#270: Dr. Dawn Mussallem - The Exciting Research on the Power of Plants for Breast Cancer Prevention and Recovery (Part 1)
From l to r: Carleigh Bodrug, Dr. Dawn Mussallem, Dr. Gemma Newman, Rip Esselstyn at 2024 Plant-Stock
Rip Esselstyn welcomes back Dr. Dawn Mussallem, a breast cancer and lifestyle medicine specialist at the Mayo Clinic, to discuss the profound impact of whole food, plant-based nutrition on cancer prevention and treatment.
The conversation delves into the alarming rise of breast cancer diagnoses in younger populations, emphasizing the need for early intervention and lifestyle modifications to reduce risk factors. Dr. Mussallem passionately advocates for a dietary shift towards whole plant foods (among the other lifestyle medicine pillars), detailing how these choices can empower patients in their recovery and enhance overall health.
The discussion also includes current research, including a meta-analysis showing that soy consumption is beneficial for breast cancer survivors and insights into how plant-based diets can improve quality of life during treatment.
Dr. Mussallem encourages her patients to focus on what they can control, namely their food choices, to foster better health outcomes and support their cancer recovery journey. The episode serves as a powerful reminder of the agency individuals have over their health and the positive changes they can implement in their daily lives to combat illness and promote longevity.
Episode Highlights
02:06 - Dr. Mussallem's Background and Personal Journey
03:08 - Discussion on Cancer Risks in Today's Society
03:23 - The Role of Food in Cancer Prevention
07:55 - Dr. Mussallem's Role at the Mayo Clinic
21:24 - Exciting Research on Soy and Breast Cancer
36:26 - The Nurses' Health Study on Aging and Plant Protein
40:04 - Part 2 Coming Soon!
Research Study Information
American Cancer Society Meta-Analysis (Nucheta et al) in 2022 to the benefit of soy among breast cancer patients
The American Cancer Society's 2022 report on cancer survival rates related to soy consumption provides several key findings. According to the American Cancer Society Nutrition and Physical Activity Guideline for Cancer Survivors, soy intake, whether prediagnosis or postdiagnosis, is associated with a lower risk of breast cancer recurrence. Specifically, the meta-analysis reported a relative risk (RR) of 0.75 (95% CI: 0.61-0.92) a 25% reduced risk of breast cancer recurrence with higher soy isoflavone intake.
Additionally, the guideline highlights that soy food consumption before diagnosis is associated with a lower risk of overall mortality.
The pooled analysis by Nechuta et al. found that the effects of soy isoflavone consumption of ≥10 mg per day, compared with <4 mg per day, were similar in both Shanghai and US women, with hazard ratios (HR) for recurrence being 0.69 (95% CI: 0.47-1.01) in Shanghai and 0.76 (95% CI: 0.58-0.99) in the US.
These findings suggest that soy food consumption can be beneficial for breast cancer survivors, particularly in reducing the risk of recurrence and potentially improving overall survival rates.
Here is the resource it came from:
American Cancer Society Nutrition and Physical Activity Guideline for Cancer Survivors.
Rock CL, Thomson CA, Sullivan KR, et al.
CA: A Cancer Journal for Clinicians. 2022;72(3):230-262. doi:10.3322/caac.21719.
Another Study
A systematic review and dose-response meta-analysis by Nachvak et al. found that a 10 mg/day increase in soy isoflavone intake was associated with a 7% decreased risk of mortality from all cancers and a 9% decreased risk of mortality from breast cancer
Soy, Soy Isoflavones, and Protein Intake in Relation to Mortality From All Causes, Cancers, and Cardiovascular Diseases: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.
Nachvak SM, Moradi S, Anjom-Shoae J, et al.
Journal of the Academy of Nutrition and Dietetics. 2019;119(9):1483-1500.e17. doi:10.1016/j.jand.2019.04.011.
Dr. Barnard Research
A Dietary Intervention for Vasomotor Symptoms of Menopause: A Randomized, Controlled Trial.
Barnard ND, Kahleova H, Holtz DN, et al.
Menopause (New York, N.Y.). 2023;30(1):80-87. doi:10.1097/GME.0000000000002080.
The Nurses Health Study on Better Aging with Plant-Based Proteins
The study from the Nurses' Health Study that shows plant protein is the best way to promote healthy aging is by Ardisson Korat et al., published in 2024. This study evaluated the long-term role of dietary protein intake in healthy aging among 48,762 female participants aged <60 years in 1984. Healthy aging was defined as being free from 11 major chronic diseases, having good mental health, and not having impairments in either cognitive or physical function.
The results demonstrated that plant protein was significantly associated with higher odds of healthy aging. Specifically, the odds ratios (ORs) per 3%-energy increment with healthy aging were 1.38 (95% CI: 1.24-1.54) for plant protein, compared to 1.05 (95% CI: 1.01-1.10) for total protein, 1.07 (95% CI: 1.02-1.11) for animal protein, and 1.14 (95% CI: 1.06-1.23) for dairy protein. Additionally, substitution analyses showed significant positive associations for the isocaloric replacement of animal or dairy protein, carbohydrate, or fat with plant protein, with ORs for healthy aging ranging from 1.22 to 1.58 for a 3% energy replacement with plant protein.[1]
These findings suggest that increasing plant protein intake in midlife is associated with higher odds of healthy aging and several domains of positive health status.
Dietary Protein Intake in Midlife in Relation to Healthy Aging - Results From the Prospective Nurses' Health Study Cohort.
Ardisson Korat AV, Shea MK, Jacques PF, et al.
The American Journal of Clinical Nutrition. 2024;119(2):271-282. doi:10.1016/j.ajcnut.2023.11.010.
Episode Resources
Watch the Full Episode on YouTube
Dawn’s First Appearance on the PLANTSTRONG Podcast
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Full Transcription via AI Transcription Service
I'm Rip Esselstyn, and you're listening to the PLANTSTRONG Podcast. Today, I am thrilled to welcome back to the PLANTSTRONG Podcast, Dr. Dawn Mussallem. She is an absolute ray of sunshine, and she shared her incredible life story on episode 156 of thePLANTSTRONG Podcast. If you didn't get a chance to listen to it, I highly recommend it. But today, she's here in her professional role as a breast cancer and lifestyle medicine specialist at the Mayo Clinic Cancer Center in Jacksonville, Florida. And she's going to share some of the outstanding science and research that is emerging on the benefits of whole plant foods in the prevention, treatment, and healing from a cancer diagnosis. There is so much exciting news here that we're going to break this up into two parts. Part one, coming up right after these words from PLANTSTRONG.
The Misuse of Plant-Based Labels
[1:04] 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 atPLANTSTRONG. 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.
Heartfelt Reflections on Plantstock
[2:04] Just two months ago, 300 of you were at the beautiful Blue Ridge Assembly in Black Mountain, North Carolina, for our 13th annual Plantstock Celebration, and it was magical.
[2:20] I want to start today by letting you know that sadly, Black Mountain and the location where we hold these annual retreats suffered extensive damage from Hurricane Helene, and while the the staff and team members are fine. The facility is not. So please keep the town and the Blue Ridge Assembly and all those that were affected by Hurricane Helene in your thoughts, including our PLANTSTRONG brothers and sisters in the area. Our hearts are with you. And speaking of hearts, today I welcome back our friend and one of the biggest and best hearts in the whole wide world, Dr. Dawn Mussallem.
[3:05] Dawn herself is a heart transplant recipient, and today we turn our attention to Breast Cancer Awareness Month. At our recent PlantStock event, Dr. Mussallem, along with Dr. Gemma Newman and Dr. Will Bulsiewicz, discussed some of the recent studies in the emerging science, all extolling the benefits of a whole food, plant-based diet it on the prevention and treatment of cancers, including breast cancer. Dawn is a breast cancer and lifestyle medicine physician at the Mayo Clinic Comprehensive Cancer Center located in Jacksonville, Florida, and she works daily with patients who have received a breast cancer diagnosis.
[3:51] Now, they come in scared, confused, angry, they feel out of control, and little do do they know how absolutely fortunate they are to have Dawn Mussallem on their care team. Today, in the first part of this two-part series, Dawn shares with us her thoughts on what's driving cancer risk in today's society. It's a nuanced discussion, and she offers plenty of food for thought. And much of the discussion does center around food, because as we all know, it's the food, it's the food, it's the food. A whole food, plant-based diet is the way to prevention, healthy aging, and a smoother recovery from cancer. But let's hear all about it right now with our own magic bullet, Dr. Dawn Mussallem.
[4:50] Dr. Dawn Mussallem, it is beyond fantastic to see you again. I can't even tell you how great it is to see that incredible smile on your face. Look at, you have such a nice, wonderful blue blouse on as well. Well, you know, I love bright colors. It helps to just amplify the existence of this wonderful day. That's what I would say. And I think blue is my favorite color. Well, that's so funny. As soon as I say that, I'll name like five other ones, too. So blue is my favorite color today. It is. It is by far my favorite color. Love blue. I've always loved blue. So, Dawn, for those that don't know, Dawn first appeared on the PLANTSTRONG podcast probably about a year and a half ago. She was episode number 156. We talk all about her amazing journey, her story. and if you want to do a deep dive into all things Dawn, please go back and listen to episode 156. It's really remarkable.
[5:57] But Dawn, the reason why I've brought you back on today is because October is
Breast Cancer Awareness Month Focus
[6:03] Breast Cancer Awareness Month. This is obviously something that is very near and dear to your heart. And so I'd love for us to just powwow for about 30 minutes around what you're currently doing at the Mayo Clinic Jacoby Center for breast health and what you've been doing since 2015, why you love it so much. And some of the exciting research that's come to light in the last 10, 8 plus years that I think is very hopeful for breast cancer. But before we do that, I think it's important that we do take a step back and let people know that you yourself are a breast cancer survivor, correct? So I actually had stage four non-Hodgkin's lymphoma when I was in medical school. Oh, my bad. My bad. No, there's an interesting backstory to this. So that was 23 years ago. And then that of course caused the complications. And I ended up with heart failure, had the heart transplant. And then last year was the first time they were able after my heart transplant to do breast MRIs.
[7:20] Because previously I had the defibrillator and all this hardware in my chest because of the heart failure. So they could never do breast MRIs, but I was very high risk. The risk for young cancer survivors who have had radiation is actually the same. Is that a BRCA survivor? So this is actually a great thing to talk about is breast cancer risk. Sometimes you can't avoid some risks. And so my risk was over 75%. They found something on my MRI. It wasn't amenable to biopsy. So I actually last year had to do a bilateral mastectomy for situation. They weren't sure if it was cancer, it turned out not to be high risk lesions. But fortunately, I am fine from that I, my grandmother did die of metastatic breast cancer. So it is very personal to me. So it is very interesting that I had to go through that. And it's made me such a better doctor because of it, in terms of how do I counsel my patients, when they're young, or middle aged or old, it doesn't matter, it really does change how you perceive and feel your body for some period rate of time, even though before this happened, I never thought I would be that woman. It actually was very hard for me emotionally. So it allows me really to be in that space with my patients and in such a tender way that I, I, I love that I went through that. So yeah, I didn't have breast cancer, thank God, but I had to do the prophylactic side of it. Got it. Got it. Got it. Thank, thank you for clarifying all that. Now.
Dawn's Journey and Professional Role
[8:48] Tell me a little bit about your position at the Jacoby Center for Breast Health. And is this something that you devised? Was it something, a position that was there and you kind of applied for it and got it? And who are you working with exactly? Thank you so much for asking this question. And at Mayo Clinic across our enterprise, we have three sites, Rochester, Florida, and Arizona. Arizona we are the only place besides Cleveland Clinic and we partner with them in some educational opportunities internationally actually that have diagnostic breast clinics it's a breast clinic where we work with women who are at an elevated risk of breast cancer we work with women at the time of their diagnosis they come in to see us first from there they go and see the rest of the oncology team the surgery team the radiation oncology team and then it's a holistic practice is that they come back to us in that diagnostic breast clinic for survivorship care. Now, in 2015, when they had asked me to come and redesign the breast center, that diagnostic part of it, both for high risk for newly diagnosed breast cancer patients, as well as survivorship, that's when I started the integrative medicine and breast health program at the Jacoby Center for Breast Health. And it really is the first of its kind, the only of its kind. It's an immersive program that is built on the foundation of lifestyle medicine and.
[10:14] Pretty much 95% of what my conversation is with my patients is on whole food, plant-based nutrition. And it's, it's so exciting. And the reason it's really important for NCI designated, you know, that's a national cancer Institute designated cancer center to have a program like this is because so many cancers are preventable. We know that the American cancer society says 40% of all cancers are preventable. And we know that's a huge underestimate. Actually, actually,
The Importance of Whole Food Nutrition
[10:41] that's just the best we can do. Regardless, even if that's an underestimate, that is a huge number of preventable cancers. When we look at breast cancers, we know at least 33% are preventable. And we really feel if we were able to make changes earlier on in young girls lives, maybe even as far back when they're in utero pregnant, when their mom is pregnant with them, there's even risks that occur then that maybe 75% of breast cancers can be completely eliminated.
[11:09] That's why primary prevention is so important. I believe in mammograms, women need to do mammograms at the age of 40. That's when we find breast cancer early enough, so it's easier to treat. And if a woman has a family history of breast cancer, particularly a family history of breast cancer that occurred in young women, that woman may need to start her mammogram earlier, 10 years younger than the youngest relative ever diagnosed. But you know, going back to primary prevention, that means let's live a healthy life. So this, this cancer never has to happen. And we are seeing a rapid rise in cancers in young people. I currently have a 20 year old young woman with breast cancer and it gives me chills to talk about this. And, you know, the first thing that happens in that visit is the mom and the daughter say, how did I get this?
[11:56] How did this happen? You know? So it's really, it's really scary, honestly. And some of it's not totally in our control, but what's in our control is what we're going to talk about today. Yeah. But let me, let me go back and I have two questions for you based upon what you just said. One of them is, so you've, you mentioned that, I think you said 75 or 80% of your job, maybe you said 90% is talking to your patients about whole food, plant-based nutrition. That absolutely makes you giddy. And my question is, how do the vast majority of your patients respond to your suggestion of whole food, plant-based nutrition? Do they take it? Are they interested? Yeah. You know, there's so much support. It's really exciting. It's kind of a fun thing at the breast center. They tell the patients, she's our magic bullet. You need to meet with her.
[12:52] So the patients come, I have them do a 24 hour food journal. I have them let me know what their, you know, history of preference with nutrition and the relationship with food is how much the exercise, how much alcohol they consume, what supplements they take. So I have a good understanding of where that patient's at before I even join them in the visit. That really helps me. And from there, the first thing, you know, after we get to meet each other and we share names and just a little bit of background about each other, I ask them, what are your goals for this visit? I say, you know, I know what I want to review with you. There's some things that are very important in a breast cancer journey, but it's really important for me to know what I can do for you. I want to start there. You know, some women may not be ready for this. They may have emotional trauma. They may have something completely different
Engaging Patients in Nutrition
[13:43] that they need to talk about. But within that year after their breast cancer diagnosis, we have completely unveiled and unraveled the nutritional aspect of their care. We support the women with breast cancer retreats, where we do whole food plant-based meals for the women. And then every month I have a drop-in session for all my patients at lunchtime. And we just talk about any questions they have about food, fun new recipes, fun new studies related to food and breast cancer. So it's really exciting. And the women love it. My patients really...
[14:18] Do pretty darn well during treatment, during chemotherapy, during radiation.
[14:24] And, you know, I have some women that are running marathons or doing dragon boat races after their breast cancer diagnoses, when they're really working on their body compositions, they're having remarkable weight loss, successful weight loss. And I get these comments, gosh, I don't even feel like I'm dieting. I'm enjoying food and I'm losing weight. I feel good. I have one woman, I shared that slide at Plantstock this year. She said, I feel better now than I felt before my breast cancer diagnosis. That gives me chills. That's, that's why I love my job right there. Incredible. You, you mentioned that a 20 year old that you recently saw that has breast cancer. Do you have any thoughts on what caused her breast cancer or just, I mean, that seems really young, obviously. It is so young. And, you know, the first thing we would think is, oh, there must be a genetic contribution to this. Her genetic testing was actually negative. There was no family history of breast cancer. We know that genetic links to breast cancer account for about five to 10% of breast cancers, maybe up to 15%. That number will keep on growing as we know more about the micro, about the, you know, genome project and we're identifying more genes potentially. Another five to 10% are family history. So you hear what I'm saying? Only about 25% or so are from family history and genes. The rest is from environment, lifestyle.
Understanding Young Breast Cancer Cases
[15:50] There's a lot that gets unpacked. We now know, and you shared that article with me, Rip, about the exposure to pollutants and microplastics that was just recently talked about in Frontier's.
[16:04] And there is suggestion that when moms are pregnant with their daughters, their exposure to microplastics may, in and of itself, even start to affect that fetus. There's exposures many years ago moms were exposed to called DES that increased breast cancer risk. But, you know, as a young girl is growing up, we know that weight gain during the younger years can be a trigger for increasing breast cancer risk. We know having a period at a younger age. And, you know, what's interesting, again, going back to that article with the plastics, we know some of these microplastics can mimic estrogen. And there's suggestion that maybe that's what contributes to this earlier menses in young girls. And that drives breast cancer risk. You know, so for a 20-year-old girl, those would be a few things. In addition to sedentary, she wasn't active. She did not exercise much. And young kids nowadays, they don't move. They sit a considerable amount. And then alcohol exposure. We have young kids starting to drink at very young ages. Some parents are actually accepting of that. And we know that that alcohol exposure throughout the life cycle is extremely toxic to breast tissue, particularly when the breasts are developing. And then we think about vaping, you know, vaping. We don't we haven't even begin to understand what those concentrates do in the breast tissue for these young individuals who are really frequently using these products nowadays.
[17:33] So it's quite scary when you think of all that these young folks are being exposed to. And I didn't even talk about food, right? Then we have the ultra processed food. And we know that ultra processed food in our young people accounts for 67% of their diet. You know, we know baby formula has mono and diglycerides in it mono and diglycerides have been linked to a 24 percent.
[17:58] Increased risk of breast cancer you know i know we're not talking about prostate cancer but mono and diglycerides have been linked to a 46 percent increased risk of prostate cancer they're they're in so many different food products yeah they're in every they're in yogurt they're in some plant milks you know so mono and diglycerides are a no-no Karen Gans in Midlake to a 32% increased risk of breast cancer. This was a study that they looked at a large group of individuals. They followed them over seven years. There's associations. It doesn't mean that the direct you consume this, you get this, but there's an association that's certainly risky. And so we want to consume food.
[18:39] That's as close to nature as possible. The biggest part about a whole food plant-based diet is the whole food part, you know? Yeah. I've got to remember how thorough you are at answering every question, but, but those are, those are a lot of different factors that come together to kind of make it very, very difficult for somebody to steer clear of these cancers, these diseases, unless you're really, I think, making an effort to eat whole food, plant-based, not vape, not do alcohol, you know, be mindful of your, what you're being exposed to, all those things. You know, another doctor that's going to be part of this October breast cancer awareness Awareness Month is going to be Dr. Christy Funk. And do you know Christy? Have you ever met Christy? I need to meet her. I have never met her, but she's awesome. Well, she is awesome. But, you know, we were talking about alcohol. She, because of all the evidence, has finally, as of January 1st, 2024, has given up alcohol. So it's pretty good.
Conversations on Patient Care
[19:51] I agree. Yeah. Yeah. Let me ask you this. You mentioned, you know, how much you love your patients. How many patients like roughly are you seeing at one point in time? Are we talking 20? Are we talking a hundred? I have no idea. Yeah, no, I really like to have my visits one-on-one with patients for the first time. And my visit with patients is 90 minutes, you know, and that's not even enough time. Currently this week, I had two residents shadowing me. And when I shared with them, I had 90 minutes. They were like, what? I said, just watch, watch what happens. And I still go over, I'm still late. I have to ask for forgiveness that the rooming folks, I have a telehealth practice because my patients are actually from all over the world. So it's really cool. school um and so the the folks that room them like electronically through zoom they work at mayo clinic and i have one person assigned to me so she lets all the ladies know you're going to be waiting a while go do something she'll yell out to you come on uh but i don't like to rush them you know if someone's 60 years old you're unpacking 60 years of their lifestyle into the conversation but gosh it's so cool i my resident this week his name is dr klein he is studying to be anesthesiologist. And he said, it's so interesting. He goes, we prescribe pills in milligrams, but we eat food in pounds.
[21:16] That's really good. That's great. You know, but in addition to that one-on-one time, I do those drop-in visits for my patients at lunchtime, twice a month. And then we do these big retreats with at least a hundred women in those retreats a few times a year. So that's really exciting where we can do more immersive. And we usually offer those out Zoom as well. That started during COVID, which was really nice. And at that time, we would have multiple countries joining us just for that educational component, which is wonderful. Yeah. So we lived it up at PlantStock this year. You were a huge part of the success of PlantStock. doc. And we had a panel discussion with the docs that were there yourself. So Dr.
[22:03] Dr. Will Bulsiewicz Dr. Gemma Newman, and Dr. Dawn Mussallem. And during this panel discussion, you brought up some really, I think, compelling and exciting research that's just gone on in the last two, three years that is very, very, I think, hopeful for women, breast cancer.
Latest Research on Soy and Breast Cancer
[22:23] So So do you want to start with the first study? It's the American Cancer Society Meta-Analysis in 2022. Is that a good place to start? Yeah, let's start out there. So I love that. So the American Cancer Society, they did their update in 2022 for cancer patients, when it comes to nutrition and exercise, and they really helped support the importance of understanding that soy is not harmful. You know, to this day, I can speak to a group of doctors or to patients, I would say every day, about 80% of my patients I see are terrified of soy. You know, it's so cute. They'll say, I don't even eat soy sauce. I'm like, well, soy sauce doesn't even have soy as a flavor. And so you actually could have done that. But, you know, it has salt. That's for another conversation.
[23:10] But anyways, what the American Cancer Society had published in this 2022 paper was a very nice meta-analysis from researchers, Nuchetta and colleagues. And what they showed is something that we've known, But what they showed is that after breast cancer diagnosis, those patients that had more soy compared to those that had less soy, those with more soy had a 25 percent reduced risk of breast cancer coming back. And this was a strongly statistically significant finding. There was no wavering on the fact that this was real. This just this didn't happen by chance. So very wonderful study. We've known this for decades, though. There's been plenty of studies that said the same thing, but it feels really good to be able to be in that room with patients and let them know that this isn't my opinion. This isn't just one study. This is a review of several studies. There was almost 8,000 patients in this cohort total. And so it feels really good to give patients that support. Now, what it showed us is that in this study, there was more benefit for those women that had estrogen receptor negative breast cancer, but the women with estrogen receptor positive breast cancer still got benefit too.
[24:19] At the end of the day, there's no harm, right? And you can replace animal protein when you consume the soy. And that kind of brings us right to the next study. I mean, I think it dovetails right into Dr. Neil Barnard's study about soy. Before you dovetail into that one, can you let people that don't know, like myself, what's the difference between an estrogen negative and an estrogen
Estrogen Receptor Explained
[24:42] positive type of breast cancer? Oh, that's a great question. The majority of breast cancers that are diagnosed are estrogen receptor positive, about 75%. You know, that is going to be closest to what you would expect a breast cell to be like there's estrogen receptors on a healthy breast cell. And there's estrogen receptors on 75% of breast cancers that are diagnosed. Now, as those cancer cells start to mutate and become more differentiated, they become more different than the natural breast cell, things start to change that estrogen receptor becomes less positive. So as you get estrogen receptor negative breast cancers, those are the more aggressive breast cancers actually. So that's what's so fascinating about that here. We're dealing with a more aggressive breast cancer, one that you really want to make sure you reduce the risk of it coming back. And so he is accomplishing that in this meta analysis by new Chet and colleagues. So just a remarkable study. And yeah.
[25:41] Two things, two comments. You mentioned soy isoflavones. What are the best foods that have soy isoflavones if soy sauce doesn't have it?
[25:54] Great question. So I like to go as close to nature as possible. So let's start with edamame. And I do recommend when I recommend edamame, definitely non-GMO, which the majority of soy for human consumption is non-GMO, but there's still some out there that aren't. I love soy nuts for my patients too. So if they're traveling and they don't have access to soy because they're traveling, they'll pack soy nuts. I pack soy nuts all the time when I travel. Suitcase. And by the way, at the airport, when you go into the airport store and everything else is so expensive, the soy nuts are the least expensive thing. So fire soy nuts. And you have soy milk. I consume a lot of soy milk. Soy milk is amazing in coffee. Coffee is actually another thing that has shown some breast cancer benefit, benefit hasn't shown harm. So that's cool, right? Because I love my coffee. But what's cool with coffee, I know I'm going on a sidetrack, but this is a fun food fact right here, I have to share, you know, the chlorogenic acid is the polyphenol that's in coffee. And you get the most benefit, if you have light and medium roast, you kind of lose that benefit with dark roast. But you know what else if you put dairy, cow dairy, and coffee, you lose the ability to absorb it as effectively. So use that soy milk in your coffee. You get some nice natural fat. You know, you don't want to use oat milk with fat. You can actually use PLANTSTRONG oat milk to my coffee. So you can do the oat milk, but you want to make sure that that that plant milk doesn't have oil in it to make it fatty. So soy gives you that nice level of fat.
[27:20] You know, tofu tempeh today for lunch. I had nice tempeh. It's great in a salad or however you want to have it. So those would be my top four that I recommend for patients. Are you, Dawn, are you dangerous on, on, on caffeine? I don't know. You'd have to ask people that are around me when I have it. How many, how many, how many cups of coffee do you have a day?
[27:43] Usually two in the morning. Got it. Small ones. There's small. Got it. Actually, I can't wait. I cannot wait to get up in the morning and have my coffee. It's like my favorite thing. It really is. I so look forward to it. Well, and I want people to know that I got a email from you this morning at 3.18 a.m. And I was like- That's because you're tech-less time. Got to be a mistake.
[28:09] You're right. It's 4.18 your time. So that makes me feel a little bit better. There you go. Wow. I don't know. You in our last conversation, we talked about what time you get up in the morning. I think it was like four eleven or something like that. Yeah. Yeah. I love the morning. I honestly I wish that sleep was not one of the pillars of healthy living because I just don't have time for it.
[28:34] I do sleep, but it's such a waste of my time. I want to be alive and awake. wake, you know, so I sleep, I really do do work on that, but it's not my favorite thing to do. Yeah. Well, okay. So we'll, we'll move on from, from, from lack of sleep. Let's in, in your email to me that this morning, as part of this, these research studies that we were going to cover today, you also said, you mentioned another fun fact that was kind of part of this, this first American Cancer Society meta-analysis. And that was an increase of 10 milligrams a day of soy isoflavones does something with mortality for all cancers and mortality for breast cancer. Do you know those statistics? Yeah, we see that it can decrease, it can reduce the risk of dying from all cancers by about 7% and from breast cancer by about 9%. So, again, this is really exciting. And we know that when it comes to soy, there's been a lot of data with prostate cancer and also lung cancer, which is very interesting. You know, so it's always fun to see these.
[29:40] These studies. But at the end of the day, what I would say is soy is such a healthy protein because you're replacing an animal protein, you know, and you get a very high quality complete protein in doing so. So I really encourage the consumption. So you don't want to overdo it. You know, I tell my patients one to three servings a day is enough. You know, if you get more than five servings of soy a day, you actually start to bump up the insulin growth factor. And that's why we stay away from animal protein. So don't overdo it. You know, it's, it's probably not going to hurt you but you want variety. You don't want to just have soy and there's fat in soy too. So, you know, make sure you're getting your beans and lentils and all the other plant sources of protein, but soy is safe. Bottom line, that's the take home message here. And isoflavones, what are isoflavones? Are they specifically a type of phytonutrient?
[30:27] Exactly. Yeah. Yeah. Yeah. Yeah. You know, and I guess a lot of people feel like it's an estrogen. It's not an estrogen. It doesn't bind the same way estrogen does in the breast, you know, so I don't call it a phytoestrogen. I call it an isoflavone, you know, a plant phytonutrient is what I call it so that there's not that miscommunication for people. Super smart. Super smart. Yeah. The the amount of, I think, misinformation that's out there right now swirling around soy is super unfortunate. So let's. So you suggest that a nice, I think, transition from this study would
Dr. Neil Barnard’s Study on Hot Flashes
[31:09] be to Dr. Neil Barnard's. Yeah. Right. What can you tell us about his study?
[31:15] You know, what a great study. And I see the effectiveness of the study he did in my patient population every single day. It's remarkable. In fact, I spoke to a young woman today and she was sharing with me how much the soy has helped her. And it's really exciting when women are struggling with post-menopausal symptoms. And, you know, when it comes to breast cancer, again, 75% are estrogen receptor positive. You know what that means? That means we have to turn off that estrogen receptor for at least five years in these women. This is really hard in women who are premenopausal because you figure, holy cow, their body actually needs estrogen. All of a sudden, you have to not just, you know, stop what they have, but then you take it even lower.
[31:58] And it's really challenging, meaning that in these young girls, we suppress their ovaries, and then we give them a medicine to limit fat production in their body fat and peripheral tissue where estrogen is also made. And postmenopausal women, you know, they're already menopausal, their ovaries are no longer producing estrogen, but we further suppress them by again, making sure they're not making estrogen that peripheral tissue. So what happens is, these women with estrogen receptor positive breast cancer on these medicines, have extreme menopausal symptoms in some situations, major hot flashes, you know, and they can't sleep because of it, they wake up soaking wet, they're tossing and turning, and then they feel cold, then they're hot. It's really uncomfortable for them. So what Neil Barnard's study showed is that with a half a cup of edamame a day, this is such a cool study. I get chills.
[32:46] 88% reduction in hot flashes and 50% of his cohort had complete amelioration of the hot flashes, but it gets better. In this study, he also showed that the mood was better. This is great here. Libido is better. And over a 12 week study, these women lost eight pounds. I mean, I mean, just amazing. And I see this in my patient population every single day and every single patient I see. And it's so awesome because...
[33:15] Sometimes women come in to see me and they saw a traditional medical doctor who's not really focusing on some holistic means to control hot flashes. And the last thing a woman wants to do is to take another pill because a pill is causing a symptom. And I oftentimes see that doctors on the outside will prescribe gabapentin. It's a medication that's used even for neuropathic pain and it can cause weight gain. Like that makes no sense, right? It makes them tired. So here you have a poor woman being treated for breast cancer with hot flashes and her doctor gives her a pill that's going to cause weight gain and makes her tired. And instead we can use soy extremely effectively. So it's really a hopeful thing. And I see a lot of success with the use of the soy in that situation. Yeah.
[34:01] And when you hear half a cup of edamame with your patients, do you just suggest that they go down to the store and get some frozen in edamame and then just kind of eat it like that? You know, it's cute. I use Jane's Be a Plant-Based Woman Warrior picture on the cover. I really recommend that cookbook to all of my patients. It's how I onboard them with eating a healthier lunch is by doing the grain bowls. So we look at that picture and she has edamame on it. So that's usually how I have them do it is to sprinkle it on their salad. I have them thaw it out. Those edamame are blanched, so you really don't have have to cook it. I think it is better to cook it from a digestion standpoint. But bottom line, I usually have them put a little lemon juice, a little bit of, you know, hot sauce, season it up however they want, heat them up, keep them in their refrigerator, and then just add a half a cup to their salads, or they can just have them as a snack throughout the day. But I use a VF1 based woman warrior that that image and then they they buy the cookbook, they really enjoy that the title is so awesome. Anyways, for the topic we're talking about, it's very empowering for them. And there's just so many recipes in there that really help to support the women. And what they're doing for the lunch. And when it comes to behavior change.
[35:12] You have to enjoy it to be successful at it. And that's why I love working with my patients. I mean, I'm giddy about it. I love this stuff. I feel so great because of it. I feel so fully alive, so vibrant. And I see that in my women. When they come back, they're really excited. Last night during the hurricane, one of my patients is a retired pediatrician. She sent me a picture of her dinner last night. It was like this amazing grain bowl. It's so cool. I get pictures all day long in my patient portal of food my patients are cooking, when my colleagues are, you know, getting messages about things that are maybe not going quite as well. So it's really such an exciting experience to see patients leaning in, nourishing their body, enjoying it, having this positive behavior change that's going to improve their breast cancer outcomes, help them attain their vitality and flourish after. So it's really terrific. So thank you and thank your family for making it more possible for people. Listen, you mentioned and leaning in, I think I can't help but think that one of the huge reasons why all of your patients, or let's just say many of your patients are embracing this is because of how you have leaned in to this lifestyle, the amount of joy. And as you just said, giddiness that it just emanates from you around the lifestyle. It's like, people are like, man, I want what she's having. I want what she's eating. Give me, give me twice as much.
[36:36] Well, you too, Riff. I mean, but it's true. You know, you go to a lifestyle medicine conference and holy cow, there's no burnout. Everyone's so high energy. Everyone's running. It's so cool. You know, so I agree. You know, it really is such a blessing to be in this space, but you have to be authentic to your message if you're going to work with people in this space. And that's what I show the residents, you know, in the afternoon, I say, hey, I want you to go to the gym. Hey, I want you to go to the grocery store and go buy some plant-based food,
Plant-Based Proteins for Healthy Aging
[37:01] make a plant-based meal. They kind of love working with me that's probably why i have so many residents that want to rotate with me go go rotate with her she'll she'll send you to the gym to go work out and yeah she'll make you go to whole foods to buy some healthy food uh let's talk about one more study and that's the uh the nurse's health study on better aging with plant-based proteins came out in 2024 right just Just, you know, like, uh, can you tell me like what this study is saying? So this is so cool because, you know, I always have women say, but don't I need some meat for iron or like, actually, that's why I don't want you having meat is because of the iron. We talk about that. Don't I need dairy for my bones? Don't I need fish to get some omega-3 fatty acids?
[37:51] So what I share with them, this nurse's health study that had almost 50,000 people at 50,000, predominantly women, they followed them for about 30 years. Every four years, they did an update on the nutritional pattern. And what they showed is that the path to healthy aging, which isn't that what we should be trying to do is be the healthiest versions of ourself for as long as we could possibly be on earth, right? So it answered the most important question possible. And what it showed is the path to healthy aging was with plant protein. It outshined dairy and animal protein. Otherwise, you know, what's cool is in that study, if you just read it, it makes it still look like there There was some benefit of dairy and animal protein, but there wasn't if you controlled for the fruit and vegetable intake. So really the only benefit was with plant protein. And that's amazing. And it was a 38% benefit. So it was a really fascinating study. Patients love hearing it. You know, I'm not in the business of making women whole food plant only. My goal to start them off is, listen, breakfast is easy to make whole food plant only. And if they're doing an animal product, it's processed, it's going to be processed meat. that's a carcinogen. We know that it is linked to cancer. So there's no room for that. So let's definitely make breakfast whole food plant only. What do you recommend as a nice, simple breakfast?
[39:10] My favorite breakfast is overnight oats for women. It's so easy. If they have children, I have them involve their children with it at nighttime. You can vary it with, you know, if you want to use berries, which is predominantly what I encourage them to do. Just get the frozen. We know frozen berries have the same nutritional value as fresh, probably more. I encourage the wild blueberries. They can save some money so they don't have to buy the organic ones, which are usually more expensive. But I also encourage them to get variety through the week. You know, do some apples that you cut up, maybe buy some frozen peaches that you put in there. Just have fun with it. Do the overnight oats. I have them do oats with some flaxseed. Of course, there's soy milk and cinnamon. I like for them to use some Ceylon cinnamon just because that can help to lower a little bit of the blood sugar too in that response. So I try to have them get a teaspoon of that in there.
Closing Thoughts and Future Episodes
[40:01] Uh love it wow wow wow wow wow isn't she spectacular now i'll make sure to link to these studies that we discussed today in the show notes so that you can learn more, and be sure to stay tuned because Dawn will be back in two weeks to share even more studies and good news about plants i understand that a cancer diagnosis is really complicated and there are many factors at play as we discussed today. However, I love what Dawn said that there are so many things out of our control. So let's focus on those aspects of our health that we can control and that includes our food choices. Dr. Mussallem is here to help and we here at PlantStrong are here to help as well. Thanks again for listening. And remember to always, always keep it PLANTSTRONG.
[41:04] The PLANTSTRONG podcast team includes Carrie Barrett, Lauriw 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 CrileEsselstyn. Thanks so much for listening.
