exercise can support reduction of not just breast cancer but other cancers too right and and i guess to touch on like i guess with people who go through breast cancer or um if they’re going through kind of treatments uh you know chemotherapy or radiation and um even if people go through like surgery right um are there things that they can do in that process to support that that experience that they are going through so firstly pre-surgery rehabilitating yourself and really getting yourself as fit as possible is actually going to really help you to recover from any type of surgery whether it’s breast cancer or any type of any surgical heart disease whatever it is and i think that rehabilitation is something that we’re really starting to look at in the research kind of world with cancer it’s like can we help people in that five to six weeks between diagnosis and starting surgery or treatment or whatever because the stronger we can get them they’re more likely to have their how to kind of get through it and reduce side effects what we do know is that for those having chemotherapy and radiotherapy if the exercise before their treatment is given it can help reduce side effects again i don’t know the exact mechanisms yet but in australia they’re prescribing exercise before each chemotherapy and radiotherapy session so right before right now before so i mean that how it works we still need to it is to do with increased blood flow which means that you know there’s more blood going in the system so it can take away any damaged cells it could because it increases your breath right your oxygenation all of those things i’m sure there’s plenty of other things that exercise physiologists could tell you more about but for me personally and when i had radiotherapy this year i’ve got a spin bite behind me and i’m actually leaning on it but um i just made sure i did went on the bike before i went to every single radio therapy session i’m not saying i didn’t have side effects i did i was tired but it did help me to get through and i didn’t want to necessarily exercise in those days some of the days i felt more tired but once i started i was okay and i think in the past all in all countries they kind of told you to rest and eat what you wanted and just everyone’s going to lose weight it’s not like that most people have cats now overweight or obese very few people some people do don’t get me wrong they throw up a lot in chemotherapy but these days people are just they’ve got really good anti-metics to stop you throwing up with chemotherapy so people don’t necessarily lose weight it’s really a good thing if people can keep moving and um you know supporting them to having a sense of control over something i have um i have a more kind of personal question with regards to your experience with you know three times going to to uh radiotherapy i guess if that’s correct this is the first time i’ve had radiotherapy so wow yeah so they can’t really radiate an area it’s not really helpful if they’ve radiated it before so i’ve never had radiation i’ve had a very slow growing non-aggressive breast cancer called the first had something called ductal carcinoma situ which means it was trapped in the milk ducts did not spread outside of that um but it was all over my breast i had a mastectomy and hormone treatment the second time it was a tiny tumor uh i think nine millimeters or something and it was in the skin of the mastectomies i had something called a skin sparing mastectomy where they kept the skin and they kind of scraped out all of the breast tissue and i had an implant and then they could just remove that tumor and then they talked a lot about radiation but they just couldn’t decide whether it was the right thing because one of the things about having radiotherapy as a younger person is that especially depending on where your exact tumor is it can affect your heart and and damage your heart and lungs so they have to be really careful i also can increase the risk of other cancers like you know so um they have to be quite careful so i’ve only had radiotherapy this time i haven’t had chemotherapy either so i think we have to remember that everyone’s treatment’s different i have had a non-aggressive i have not it’s never been in my lymph nodes it’s spread anywhere so it’s been quite localized and so my treatment has been very localized um but i do have hormone treatment which is a more systemic treatment which goes around your body and it’s to block estrogen receptors in my body because i have a very positive breast cancer okay and does might sound very cold-hearted but does it at some point does the sewer to cancer come become normal so you come from a family where you know there there are risks you are aware you are well equipped you’re not knowledgeable about it does the you know the mental hurdle that comes with it do you feel that does it ever no we do so no the shock each time even though i think what’s helped is working in the field that’s helped because the more i learn the more i feel in control the more i think i can do the actual experience like if you told me the first time i’ve had it two more times i’d have been like no i’m done bye i’m off i just just take me to dignitas i’m done i can’t be doing this again um but in practice you do do it again and you know it is the way it is and i think from a philosophical point of view i’m like great i’m getting to learn stuff that will i be able to use to help my research my patients and anything else i do so from that perspective i feel not privileged but it is a part of a journey and i’m learning more that doesn’t mean i don’t get really upset and crying like still have a bit of a cry last night and you know i was thinking this is not fair why me you know what you knew and and i’m sure you know i don’t think you can really stop feeling the impact of it and you know it’s almost actually aggregated and it’s almost worse each time because you know what it’s like and you also realize that most people don’t understand particularly when you’re younger what it feels like by the time you get a little bit older you know most people had somebody in their families or lives or friends who had you know some sort of cancer if not breast cancer but yeah especially my like when i was diagnosed like none of my friends got it you know in the 20s and 30s i already understood and it was like what so i yeah no it doesn’t from personal perspective no working in the field is a whole different ball game and that doesn’t it doesn’t anaesthetise you against it but does make you have more reasoning with it right right and i mean this took i guess to echo or like come from there at that point like other things that in that in that journey right that have really personally helped you in kind of navigating like the the experience i mean that’s not uh besides the lifestyle choices and the food and nutrition aspect of things and exercise yes absolutely i think you know the first time it took me down a real journey of personal development and that kind of brought me to more of an integrative approach and understanding kind of how our psychological mental emotional health impacts our physiological health and i think that he’s been really important i think um the last two times i’ve had breath work meditation and a whole lot of other complementary and integrative approaches which i didn’t have the first time i didn’t have in my toolbox i think that’s really helped understanding how diet can change i knew diet could and i could understand the scientific mechanism but like how kind of it can affect your epigenetics and like your healing and also just having some more spiritual holistic kind of tools so knowing that there’s different practices like qigong or yoga or whatever or chakra meditations or stuff that kind of moves things energetically i could not explain the science i i have no idea but they are things that have helped me to feel better um and i think having a really really really good psychotherapist who specializes in cancer has made the world of difference helping me to understand how i interact with the cancer experience but also how i chat with people and how they treat me and how you know what’s been going on so all of these different things um and i’m also really open to things like i love sound barbs i love you know oh my best friend’s a yoga teacher so i i think the ayurvedic you know when i had breast cancer and the second time i went as soon as i was allowed to i went to an antibiotic health form which was brilliant naturopathic health which was brilliant and it helped to kind of revitalize me and to kind of get me back in sync almost and kind of you know hate to use my detox because that wasn’t what i did it was more just to balance me again um give me a space to rest and talk you know because in the uk it’s quite hard to just rest especially if you live alone so going to somewhere like that anywhere there’s sunshine it’s in india they’re making all your food they’re doing everything for you all you have to do is relax and enjoy free massage you know all of these things i’m i think they all can have their moments and they can all help and i think we must unlock them i think it’s so important it’s such an important part of the healing process and then you know and some things are going to work for some people or something not and that’s that’s just the way it is yeah i think you you highlighted a really crucial and like essential part of like anybody’s um healing journey in in any type of uh illness right um and for them to like be open to the fact that they are jus it’s not just like these factors you you can’t be in control of all the factors and there’s some things where you just have to kind of have the faith to to to be open to listen and like receive information right um yeah i think i think that’s a great uh insight that you you can share with our audience and then anyone listening really um yeah i don’t i don’t know if there’s like yeah for me on that note i think we can we can conclude our our episode with our rapid fire questions yeah um so the the first one is what is the worst uh helped advice uh you’ve ever received in your life it’s actually hard because i thought about this i think be positive because it’s so annoying because it’s not always helpful and sometimes it can be toxic positivity yeah and if you understand what i’m going through you get time to be positive because you have no idea you have no idea what it is to go through i’m going through so i’m going to say that that’s that’s a good one um and if there was one habit that we you you would say that we should all adopt what would that be eat the rainbow eat the rainbow a massive diversity of fruit vegetables and plant-based foods every day and like really use the colors of the rainbow to pick different things each day and you will definitely change your health i like i like the how to memorize it just eat the rainbow and the last one is if you were to put a soundtrack to your life what would it be it was already hard one but i think my favorite song i’d rather i’d rather share that as walking on sunshine with katrina it’s a really classic old song but i think it just makes me feel joyful and it’s been a difficult year for everybody two years for everybody and it’s a joyful happy song and i think sometimes we have to make the choice to be happy and i was listening to another podcast by mo gordot who writes beauty about happiness happiness is a choice of mine so we need to choose to be happy so sometimes listen to these songs and enjoy things that make us laugh and joyful they’re going to have such an impact on our health they’re going to make us healthy and more positive and happy and i think that’s a good thing yeah agreed well thank you so much toro thank you so much for having me i really appreciate it and i’d just like to say i want to dedicate this particular episode of dear friend of mine charlie who sadly passed away from secondary breast cancer today and in her honor she had the most amazing grace and graciousness and acceptance of her cancer and for that reason i think it’s great to dedicate this episode to her what a beautiful way to end our episode and also the breast cancer awareness month so again thank you so much doral