#271: Dr. Amy Comander - PAVING the Path to Wellness for Breast Cancer Patients
Dr. Amy Comander is PAVING the Path to Wellness for breast cancer patients.
Rip Esselstyn continues his special series for Breast Cancer Awareness Month with Dr. Amy Comander, a leading expert in breast oncology and lifestyle medicine at Massachusetts General Cancer Center. Together, they delve into how breast cancer survivors can reclaim their health and thrive after a diagnosis through lifestyle changes and holistic wellness practices.
Dr. Comander introduces her innovative 12-week program, "Paving the Path to Wellness," which supports breast cancer survivors in their recovery by focusing on the whole person-body, mind, and spirit- with the goal to empower individuals to live healthier lives with a sense of purpose.
The episode also highlights the growing concern of younger individuals being diagnosed with breast cancer and the importance of preventive lifestyle measures.
Dr. Comander emphasizes the powerful role of a whole food, plant-based diet in reducing cancer risk and improving overall health, providing practical tips for patients to incorporate more plant-based options into their meals.
Exercise, too, plays a critical role in recovery, and she discusses how it can reduce the risk of cancer recurrence. Dr. Comander also addresses the lack of confidence many healthcare providers have in guiding patients toward effective exercise routines, identifying an area for improvement in oncology care.
The conversation also explores the importance of sleep, stress management, and social support, with Dr. Comander sharing heartwarming stories of patients finding community and healing through her program.
This episode is a must-listen for anyone interested in the intersection of lifestyle medicine and cancer recovery, offering valuable insights and hope for breast cancer survivors.
Episode Highlights
4:08 Welcome Dr. Amy Comander
8:05 Dr. Comander’s Journey through Med School
11:56 The Intersection of Oncology and Lifestyle Medicine
14:16 The Need for Lifestyle Medicine in Oncology
15:44 The Role of Lifestyle in Cancer Prevention
18:00 Understanding the Links Between Alcohol and Cancer
21:51 Dr. Comander’s Paving the Path to Wellness Program
23:49 Expanding the Program's Reach
26:07 Patient Stories and Impact
32:45 Exploring the Paving Steps
39:23 Setting Goals for Recovery
45:16 Advances in Breast Cancer Treatment
1:00:21 Celebrating Patient Milestones
1:01:14 Closing Thoughts and Gratitude
About Dr. Amy Comander
Dr. Amy Comander specializes in the care of women with breast cancer. Dr. Comander is Medical Director of the Mass General Cancer Center in Waltham, where she also serves as Director of Breast Oncology and Cancer Survivorship at the Mass General Cancer Center in Waltham and at Newton Wellesley Hospital. She is an Instructor in Medicine at Harvard Medical School. She received her undergraduate degree and a master's degree in Neuroscience at Harvard University. She received her medical degree at Yale University School of Medicine. She completed her Internal Medicine residency training and Hematology-Oncology fellowship training at Beth Israel Deaconess Medical Center and Harvard Medical School. She is board certified in Hematology and Medical Oncology, and she is a Diplomat of the American Board of Lifestyle Medicine.
Dr. Comander is well-known for her compassionate care and passionate devotion to her patients. She has served as a medical advisor to Oneinforty, a non-profit organization dedicated to educating people of Ashkenazi Jewish heritage about the one-in-forty chance of having inherited a BRCA mutation. She is proud to serve on the board of the Ellie Fund, a non-profit that provides services and support to women diagnosed with breast cancer in Massachusetts. Dr. Comander has a strong interest in improving the quality of life and outcome of cancer survivors through important lifestyle interventions, including physical activity, diet, and mind/body interventions. She promotes healthy lifestyles for both her active treatment patients as well as those in the survivorship phase of care. She has launched PAVING the Path to Wellness, a 12 week lifestyle medicine based survivorship program for women with breast cancer.
Episode Resources
Watch the Full Episode on YouTube
PAVING The Path to Wellness Workbooks
To stock up on the best-tasting, most convenient, 100% PLANTSTRONG foods, including our all new chilis, check out all of our PLANTSTRONG products HERE.
Give us a like on the PLANTSTRONG Facebook Page and check out what being PLANSTRONG is all about. We always keep it stocked full of new content and updates, tips for healthy living, and delicious recipes, and you can even catch me LIVE on there!
We’ve also got an Instagram! Check us out and share your favorite PLANTSTRONG products and why you love it! Don’t forget to tag us using #goplantstrong 🌱💪
Full Transcription via AI Transcription Service
I'm Rip Esselstyn, and you're listening to the PLANTSTRONG Podcast.
Introduction to Dr. Amy Comander
[0:05] Today, as we continue our series on Breast Cancer Awareness Month, you're going to meet a special oncologist and lifestyle medicine physician who is paving the path to wellness for her patients. That's coming up right after these words from PLANTSTRONG. Hey, I'm going to let it fly here. the term plant-based has lost its way these days you can slap that label on just about anything even ultra processed junk like oreos or get this the other day i saw plant-based reese's peanut butter cups that is not what we're about at PLANTSTRONG our products are made from real whole plants, nothing refined, no oils, and we keep the salt in check. We believe that you can have great tasting convenient food without having to sacrifice your health. And yes, we're a small brand going against the grain in a market that's full of shortcuts, but we're here to fight for your right to real whole plant-based food. Kale yeah! Thanks for supporting us on this critical mission. To learn more, head on over to plantstrong.com.
[1:26] Last week on the PLANTSTRONG podcast, we had part one of our interview with the incredible Dr. Dawn Mussallem from the Jacoby Center for Breast Cancer at the Mayo Clinic in Jacksonville, Florida, where we discussed a couple of the recent studies on the benefits of whole food plant-based nutrition for the prevention and healing around breast cancer. We're going to have part two of that conversation in a few weeks, but today I want to introduce you to another Lifestyle Medicine Brock star, Dr. Amy Comander. Dr. Amy Comander also specializes in the care of women in breast cancer. She is medical director and director of breast oncology and cancer survivorship at Mass General Cancer Center in Waltham, Massachusetts. She's also board certified in lifestyle medicine and is an avid athlete and super busy doctor. She embraces these pillars herself every single day.
[2:35] It's the work that she's doing at Mass General Cancer Center that really caught my attention. Dr. Comander and her colleagues have developed a 12-week program called Paving the Path to Wellness, where they work with breast cancer patients on their healing journeys using the pillars of lifestyle medicine, including social connections that are so important. Movement, why we all need to move. Sleep, so many of us are deprived with sleep. And of course, you guessed it, a plant-forward diet. Now, this 12-week program is specifically designed to enhance your body, your mind, and your spirit, both after and during breast cancer treatment, with the goal to help you achieve your optimal level of wellness. They cover numerous topics that are of importance for breast cancer survivors, including sexual health, physical therapy, behavioral health, integrative medicine, nutrition, and culinary medicine.
[3:41] So often we hear stories of patients who are simply sent on their way after a diagnosis and treatment with no real plan of action and no support system. They're left wondering, what's next? How do I get back to my full self? How can I get back to normalcy and thrive?
Welcome Dr. Amy Comander
[4:02] Well, Dr. Comander and her team are digging in deep to change that paradigm. Please welcome Dr. Amy Comander.
[4:11] Music.
[4:16] Dr. Amy Comander, welcome to the PLANTSTRONG Podcast. It is so good to have you because this is Breast Cancer Awareness Month, or as you love to call it, Action Month, and who better to have than yourself? So welcome to the show. Thank you so much. It's an honor to be here. Yeah. So where are you this fine day? Where am I talking to you from? I am in Newton, Massachusetts, which is right outside of Boston, and it's a beautiful fall day. It is October, as you noted, so it's Breast Cancer Awareness Month or Breast Cancer Action Month, as I like to call it. And how long have you been in Austin? I'm Boston. I'm in Austin.
[5:07] Honestly, for a really long time. I was a Harvard undergrad, and then I did leave Boston for medical school, but then I've been back ever since for all of my medical training and as an attending physician. So it's been a while. Wow. So do you love Boston and all that it has to offer? I honestly do love it, but I will acknowledge my husband is from Miami. And even though he's been here longer than me, I feel like he is still adjusting to the winter. So we're toughing it out, but it's always a struggle in the wintertime. Now, did I see, did you recently run the Boston Marathon?
[5:48] So yes, I ran my 11th consecutive Boston Marathon this past April. I run it, well, I've been running it for the past 11 years. And I always run to support charitable causes. So it's a passion of mine. I would never miss it. Wow, 11 straight years. And what'd you do during COVID? Was it virtual or how did that happen? Great question. I remember that day in March of 2020, I'm sitting in clinic and I see an email that the Boston Marathon is being postponed, which of course was definitely the appropriate thing to do given everything that was going on in the world at that time. But it did, you know, it was quite upsetting at that time to read that email. They did defer the marathon till the fall and it became a virtual Boston Marathon, which meant you could run it anywhere you wanted during a certain timeframe. So a friend of mine did run together on the course. So that was actually a memorable Boston Marathon for us. Mm-hmm. Well, congratulations, 11. That's pretty phenomenal. Quite the record. You're putting a lot of pressure on yourself.
[6:56] Well, I run for, you know, I've been running for the past few years to support the LE Fund, which is a great nonprofit organization here in Massachusetts that provides supportive care services to individuals with breast cancer. So that's a passion of mine too. So that's my why. That's what gets me out the door to train, especially in the winter. So I really love doing it. and it's such an exciting day in our city. So you should come sometime. It's on Patriots Day, which is always the third Monday of April. Yeah, yeah.
[7:24] Don't you have to qualify for the Boston Marathon? Or if you've done more than five, do you automatically qualify? Great question. You do have to qualify for the Boston Marathon. And I am in awe of those individuals who do qualify because that is really tough. But if you don't qualify like me, you can run for charity. So if you choose the fundraise and there are so many amazing causes that you could run Boston for that, that is a great option for somebody who truly wants to run the marathon, but isn't going to qualify anytime soon, which is me. Yeah.
Dr. Comander’s Journey
[8:01] Well, so you mentioned the charity that you love running for is for breast cancer. So with that, I think it's a great transition. Let me... Tell the audience a little bit about yourself. And that is, you know, you're the medical director of Mass General Cancer Center. That's in Waltham. Is that pronounced correctly? Waltham? Waltham. It's okay. Waltham. Waltham. Waltham. There you go. Waltham, Massachusetts. You also serve as the director of breast oncology and cancer survivorship there and Newton Wellesley Hospital. You're also an instructor in medicine at Harvard Medical School. My question to you is, wow. I mean, have you always been like this really ambitious human being?
[8:53] If you ask my friends, they would probably say, yeah, that's Amy. But I love everything I do. I also oversee our Lifestyle Medicine Program at the Cancer Center, which is a lovely, amazing program with a wonderful team. And it's a true passion of mine to bring those tools, not just to our patients with breast cancer, but to all individuals with a cancer diagnosis. And I hope we continue to spread the word about the importance of this for cancer patients. Yeah. Yeah.
[9:21] So speaking of ambitious, you mentioned, did you say you went to Harvard undergraduate? Yes. Okay. Harvard graduate, undergraduate. Where did you go to high school? Well, I actually grew up in Savannah, Georgia. So I grew up in the South. My parents were actually New Yorkers who ended up in Georgia since my dad was in the army. And so I grew up there. And to be honest with you, by the time I was a senior, I was like, I just was ready to be somewhere else. You know, I wanted to be in a big city and I just fell in love with Boston. And I'm so grateful that I did end up here. And obviously I'm still here. Yeah. So let us know, where did you go to medical school and residency? Right. So I was fortunate to go to the Yale School of Medicine in New Haven, which was also an incredible experience. I've heard of that place. Yeah. And then I ended up back in Boston for internship, residency and fellowship. And then of course I've stayed ever since. And my husband was here as well. And he's been here the whole time actually since college. So we met in college. And so that's kind of why we're stuck here, but we do love it.
[10:34] So you met your husband at Harvard? Correct. And were you in the same class? Were you guys, did you bump into each other in the cafeteria at a bar?
[10:44] We were in the same class. And my husband is also, he's actually a physician scientist at Massioneer. He does really good work in research and gene therapy for individuals with inherited retinal disorders. So he does very cutting edge, exciting work. And so it's really great for him to be at Massioneer.
[11:05] So is it fair to say that your specialty is oncology? Correct. Yeah. Breast oncology. Yeah. And so for people, that aren't familiar with oncology, what exactly is oncology? Yeah, so oncology is really a fascinating field that's changed so much, even since my medical training, and really focused on the care of individuals with a cancer diagnosis. And as I'm sure, you know, your listeners and you can attest, like this field has changed so much, just even in the past 20 years with all the exciting advances that we've witnessed. So it's really an honor to to be an oncologist. And my job is very tough, but I love what I do because of my patients. I love my patients. They inspire me every day and I learn so much from them.
The Intersection of Oncology and Lifestyle Medicine
[11:54] So it's really a passion of mine. Yeah. Well, I want to talk about that in just a little bit. So you mentioned that you're also involved with lifestyle medicine and that it sounds like has become another huge passion of years, when did lifestyle medicine poke its head up? And when did you go, oh, that looks interesting. I think I'll check that out.
[12:20] Yeah, great question. So it's funny. So in my undergraduate days, I thought I'd be a neuroscientist. So I was really into studying psychology and neuroscience and integrating those tools. And somehow I thought I'd end up in psychiatry or neurology or something like that. Obviously, I ended up in oncology. That's a whole other story. But when I was working at MGH, I remember one day I just saw a flyer for a lifestyle medicine conference that was being sponsored by the Institute of Lifestyle Medicine and Harvard Medical School. And I looked at the agenda. You know, there was talks about how to prescribe exercise to your patients, how to talk about the benefits of a plant based diet. Like these were the topics. And I was like, wow, I'm personally so interested in these areas. But I really didn't have a lot of education or training in those specific areas. And all of my medical training. So that's how I ended up at that conference. And I was really blown away. That was my first introduction to lifestyle medicine. And I was just sitting there thinking like, wow, I need to learn more. I need to bring these tools to my patients with breast cancer who asked me these questions all day long in clinic. And obviously to cancer survivors in general, there's so much power from this field in terms of the evidence-based information that we can use to help our patients.
Exploring Lifestyle Medicine
[13:35] Yeah. What year was this that you went to this? Can you remember? I want to say it might have been 2012 or 2013.
[13:44] So a good 12 years ago. Yeah. Yeah. Yeah. So that's pretty good. I mean, you've kind of been in the thick of it for over a decade. Good for you. You were one of the early pioneers. Well, I mean, I think it took me some time to really get into it, to do the board certification, lifestyle medicine, et cetera. But you're right. I did get exposed to it and interested and then, you know, found ways to learn more and, you know, certainly bring other colleagues into the fold, too, who are interested. So that you're right, though. It has been a while. Yeah. Yeah.
The Need for Lifestyle Medicine in Oncology
[14:16] Did you, I mean, so when you started learning more and more and more, did it just, were you like this intuitively kind of makes sense?
[14:26] And it just kind of resonated with you? Because I'm just, I am, frankly, just amazed that more physicians somehow or another haven't embraced this. And that unfortunately, you are part of the minority instead of the majority. And I'm wondering if you have any thoughts around that. You know, it's a really great question. I think back to my days in medical school at Yale, which I would, you know, a great place to be in medical school. We had really amazing lectures from world renowned professors. But when I think back to education about nutrition, benefits of exercise, you know, I don't recall a lot of specific instruction on those topics. And similarly, an internship residency fellowship. I mean, there's so much information that we need to learn and acquire, obviously, to become doctors and then later to become an oncologist. But these tools are absolutely important. I fully agree with you. There is such a need to integrate this information, certainly in medical school. And I know that's changing, but we obviously need to do more. And, you know, I'm working with a Hemonc fellow right now at Cleveland Clinic, Dr. Jasmine Hundell. Give her a shout out. And I know she's very passionate about this area. So I think the future is bright, that more doctors are learning about this and interested in bringing these tools to their patients.
The Role of Lifestyle in Cancer Prevention
[15:44] Well, I know on your your Instagram post, you recently posted it was a study that came out and it basically cited that almost 40 plus percent of these adult cancers are really due to lifestyle. file.
[16:06] And when I see studies like that, when I see numbers like that, and I think that's really low personally, but.
[16:15] 40 or 50% of these major cancers are preventable through these modifiable risk factors. I'm like, wow, I mean, this should be headlines everywhere. A hundred percent agree. I mean, thankfully, we've seen major strides in reduction of use of tobacco, right? Which has definitely led to a decrease in cancer incidence and mortality. But, you know, we excess body weight, as we know, is a major issue plaguing the United States and countries around the world. And let me ask you this about excess body weight. What is it about excess body weight that contributes to the acceleration of tumors and cancers? That's such a great question. And I feel like researchers are still trying to figure out exactly the mechanisms by which obesity or excess body weight increases risk of actually 13 different types of cancers. And that was published in the New England Journal in the early 2000s. So this is not new information. We've known this for quite some time. You know, is it because of excessive inflammation in the body, oxidative stress, insulin resistance, changes in the gut microbiome? I mean, I think I'm listing all these things because I feel like we're still trying to understand these mechanisms so we can pinpoint this and address that issue in order to help reduce risk of cancer. Because, yeah, as you know, cancer incidence, unfortunately, is increasing in individuals under age 50. And we really need to figure out the reasons why and address that. Yeah.
[17:45] And I cut you off with body weight. We were talking about how so much of the country is also overweight. And you mentioned how we've pretty much, I think, done a good job eradicating smoking.
Understanding Alcohol and Cancer
[18:00] And I looked it up and the definition of eradicating is getting less than 20% of the population to be doing something. So wouldn't it be great if we could have, we could eradicate the eating of animal products and animal byproducts? So it's less than 20% of this country. That'd be, wow. And then the last thing I think where you were going was alcohol consumption, if I'm not mistaken. Right. Yeah, we know that. In fact, that was a recent report that came out from the AACR just a few weeks ago, highlighting that alcohol is a carcinogen and a significant contributor to cancer risk in this country. It's actually the third leading risk factor, modifiable risk factor, I should say, after tobacco use and excess body weight. So it accounts for about five percent of cancer risk. So, you know, I think and actually what was also interesting in that study is over half of Americans did not know that alcohol use does increase risk for cancer. So certainly it's a public health issue as well. We need to get this message out. So what what how do you approach alcohol with your patients?
[19:06] Right. So certainly there's a lot of research in breast cancer that, you know, excessive alcohol use for my patients who have breast cancer is not recommended. So, you know, based on many studies from the Nurses Health Study and other studies, I don't tell my patients they have to completely eliminate alcohol. But I like the AICR, American Institute of Cancer Research's motto, think before you drink. So be mindful. Why are you having a drink? So if you're at a wedding and it's a big celebration and you want to have that glass of champagne, you can have that glass of champagne. But in general, you know, people who drink mindlessly, I hate to say that, have that two glasses of red wine each night, which a lot of people do. You know, I think that is an area that I really work with my patients to cut down on sort of the mindless drinking. I'm not saying people are drinking in a mindless way, but, you know, sometimes there's just not a lot of thought because you don't think it's perhaps harmful to health. Yeah. Do you know who Dr. Dawn Musalem is? Yes. I'm a huge fan. Love her. Yes. Yeah. So just had her on last week. So you're going to be on the heels of Dawn. So you guys are like soul sisters. I love her very much. And I can't wait to see her at ACLM in a few weeks. Yeah. Oh, how exciting.
[20:28] But we talked a little bit about alcohol and I mentioned to her and I'll just repeat it that, do you know who Dr. Christy Funk is out in L.A.? Yeah. And so we also have her on this month as part of breast cancer. Not awareness, but action month.
[20:48] And she mentioned to me that, you know, she's known about alcohol and she just said she's never really done anything about it. But she said, finally, she decided I got to do something. And so she hasn't had a drink since January 1st. Oh, wow. Yeah. I have a tip. So a wonderful oncology registered dietitian I work with, Carol Sullivan, has a tip to help people who have that craving for red wine, holding the wine glass and sipping it at night. She tells them to substitute with tart cherry juice, which actually does have benefits in terms of perhaps helping with sleep, helping with arthralgias that many of my patients experience secondary to their treatment. And so I've actually had some patients tell me putting the tart cherry juice in the wine glass really helps them. So that's one pro tip I can share. Thanks to Carol. That's a great pro tip. So anytime while we're talking, if you can think of a pro tip like that, that is gold. Okay.
Paving the Path to Wellness Program
[21:52] So let's talk about your signature program that you started. It's called Paving the Path to Wellness. And it's a 12-week program. And you've also got this flywheel of 12 different things that you ask people to follow. And I think that it's fair to say that.
[22:14] It really, it steps for not only breast cancer survivors and thrivers, but also people that maybe haven't, that are trying to prevent breast cancer, and it can allow everybody to kind of optimize their outcomes or their life going forward. Yes. I just want to say getting back to that conference I attended, you know, back in when I first started at Mass General, that's where I met Dr. Beth Brady's, who is currently the president of the American College of Lifestyle Medicine. And we had coffee after the conference because she's so generous with her time. And I was like, I want to start a program for my patients with breast cancer. I'm going to focus on diet. I'm going to focus on exercise. This was me. Okay. And she's like, Amy, you should think about a program that incorporates all the tools of lifestyle medicine. Your patients would derive such great benefit. And around that time, she had been offering a program called paving to stroke survivors at Spalding Rehabilitation Hospital, which is a Harvard Medical School affiliated rehab hospital here. And that's actually how our collaboration began. So paving is really the inspiration of Dr. Frady's, I have to say. And we began this collaboration to offer this to individuals with breast cancer. So that's really where I took off with it. And I need to work closely with her and another wonderful colleague who you may know, Dr. Michelle Tollefson. And so I have really grown this program at Mass General.
[23:43] And right now we have like 65 people doing it. It's really amazing.
Expanding the Program's Reach
[23:48] Happy to tell you more about it. And we hope to offer it to more because there's so much interest from this population. There are 4 million breast cancer survivors in the US and we need to help them. And these tools have so much power, as you know. Wow. I didn't know 4 million. So 4 million women that living and hopefully thriving.
[24:13] That's the goal of our program. We want to help people not only survive, but to thrive after their diagnosis of breast cancer. Yeah. And is this your fifth year of the program? I know it's hard to believe time flies when you're really having fun. But yes, I started it back in the fall of 2019 at a little conference room at Newton Wellesley Hospital. It was in person. And then, you know, in the spring of 2020, I was launching it again. And that's when COVID happened. So we transitioned to a virtual format via Zoom. And honestly, we've continued offering it that way. There's pros and cons to in-person versus virtual, but it's really enabled us to meet the needs of our patients who seek care at MGH or like all over Massachusetts. So it's really been wonderful. And we have this amazing community that's really developed from people who have participated in this program. Okay. So when you decided you were going to launch it in 2019, is there somebody within the hospital organization that you have to go to to get permission to do this? And if so, how challenging was that?
[25:18] Well, I will tell you, I had a dear patient, Arlie Langseth, who sadly has passed away, but I will tell you her passion was lifestyle medicine. She did not know it at the time, but as a breast cancer patient, she sought out all the areas of lifestyle medicine to educate herself as she was going through her treatment. Her dear husband, donated to support the development of this program. So I just went with it. I may have told an administrator, I'm getting a hospital conference room and starting a program. And they were probably like, great, but I just did it. And I had funding and that supported bringing plant-based food from the hospital cafeteria to the women who participated. And really that was the only cost we had in getting some workbooks for patients. But really, we just, we just did it. Yeah. You know what?
Patient Stories and Impact
[26:08] Kudos to you for having that attitude and that gumption. This is just a little side story. I can remember back in...
[26:18] Must've been 2001, my father was down visiting me in Austin, Texas. And he doesn't like to just hang out. He likes to be busy. And so I tried to get him speaking engagements at different places that I knew, the fire station and the workout club and the library. And I even went to a couple hospitals and two of the hospitals that I went to, they both said, this is too preventative oriented. And they said, no, thank you. So it's amazing how far we've come, right? That is crazy.
[26:56] But so let's talk about your program. Yeah. So how about, how about, how about if we, so I know that you basically have, do you call them 10, 12 pillars or how do you refer to them? Yeah. So, so we do focus on the six key pillars of lifestyle medicine, which I'm happy, you know, exercise.
[27:19] Plant-based nutrition, sleep, stress management, social connection, and avoidance of use of risky substances. So those are the six, you know, pillars of lifestyle medicine. But when Dr. Frady's developed this program, she also wanted to incorporate other steps such as how do we make goals? Like what is the science of goal setting, which is really interesting. You know, how do we form new habits? What is the, you know, why do we need to take breaks or timeouts? What is purpose? And how is that important sense of purpose after a cancer diagnosis? That's a really big topic for our program. So she incorporated a total of 12 different topics, as you noted, and we meet weekly over 12 weeks and take a deep dive into each topic and also discuss the evidence that's relevant for breast cancer survivors. And we make it very interactive and supportive. And the patients honestly probably learn more from each other than from me and our other leaders. but it's really been such a powerful program and it gives me such satisfaction to do it too. I just absolutely love it. Well, I just can't even, I can't even imagine how fantastic it is to have this kind of a community, this kind of support where women, and I would imagine men,
The Importance of Community
[28:31] there might be maybe very few.
[28:34] Men get breast cancer too. We actually have not had a male participant yet, but men would be welcome. I want to say that. Okay. But these, where these women up to now have a place to just share something as that is just taking the earth out from underneath their feet and wow so this is huge i would i would love to throw to you each one of the 12 and then just talk about it for a little bit just so people can get a sense so the first one is is physical activity. And I guess my question to you is after somebody has, well.
[29:14] Let's set some ground rules here. Are we talking about people that have not had breast cancer or is this people that have had breast cancer and now they're trying to thrive and live after that? You want to do it that way? The program as it currently is formed is for individuals who've had a diagnosis of breast cancer. But you're right. These tools are so important for risk reduction as well. But that is the current population. Individuals who have had breast cancer. So physical activity, what is your position on physical activity after breast cancer?
[29:48] Ooh, this is one of my favorites, but of course I love all the topics. So obviously from talking to Dr. Musalim and Dr. Funk, you're going to learn all about the immense benefits of physical activity for breast cancer survivors. There are so many studies that demonstrate that exercise itself can help reduce risk of recurrence from breast cancer and improve outcome from breast cancer. So this is huge, just from exercise. So in fact, exercise is now incorporated into the guidelines from, you know, my organization, the American Society of Clinical Oncology, and other major reputable organizations. So we need to be talking to our patients about exercise. But I will tell you that many in my field do not feel comfortable providing counseling and advice about an exercise regimen. And there's really not enough programs out there to provide instruction to patients. So this is another area of great opportunity that we need to work on, not just for the breast cancer patients, but for all cancer patients.
[30:47] I mean, yeah, I really think that physical activity is built into our DNA as human beings. And there's just so many incredible benefits that have been shown around movement. What about, I'm trying to think what, what is great that goes right after that. Cause I also notice in your, we can go down it so we can keep it simple attitude.
[31:13] Okay. You know what? You know what? Let's do that. Let's do that. Cause I have that in front of me. So, okay. So yes, attitude. Yay. So that is a big one, right? Especially for unfortunately our patient population who has just gone through cancer treatment. Usually most of our folks have completed primary chemotherapy, radiation therapy. Some of them are still in the midst of it, but they're taking their anti-estrogen therapy or other targeted therapies. So attitude's a big one. So we talk about that a lot. And what comes with attitude, like how you cope with your diagnosis, the concept of self-compassion, the work done by Dr. Kristen Neff and others. And a major topic we discuss in our groups is how to handle fear of recurrence. Because if you ask any breast cancer survivor, that is always top of mind is that back pain I'm having related to my breast cancer and really tackle that and discuss strategies to help individuals manage that problem because it is always on their mind, unfortunately. Yeah. I mean, I, I think, uh, you know, the longer I live, the more I'm convinced that attitude is everything. So vitally important to everything we do in this lifetime.
[32:27] And again, as you said, we're going to be using paving steps. So the next thing is V, which is variety. What do you mean by variety? And we just did this topic this past week, and this is a fun one.
Exploring the Paving Steps
[32:42] I mean, some of our patients like this one the most, and you'll like it too. We just talk about variety with regard to the other things like physical activity. What are different types of exercises that you can try that might bring joy? When we think about nutrition. We say, eat the rainbow. What does that mean? Maybe you try different fruits and vegetables that you've never tried before. When we think about managing stress, what are different techniques that one could use to help address that? So we just talk about thinking of creative ways to explore all of the different topics. And we always have a great discussion with the women about that topic. Well, I've heard this quote, that variety is the spice of life. That is what we launched the session with. So that is a great, great quote, for sure. Good.
[33:30] I is for investigations. I have no idea what that means. Investigations. What am I investigating? So we encourage each participant to think of herself like she's the N of one in a scientific experiment. So we all want to try new things. So let's say, you know, an individual's like, oh, I really know. Dr. Comander told me I need to start a strength training program to help my bones and improve my muscle mass after my breast cancer treatment. I guess I will go to a gym and try a class two times a week to really work on strength training. How do I feel? So we encourage our participants to do little experiments on themselves and think of themselves, you know, have a hypothesis, gather the data, look at the results. And so that's what we talk about when we focus on that topic. And we have a lot of fun with that too. Yeah. It's, well, it's nice. It gives them something to focus on, right?
[34:22] N is nutrition. I have no idea where you're going with this one. And I know I have to hold up the cookbook, right? I have the plant-based woman warrior cookbook right here. So we talk about different approaches for incorporating more plants into our diet. You know, what are the recommendations from organizations like the American Cancer Society, American Institute of Cancer Research, American College of Lifestyle Medicine? How can individuals, you know, incorporate more of a whole food plant-based diet into their routine? And, you know, this is a challenge for many people who maybe never thought about that and haven't really tried to make dietary changes. But this is always a favorite topic. In fact, we actually kind of do it over two sessions. In fact, next week, I'm hosting, I'm not the chef, but I'm hosting with a chef, a culinary medicine cooking class, where we'll do some cooking with our participants and provide education at the same time. We try to make it fun and interactive. You just rattled up a bunch of organizations that are advocating for whole food plant-based. Is there anyone that you know, any of these organizations that are not leaning into plants.
[35:33] I mean, all of these organizations, American Cancer Society, of course, AICR, which I love, and of course, ACLM very much recommend incorporating at least half of your plate should be fruits and veggies, and also trying different plant-based proteins, limiting the ultra processed foods that unfortunately are such a huge component of our diet. And we're learning more and more about how they're not good for our health. So we really talk about that. And I would say the major organizations now, thankfully, do recommend a focus more on a whole food plant based type of pattern. I mean, you know, whether people eat chicken, meat or fish, you know, that gets into the details. So some of them don't specifically say patients should not consume that. But certainly there is a focus on eating the rainbow. Get lots of fruits and veggies into your diet. Yeah. So specifically around.
[36:25] Breast cancer, is there any particular foods that you recommend that women eat, for example, soy, whole soy or something like that? Yeah. So we, I think there's a lot of fear around soy and a lot of misconceptions. I'm sure you've encountered this as well. And, you know, the data would suggest that soy consumption, you know, from a whole food type of source is safe for breast cancer survivors and in fact, maybe improving outcome. So we do encourage consumption of soy, whether that's edamame, tofu, that type of thing. And, you know, for example, on our cooking class next week, I think one of our recipes does involve tofu, which some people have never even tried to cook before. So we discussed strategies for incorporating soy and other plant-based proteins into the diet. We talk a lot about alcohol and they need to limit it as we discussed earlier, because again, there's not a lot of education and awareness about that topic, which is a food, right? Food or drink. So are all the...
[37:25] Um, breast cancer survivors and thrivers that are part of the paving steps, 12 week program. Do they have to be a patient at one of your hospitals or is this for anybody? Great question. So the program we're currently talking about, I offer at the Mass General Cancer Center for our mass general patients, but in collaboration with Dr. Frades and Dr. Tollefson and Val Tiffman and another wonderful colleague, we did start a nonprofit called paving wellness. and our goal is to offer this program and for other populations through our nonprofit. So that is a work in progress, but we're excited to start doing that because I feel like there's so many individuals who would get derived benefit from this program and we do, we need to spread the word. Yeah.
[38:12] I would imagine that for those that don't know what they're getting into, maybe with this 12 week program, them, they must come out of it just raving and going, this exceeded all my expectations. I can't believe what you've put together here. And I even noticed, Amy, that you guys have put together a paving steps guidebook for people as well. I mean, so well organized. Bravo. It's your workbook. And by the way, any proceeds from that goes to our nonprofit. But yes, The workbook is a great tool and we encourage our participants to use the workbook during the course of the program and we get great feedback about that. So, but you're so right. I will say one of my patients told me this program provided me with a roadmap for hope after cancer, which is like, it was such a gift. And, you know, just comments like that are just so wonderful and touching and really, you know, this is why we do this, right? Because it really does make such a tremendous impact on our patients after they've gone through such a traumatic thing as a breast cancer diagnosis and all the
Setting Goals for Recovery
[39:22] treatment that that entails. Yeah. Well, you mentioned that. So one of the, The goals is to have the proceeds go to fund the nonprofit, Bravo.
[39:34] The last letter in paving is G goals. So what are these goals around people's recovery? What is it? Yeah, we talk about setting smart goals. So, you know, when our patients are like, oh, my gosh, exercise, like, how am I going to do that? So we talk about how to, like, break it down into little action goals. And we talk about, you know, what the recommendations are, you know, in terms of exercise for cancer survivors. But, you know, we don't want someone to be like, OK, I have to go from zero to one hundred and fifty minutes of moderate aerobic activity each week. So we talk about how to set goals and the importance of accountability and the community. And it's really powerful. And I should tell you there's five more steps. S.T.E.P.S.S. I can go. I know. I know. I'm getting there. Yeah, yeah. We got we're just getting started here. Okay. Hang in there, everybody, because that was paving. Now we're going to steps. And the first thing is stress resiliency.
[40:33] You know, I think we all know what stress is, but stress resiliency, maybe, well, what is that exactly? Right. Well, I think many would say that there's unfortunately not much out there that is more stressful than a diagnosis of cancer. And so in that session, we really focus on what are some strategies that cancer survivors can use to help manage stress and become more resilient. And so we talk about, you know, what the latest evidence with support that we also talk about different strategies. And again, the women always learn from each other. Some are really interested in meditation, forest bathing, cooking is their stress tool. Like there's just so many interesting approaches people take to manage stress. So that's always, you know, a really important topic that we focus on. Nice. I've been doing a lot of forest bathing lately and very, very therapeutic. I need to do more of that. Especially in Boston.
[41:31] So time outs, T is for time outs. Is this where you go sit in the corner by yourself? I know, those of us with kids, no, that's our definition of time out. And hey, I guess it does apply. But really the concept of taking time for yourself, the importance of taking breaks, you know, in this fast paced world, sometimes we rarely take time for ourselves just to kind of, like you said, go outside and walk or take a little hike, you know, in the middle of the day, just to kind of clear your brain. Like, and we talk, you know, there's science behind this. This is like important that we do this, that we allow ourselves to take these breaks, especially for in front of screens all day. And so we do dedicate a session to that and our participants do love that. And it's really special. Yeah. I don't think nearly enough of us take enough timeouts during the day, whether it's to meditate, whether it's to frankly do a 30 minute workout or something to just kind of reset things. Right? You're just kind of your whole system. Speaking of E, energy, what kind of energy are we talking about here? I know. So this is another really important one. See, they're all important.
[42:39] So there is this entity called cancer-related fatigue, which is really the most common symptom that often my patients will report to me in clinic. And that can be multifactorial due to specific medical reasons, perhaps anemia, thyroid dysfunction, or it could be side effects from drugs, or can just be, you know, recovery from that intense cancer treatment. And it just takes time for the body to bounce back. So we really talk about strategies to manage energy. And I work with an amazing social worker colleague, Kirsten Anderson, who, for example, talked about this concept of the spoon theory. I'm not sure if you're familiar with it, but I love this metaphor. We each wake up in the morning with a certain set of spoons that really is sort of a metaphor for how much energy we have. And so she kind of talks with the participants about if you have five spoons and you have like 15 things you were hoping to do today, maybe you need to cut it down to five and think about, prioritize what are the most important, thinking about ways to manage your energy. And so that's another really important topic for this population. Yeah. Yeah. I can't even imagine.
[43:50] Okay. P purpose. So that's a big one. And, you know, this is coming near the end of the 12 weeks, but we really have a discussion with the group about sense of purpose, why it's important for our wellbeing and overall health. And also how does one's sense of purpose perhaps change after a cancer diagnosis. And I will tell you, this is always a very powerful discussion amongst our members. And some individuals actually don't know what their purpose is, and they're trying to seek it out and figure out what they want to do now with their time. And some have all of a sudden, like, almost like an epiphany of something they've always wanted to do, and now they're going to do it. So it is, it's a really interesting topic for this popular for all of us to ponder, right? But in particular, in this group, it's always a really robust discussion. Well, regarding purpose and our time here on earth and after a breast cancer diagnosis and then surgery and all the different procedures, these days on average, how long is the average person that's been diagnosed with breast cancer surviving.
[45:10] Great question. Thankfully, due to so many advances in treatment,
Advances in Breast Cancer Treatment
[45:14] our patients do really well. I mean, the five-year survival rate obviously depends on the stage, but it's very high now. And even our patients with advanced breast cancer can live for years with that diagnosis. So our patients, thankfully, live for many years, and therefore they do have an opportunity to really contemplate the sense of purpose and what's important to them.
[45:39] So along those lines, are you a big fan of testing and testing often? What is your philosophy? And that's a really interesting question in our field. There's now this new technology. You can do a blood test on a patient and look for circulating tumor DNA in the blood. And this is kind of something they've been using in the colon cancer space for quite some time, But in the breast cancer world, these are new tests that are now being used and some patients can order them actually on their own. And but learning how to best use this technology, I would say, is still an area of ongoing research. And I do not recommend this as a standard practice. But I do have some patients who have chosen to do this. When you say, why have you not recommended this? Because we actually are still learning what to do with that data. if a patient did have a positive test and then has a scan that's negative. So this is an area that we will need to sort out over the next few years. But definitely, we certainly follow our patients closely in our clinic. And they are seen every six months in the first five years for close follow-up.
[46:46] Let me ask you this. Outside of... These lifestyle pillars that we've been talking about. Is there anything else that you've seen that in the advancement of breast cancer or other cancers that has you going, wow, I can't believe how fast medicine is moving?
The Challenges of Oncology
[47:08] I mean, I will say every day in clinic, when I have a patient, who's on a trial, for example, October 1st, just a few days ago, I saw my first patient early in the morning and she's on a clinical trial setting a new anti-estrogen medication in the adjuvant setting. So she has early stage disease and she's on this trial studying this new agent. And I just said, it's October 1st. This is breast cancer awareness month. And I did tell her, you know, I love calling it breast cancer action month. And I thanked her. You are taking action by being on a clinical trial to help us determine if this medicine you're on will be the next endocrine therapy for future women, just like you. And she was like, thank you so much for pointing that out. That really made my day. So we had so many advances in our drugs in just the past few years that sometimes when I'm in clinic, I really take a second to ponder that. And I'm like, wow, you know, we really are. I mean, it's, it takes the team, you know, we need the clinical researchers, the basic scientists, the oncologists, you know, there's just such a collaboration to help bring these drugs to our patients. And so I have seen really immense progress even in the past few years. So it's really exciting. It's an exciting field to be in, but the lifestyle piece is absolutely key as well. Oh yeah. Uh, S we got two S's to tackle here.
[48:29] The first is sleep. I'm getting tired. Yeah. Sleep is, I mean, I hate to say this insomnia, sleep disturbance, like really, really prevalent in cancer survivors and very unfortunate and sleep can be disruptive for so many reasons, hot flashes, pain, anxiety, or just hormonal changes that can make sleep difficult. So I'm fortunate to work with a colleague, Dr. Daniel Hall, who's doing a lot of really interesting research on how to improve sleep and cancer survivors. And so that's a topic that, you know, definitely helps a lot of people because we all need to work on our sleep and that and me included So that's an important one. And then the last one is actually one of my favorites. And I underestimated the importance of the last topic until I actually ran my first paving program. And that is social connection.
[49:24] So I was always like, yeah, social connection. That's a great topic. But our first paving program ended and I was like congratulating the participants for sticking it out with me for 12 weeks. And I was also secretly congratulating myself. Like, you actually did it. You led a group program for 12 weeks. And I said, you all graduated. You can move on. And they were like, Dr. Comander, we are not done. They had really bonded by studying all these topics together. And they're like, we want to do it again. And they actually did that. They did it again on their own. They stayed together and they're still like this. They call themselves the originals and they meet on Zoom once or twice a month and continue to focus on the paving steps or whatever else they want to talk about. But they continue to support each other after their cancer diagnosis, which is really beautiful. Yeah. No, we hold these retreats twice a year, typically for 80 people. And people, they come because they want to be around like-minded people. They're just dying for the social connection because where they are, they just feel so alone, right? So social connection, can't underestimate it. Yeah, so those are the 12. And in the pinwheel that I'm looking at right now, I see you've kind of broken it up into four quadrants, action, joyful heart, healthy body, and peaceful mind, which is nice, really nice the way you've done that.
[50:53] Yeah, I love, yeah, Dr. Beth Brady, that's her thing. She wants to help people achieve a healthy body, peaceful mind, and joyful heart, and then focus on the action steps needed to get there. So I absolutely love that too. So you have your paving steps. Now, recently, you came out with your breast cancer action plan, right? And that was published by Harvard Medical school.
[51:20] And you were the medical editor for that. When did that come out? And what's that all about? Yeah, it just came out, I want to say a few months ago. And it was a wonderful collaboration. And really just to help, you know, in this world of social media and TikTok and all the stuff that's out there. I feel like our patients are very savvy. They do their research. When I see a new patient, she's already like read about everything that she thinks I'm going to tell her about. So I think it's really great to provide evidence-based reputable resources for our patients because we know there's a lot of misinformation out there. So that was why I was really excited to collaborate and work on that action plan booklet, because I feel like, you know, people will trust Harvard Medical School and hopefully me to provide evidence-based information that's cutting edge and we did incorporate information about the tools from lifestyle interventions too and how those are very important after a breast cancer diagnosis yeah so hanging around harvard you've been hanging around harvard now for what about 15 20 years i mean since i came back for internship and residency i know it's hard to believe but it's been a while so have you ever run into walter willett, Um, I know he's such a fan. So yes, I've been fortunate to hear him speak and certainly been over to the Harvard school of public health. And by the way, they have an amazing cafeteria.
[52:47] So, um, but yes, I know he's definitely renowned around here for sure. Yeah. Yeah. And so is the cafeteria, do they have some nice plant-based offerings? Yes. I mean, I haven't been there in a while, but last time I was there, I was like, Ooh, this is a good cafeteria to visit because I can't always say the same about the hospital cafeteria. Yeah. Yeah. You mentioned hot flashes. I'd just like to touch upon menopause for a second. Have you found that, that kind of this, these lifestyle steps also, also help women with menopause? Definitely. I mean, we know there's evidence that certain lifestyle interventions such as regular physical activity, incorporating some soy foods into your diet, following more of a plant predominant diet definitely can help reduce hot flashes. And so, and you know, my colleague, Dr. Michelle Tollefson speaks about this a lot too. So I think it's really important to start with these lifestyle interventions for my patients. Certainly if they're trying those measures and it's really not working, we will consider various medications, you know, non-hormonal medications to help them manage their hot flashes because that is a pretty distressing symptom that many of our patients experience often secondary to some of the treatments that we're recommending for them so yeah so we deal with hot flashes a lot in our population unfortunately yeah what what's.
[54:17] What's the average age of your breast cancer patients? Right. So I know the average age as released recently by the American Cancer Society, which updated this report with statistics for breast cancer in this country for 2024. The average age is early 60s. I believe 62. But I will tell you, I mean, maybe it's because I'm at Mass General Cancer Center where it's a referral center. We tend to, I tend to see a younger population. You know, I would say the average age of my practice. It's probably mid to late forties. That's the average age that I see, but that's probably just because of where I work.
[54:54] And so would you say it's infrequent to see somebody with breast cancer in their thirties? Well, that's another unfortunate finding from recent studies, including this American Cancer Society report that was recently released that we are seeing an increased incidence of breast cancer, particularly in women under 50. And that risk, you know, can be about 1.4% per year increase over the past 10 years. And so there is an increased incidence, again, if it's under age 50, I don't know if they broke it down to women under 30, although we sometimes see that too. But I think this is a real wake up because, you know, certainly there's reports about increased incidence of early onset colon cancer and other types of cancer. So we really need to focus on why is this happening, as we talked about in the beginning and how can we address this and curtail this trend.
[55:48] What do you think is causing the increase? Well, you know, I think we both are probably on the same page about our concerns about our bad standard American diet, which I mean, I hate to say it, that's obviously we're worried that that's one of the factors. There are probably, it's probably multifactorial. You know, there's so many other potential exposures that we have from when we're kids until we're adults that could affect that, not just the diet, environmental exposures, toxins, more data about pollution, you know, microplastics. Again, I'm, there's so many factors. So often when I read articles about this, they're still like, we're still trying to figure it out. But I think, I think we'd all agree that one area that we can all work to address is our diet. So I think that's something we should focus on.
[56:36] I swim every morning. And this morning in the locker room, one of my very, very good friends, who actually turned on to Whole Food Plant-Based Nutrition. He said that his daughter... Is freaked out by oatmeal because she says it, she's heard that it causes blood sugar spikes. And, you know, there's all this noise right now around blood glucose monitor, continuous glucose monitors and all this other stuff. Do you have any, can you comment on this? And I'm sure you've had to address this with your patients.
[57:10] Yeah. I mean, I think these, the use of these continuous blood glucose monitors, certainly for our patients with diabetes, there's evidence that is beneficial, but for an otherwise healthy young woman, like, yes, her glucose will go up after you eat carbs, but you know, it's going to come back down after your body metabolizes it. And we both know that oats are so healthy for our body in terms of the fiber. And we haven't even talked about fiber. Fiber is so important in terms of helping create a healthy gut microbiome, which is so important, not just for cancer risk, but for so many medical reasons. So I think I know this is just an example of there's so much out there on social media and TikTok that, you know, young people and people my age are getting their information from these sources. And the medical community really needs to work hard to ensure that people are getting evidence-based health information. Yeah.
[58:03] What's your opinion on mammograms? And And if it's a thumbs up, when do you think women should start? So it is a thumbs up for me. And certainly recent guidelines that have been updated by the U.S. Preventative Services Task Force do recommend that all women start mammograms at age 40. Certainly, if an individual has a strong family history or potentially genetic risk, she would start screening earlier and potentially with breast MRI in addition to mammograms. So I am a fan. And definitely, since this is Breast Cancer Action Month, I would encourage people who are overdue for their mammogram to please schedule one, because we do know that over the course of the pandemic and after that, like people have unfortunately gotten behind on many types of cancer screenings. Wow. What what are you finding is the biggest challenge in your line of work?
[58:59] Oh, well, the biggest challenge for me is when a patient has a recurrence of her disease, even though I know my patients, you know, they go. They work so hard to go through their treatment and be so adherent to what we recommend and, you know, do so work so hard to improve their lifestyle. out. And as their doctor, I work so hard to monitor them and keep close tabs. But when a patient does recur, cause that does happen, it's really, really hard. So that part of the job is always hard and that will never get easier.
[59:35] What would you say now flip side of that? What's the most gratifying part? Well, I'll just tell you a story again from my clinic the other day, you know, I was seeing this lovely patient of mine who, by the way, does have advanced breast cancer that's estrogen sensitive and she's been living with it for a number of years years really doing well and she shared with me that she had two grandchildren born honestly within like two weeks of each other i think one came a little early and one came a little late so they ended up being born right around the same time and now she's a grandmother and it brings her so much joy, and i'm so happy for my patients when they celebrate these types of milestones and in my mind, I do think, thank goodness for the current treatments we have that enabled this woman to become a grandmother, times two, by the way.
Celebrating Patient Milestones
[1:00:22] And that's just really, I just love celebrating milestones with my patients like that. Yeah.
[1:00:33] So Amy, it sounds to me like you have landed in the perfect place. It sounds like you're absolutely happy and you're just sharing your gifts with as many people as you can.
[1:00:52] And I want to say, and I read this quote, it was on your Instagram channel, and I think it's really applicable to you and all the fantastic work that you're doing. And this is from Pablo Picasso, and it's, the meaning of life is to find your gift.
Closing Thoughts and Gratitude
[1:01:09] The purpose of life is to give it away, and how beautiful. The work that you're doing is so wonderful, so beautiful, so absolutely important, and I want to thank you, Amy, for coming and joining me on the PLANTSTRONG Podcast for Breast Cancer Action Month. Yay! Hey, any last words that you'd like to say? By the way, thank you so much. I truly appreciate you inviting me as a guest. And thank you for sharing that quote, which is a favorite of mine. And it exemplifies you too. So you should use that quote. Thank you for all the important work and education and outreach that you do to spread the important message about the benefits of lifestyle medicine, plant-based diets. I'm just so grateful as well. Yeah, well, thank you, my PLANTSTRONG sister. So with that, will you give me a virtual PLANTSTRONG fist bump on the way out? Boom!
[1:02:09] Go get them, Amy. Thank you. You too. Thank you, Dr. Comander, for paving the path to wellness, not just for your patients, but for all of us who want to empower ourselves with the knowledge and information that could save our lives and the lives of our loved ones. For more information, go to pavingwellness.org, and I'll be sure to link to that and other resources, including Amy's workbook in today's show notes. As always, I want to thank you so much for listening to the PLANTSTRONG Podcast, and I would encourage you to share it with anyone who you think may benefit from the information. I appreciate you and your support. Until next time, always, always keep it PLANTSTRONG.
[1:03:03] The PLANTSTRONG Podcast team includes Carrie Barrett, Laurie Kortowich, and Ami Mackey. If you like what you hear, do us a favor and share the show with your friends and loved ones. You can always leave a five-star rating and review on Apple Podcasts or Spotify. And while you're there, make sure to hit that follow button so that you never miss an episode. As always, this and every episode is dedicated to my parents, Dr. Caldwell B. Esselstyn Jr. And Anne Crile Esselstyn. Thanks so much for listening.
