The Rich Roll Podcast - From Death To Life: Dr. Dawn Mussallem On Surviving Cancer Twice, Running A Marathon Post Heart Transplant, & Why Mindset Matters More Than Medicine

Episode Date: February 16, 2026

Dr. Dawn Mussallem is a Mayo Clinic oncologist who survived stage 4 cancer at 26, heart failure, and a heart transplant—then became the first person to run a marathon within a year of receiving a new heart. This conversation explores the integrative approach to cancer treatment, why exercise might be as powerful as chemotherapy, the self-flagellation patients feel despite doing everything right, and the profound role of mindset in survival. Typically, my guests fall into two buckets—incredible story or incredible expertise. I don't know that I've ever had a guest who inhabits both worlds the way Dawn does. Her story is super inspirational, and the information is equally impactful. Enjoy! ⁠Show notes + MORE⁠ ⁠Watch on YouTube⁠ ⁠Newsletter Sign-Up⁠ Today’s Sponsors: Noble Mobile: The first phone carrier that pays you to use your phone less. Try it for just $10 with code RICHROLL👉🏼⁠https://www.noblemobile.com/richroll⁠  Go Brewing: Use the code Rich Roll for 15% OFF👉🏼⁠https://www.gobrewing.com⁠  BetterHelp: Get 10% OFF the first month👉🏼⁠https://www.betterhelp.com/richroll⁠  AG1: Get a FREE bottle of D3K2, Welcome Kit, and 5 travel packs with your first order👉🏼⁠https://www.drinkAG1.com/richroll⁠  OneSkin: Get started today with 15% off using code RICHROLL👉🏼⁠https://www.oneskin.co⁠  WHOOP: The all-new WHOOP 5.0 is here! Get your first month FREE👉🏼⁠https://www.join.whoop.com/Roll⁠  Check out all of the amazing discounts from our Sponsors👉🏼⁠https://www.richroll.com/sponsors⁠  Find out more about Voicing Change Media at ⁠https://www.voicingchange.media⁠ and follow us⁠ @voicingchange

You have to take care of your body. Seven out of the 10 top chronic diseases are preventable with lifestyle. My name is Dom U-Salem, and I'm a physician, and my specialty is integrative oncology. Five to ten percent of cancers are genetic. Five to ten percent are family histories. That means 75 to 80 percent of cancers are happening because of things, not because of genes in our family history. They're happening because of external causes. When you were 26 years old, you're just starting your medical education, and out of the blue, you're hit with this stage four non-Hodgkins lymphones. diagnosis. Dawn says it's her own experiences that's helped her career. My disease is basically what has defined me. I learned a lot in medical school, but I learned everything from being a patient. You survive this only to later suffer heart failure, which requires a heart

transplant, and you go on to become the first person to run a marathon within a year of a heart transplant. It's just set the stage for me to be in this position to help others in their moments of hardship and whether it's me sharing my story, reaches someone so far across the world that we never would have met, great. But there is that listener out there that maybe this connects with that, and then I hope it does. Dawn, it's an absolute delight to have you here today. So much to talk about. We're going to talk about the lifestyle pillars that drive well-being and longevity, also cancer prevention and recovery for cancer patients. But I want to begin with your incredible story. What I would like you to do is to just share directly to the person who is

gifting you with their attention today, who maybe is stuck or really going through it. What can you tell that person right now, right here, about what you've learned about human resilience, the capacity to face and walk through and overcome really hard stuff? Yeah. Thank you, Rich. It's really an honor to be here and your podcast got me through some of my hardest days in the hospital during my transplant. So this is very surreal. It like comes full circle. You know, in those moments, you're right. In those deep moments of adversity, you don't know. We fight so hard for certainty. But in our moments of uncertainty, there are so many deep, deep precious lessons. And as you were sharing my story, like, my existence,

is so heightened as a result of going through what I go through. I had goosebumps when you were talking. I get this incredible like chime in my left ear that's like a symphony just playing as my energy just more or less elevates. So I've arrived at this place in my aliveness and my existence purely as a result of what I've gone through. And there were moments in that journey that it wasn't easy. So what I would just share with the listener out there and it means so much to me that people trust me to listen to my story. And that's why I'm so open with my vulnerability with what I've gone through. But there's no reason to fight because it's there. And fighting's not going to change it. And if you fight, you're just going to be in that misery

longer. And so for me, I learned the gift of acceptance. And I also learned the importance of again looking for lessons. Like, this is here and what is this trying to teach me? Now, this isn't always clear. I've spoken to many individuals who have heard my story, and I feel my story in some ways was certainly not easy, but easier than some of the stories others have shared with me. Because I came from a place of my childhood,

an entire young adult life all the way through now, of never having to question love. And so for individuals who are listening, that maybe are comparing your journey to mine, I want to invite you not to do that, because each of our journeys are just so unique. And I feel I was given this gift, this immense gift of love from the day I was born until the moment I was diagnosed with cancer that carried me through every single hardship I had. And that gift is what?

That love, just that love and knowing that everything was going to be okay. Now, I'll share with you that love was partnered with deep faith. And for me, it was belief in God. And that belief in something bigger than yourself, for me, I was able to hand over any worry, any fear, any concern to that. And trust. And I feel it's so much of our ego self. What are we scared of? That was another thing.

You know, I ask, what are you scared of? I ask this to my patience. You know, we're scared of the finality of life, of dying, basically. And I guess I would ask why. I never fear death. And in my hardships, I never fought. It's funny because a lot of times people write up my story like, she battled or she fought.

And I'm like, I never fought. There wasn't one day of anything that I actually fought. It was just the art of acceptance and taking it with ease. And this was easier when I had cancer than when I had heart failure. Because when I had cancer, I was single. I didn't have a child. It was just me. I could be selfish, you know.

I could work out as much as I want to. And, of course, I always ate healthy, and I did these things and meditate and prayed. And I did everything for me. And then when I was diagnosed with a heart failure, I was a mom at the time. I was a wife at the time, right? So all of the sudden, it was no longer about me. It was about them. And so even though I tried to take as good a care of myself, that wasn't going to help me with the concern I had.

If something happens to me, what am I going to do to help them be stronger? So I tried to navigate that, you know, how am I going to make a good to be? make sure that my husband's okay if something happens to me. Let's have those conversations. What does that mean? We were very open with that dialogue. You know, crazy things. When you think you're dying, like, let's talk about it. Like, if I die, it's okay if you get married. I want you to be happy. You know, I was very open with having these discussions with my husband. And for my daughter, if she died, I did a lot of planning. Like, if I die, I want these kind of things to happen for her when she's in junior high, when she's in high school, and when she gets married. And I had these

very intimate conversations with my mom. So I did a lot of planning. Again, it's, I always tried to figure out solutions so that I never had a worry or never had to have a fear. And that gave me such comfort to just take it head on. From what I understand, at a very early age, you were obsessed with health and longevity and you were adamant about the fact that you were going to be this centenarian. This is a very unusual ambition for a young person, right? But fast forwarding to you at the beginning stages of realizing this, this dream that you had, getting hit with a stage four cancer diagnosis,

I would imagine the average person would feel a sense of unfairness and unjust. Like if you were somebody who was so focused on health and well-being, and I assume within that, you know, where you were practicing these principles to get hit with this at such a young age and as somebody who was practicing healthy habits, was there not a sense of like, why me? Mm-hmm.

I know, it's hard to believe. There wasn't. It's so hard for me to explain, Rich. You know, again, it was funny as a young girl. You're right. When people would ask me what I wanted to be when I grew up, I said, I wanted to be on a smuckers jar

because the Willard Scott Today Show would celebrate the 100th birthday celebrations with this vital 100-year-old on the smuckers jar. So I thought, oh, that's cool. I want to be in a smoker's jar. I haven't heard somebody talk about Willard Scott in 30 years.

I would sit in my nightgown, I lived in Ohio. I remember on the heater watching the TV because it was so cold. You know, you'd let the heat like blow up under your nightgown. Every little girl listening or who used to be a little girl. They were like, oh, yeah, I used to do that too. And I'd watch the Today Show, and that 100 birthday celebration was so inspiring. So you're right, I went on this path of wellness from a young age.

So when I got that cancer diagnosis, I really looked at it as I know what to do. I'm going to turn this around. I'm going to prove them wrong. You know, it was actually being put to the test, everything I knew. what I needed to do. How do you make sense of that self-belief, that conviction that you had? Where did that come from? It was innate.

I think it was a gift from God. I think it was born this way. I mean, I literally think I jumped out of my mother's womb. Joy, bliss. I was a very happy child. Every teacher that's worked with me for my younger years that knows my journey now, said, yep, if anyone was able to get through this, it was you. We remember the student you were.

We remember the joy you embodied. I just was always, like, I carried with me from a very young age, the art of optimism. I was a competitive gymnast. I was a runner at a very young age. And I just loved hard things from a very young age. So that cancer diagnosis to me was, okay, this is a hard thing. We can do this. You know, again, I had love.

My dad was there. I was actually at the time dating my husband, the father to my daughter. He was there. You know, I felt like I was so supported. And certainly, there was a lot of unknowing. But I just trusted. And this is one of those things that you wonder on a certain level. And I've dug deep to try to find science.

But science is sacred, but it doesn't have all the answers. There's so much more to life than what we can ever be able to prove. And in this unique situation, I was just given this ability to kind of navigate through life in a way that was very seamless and very artful and mindful and mindful and just grateful. I was just always so grateful for what was going good. And it always took me from this place of maybe a little bit of question, but bouncing right back over to that place of what was great. So in the aftermath of cancer, because of these intense treatments, you're suffering from

heart failure for many years. Like your heart is not operating optimally. In fact, it's only operating at like 8% of its efficiency. Is that correct? That's right. It was unbelievable. You know, after my daughter was born, I wasn't feeling good. And so I had to go to the emergency room. I was in cardiogenic shock and my ejection fraction was exactly 8%. In my years, as a doctor, I've never seen someone with an injection fraction that low. It's really not compatible with life. But again, this is the value of taking good care of yourself your whole life. I had such cardiovascular reserve my VO2, though it once upon a time was quite high,

even though it was much lower than it'd ever been before, having that heart failure with an injection fraction of 8%. My body was able to still function to keep me alive because I had such cardiovascular reserve from being so physically fit over all those years. This is a shout out to taking care of your body. What did it feel like to be in that state for so many years? And what is the experience of living

your life with an 8% ejection fraction. Yeah, it was hard. It was scary, you know? So I'm kind of like on the other end of things now. It would have been interesting to interview me then. I still was very optimistic. But I lived, how I described it is it felt like there were shackles. Like everything I did with was with total resistance.

There was so much effort. It was like climbing uphill. You know, simple things. People you don't realize, like driving. I got to a point in my heart. failure. It was such a prolonged journey of 18 years, but I got to a point where even driving was too much. And with my hands on the steering wheel, I would nearly pass out. I had to keep my hands down below. There were a lot of complications while I had heart failure. But you're maintaining

a full-time career. You're raising a daughter. You also have to endure the passing of your husband, the father of your daughter. And then in 2016, you suffer a four-minute flatline while you're presenting to the hospital leaders. I mean, you essentially die. I did. And that's where I met God, actually. So, you know, Rich, we're in such a hurry in life to become all of us.

And I'm kind of back into that rat race of life myself now, too. But we never just paused to be. And I learned the art of just true stillness in that moment. and I was presenting to hospital leaders about the success of the Integrative Breast Oncology program that I developed at Mayo Clinic. And my practice at Mayo Clinic is Integrative Oncology. I'm not a traditional oncologist. I do integrative oncology.

And I was so proud of this program because all of the lived experience combined to the educational, you know, academic prowess I had been able to really cultivate in my academic career. I was able to blend that to really ignite healing in individuals going through the the same things I had gone through. And in doing that presentation, it's just I remember it. You know, I remember because I was at the head of the table like this, you know, there's hospital leaders all around me in their suits. And I'm trying to control this mouse, this cursor at the opposite end of the screen. And I remember looking and I was becoming disoriented.

And I was trying to control it. You know, sometimes you shake it because you think it's the battery. And the cursor and this far end of the screen started getting more pale, more pale, more pale. And that was my last conscious memory. And I remember arriving in this place and my body was floating. And I remember there was just a slight breeze that was coming over me. And I remember this sensation early on in the experience of a single hair stuck in my lipstick. It's any woman listening that's happened to it, it'll drive you crazy, Rich.

You've never experienced it, I'm sure. I can't relate to this. I'm in this experience. And it evolved. to just the state of being. And I remember just this feeling as if the hands of God were holding me. And it was embodied love. It was true love, ultimate stillness,

but the most profound element of what I remember was total acceptance of the complete unknowing. And that has been the most powerful lesson I've been able to carry forward with me. it also created this knowing that life beyond our conscious awareness is something magnificent. It is so powerful, so divine, so precious, and it awaits us. So again, I so think it's our ego that tells us to this physical being. Because why else are we scared?

Like, how do we know what's beyond this life? So that is why I'm not fearful of death more now than ever. But I wasn't really fearful of death even before that experience. But I was gifted the grace of having this incredible experience. That is just set this stage for just this glorious life of knowing what awaits me after. It's an ephemeral concept for somebody who hasn't. had that type of experience in their life or for whom those ideas are somewhat foreign or difficult to, you know, wrap your hands around? Like, what is it that you take from that that would be

salient for the average person? I think what I would say is there's such importance for working toward and understanding our belief in something beyond herself, beyond this realm of our physical existence. I think that's what I invite people to do. Whether that's God or whether that's source or whether that's universe, we certainly shouldn't judge that, you know, and I think we are so quick to work at not judging others, but we're in like automatic to judge self, you know? So I think we need to be more kind, of course, to self and just not judge yourself in any

of this if you don't have that belief. but maybe just start to ask those questions. And for me, I do believe that's my superpower, right? I think that's truly what got me through all my hardest days, not only the love, but was that belief for me in God. It's a more real message that those that align with it can take it and they have deep meaning. Those that don't, there's many other aspects of my story, I think that resonate with them. I'm deeply spiritual.

I actually met with the Dalai Lama in March of this past year. And so I believe in all belief systems. I love the philosophy of Buddhism. You know, again, it's just the compassion, the love, the understanding, the devotion to that, the commitment to that is so precious. So I just think we're each very unique in what we were afforded in our belief systems as children. And I believe my life stage was sent for the very reason because of what I was going to go through. Well, it certainly infuses your life with the work that you do with just a reservoir of depth, right? So if you're working with patients, you have these experiences that are so extreme that provides your patients with a level of trust and credibility.

Like you've really gone through it. You've come out the other side. You have all this experience, not just in terms of, you know, the practical, what to do in these situations, but, you know, the real kind of meaning and message behind it. And I'm sure that your patients feel very empowered and supported by the fact that you're able to provide them with that. It's such a gift to be in that space with them when they open up their vulnerability or when they're scaring of dying.

I actually had a long discussion with a patient at the airport yesterday. She found out that her cancer had recurred. And then this morning she sent me a message that she's just so scared of dying. And just to be able to be in that space with them because, they know what I've gone through, and they know that I've had those same concerns. And there's moments when you have fears. No one wants to die. I mean, we all cherish life.

So I would not be honest to say, oh, I want to die. No, I don't want to die. And I live so healthy and exercise, and I do everything right, so I don't die. But when that day comes, it's okay, is what I'm saying. But to be able to sit there with them and give them my explanation of what I experienced in my moments, of what I feel was death or close to it. And the piece that overcame me in that moment, it really allows me for that connection

just to talk through with them what to do. And also, because I wasn't sure when I would die. You know, that was one example, but I had advanced heart failure after that moment. I know, I was going to get to that. I mean, there are five years, essentially, after this flatline experience where you're living with heart failure

before you ultimately get the heart transplant. It got so hard. It got so hard that I couldn't even have a conversation without nearly passing out. And I would just be sitting and I would have to grab on to things. Just because I thought I was dying. It was like my life force would just almost empty. It's just I was getting no blood to my brain constantly. I remember one time I was driving to work.

And I was like, oh, no, I think I'm going to lose consciousness. So I had to pull over. I called 911. They come. This is one time I did lose. consciousness was the last time I drove and my daughter was in the front seat with me. And I was driving. It was raining and she was 15. And thank goodness we were on a street that was not very fast. And I remember driving and said, okay, honey, I'm not feeling too well. I'm going to pull over

and I may lose consciousness. I want you to go on and call 911. I just somehow was able to stay very calm and they're going to come. And if you need to do chest compressions, it's exactly what I want you to do and everything's going to be okay. We were close to clinic hospital. And I didn't quite lose conscience. We were able to change seats and she's 15. She had never driven before. But she was able to drive the car somehow in the rain to the hospital and they got me there. It was these undescribable events. I remember seeing patients and examining them and my hands would be cyanotic. They'd be blue. And I remember having to lean against the exam table because I would be so weak. I thought my legs were going to collapse during their breast

exams when I would do the breast cancer exams for them. Walking to my car after work, not being able to walk up like the two stairs to where I would have to pause and then to walk to my car and I would have to sit in my car 15 minutes before I drive home. It's unbelievable. I can't believe I made it. What is it like to have someone else's heart inside of it? It's like this dance of life. It's such a powerful gift. And I knew one day I would get a heart transplant. That was the thought is one day you will need one.

We didn't know when it would be. The scientists at Mayo Clinic took my heart and they're doing research on it. And I have something called the Titan gene. And chemotherapy, radiation, childbirth are all three things that can cause heart failure in people with the Titan gene. And if you have a triple hit, it's almost assurance that that is not going to be able to assist. all those hits. And so that's why I had such a severe form of this heart failure. And it still took five years as you worked your way up this list to be a candidate. Yeah, you know, so after 2019, they still kept, or 2016, after the near-death experience,

they still tried a few more procedures. They actually did one final procedure about a year and a half later and I had a retinal artery occlusion, which essentially a stroke to the eye, and I lost my vision to my left eye, and that was when they called it quits. I remember after that procedure just thinking I couldn't even like go to the bathroom. I remember just sitting there thinking I am scared to move too much that I'm not going to survive this. So there was moments of deep concern during this whole time from 2016 until 2019 when they listed me for heart transplant. They listed me for heart transplant in 2019, 14 months with not one single call. And now we're in COVID. And so it was really hard because they didn't know what to do in COVID. They didn't know,

oh, if the donor was exposed to COVID and it goes to the recipient, what does that mean? It was complicated. And then if you went into the hospital to wait for your transplant because you got so sick, no one could visit you. But come 2021 January, I had totally decompensated at that point. I had had COVID in late 2020 and it just totally caused me not to have any more reserve in my heart. So I was admitted to the hospital after over 12 months of waiting with no call, and they put me on IV medications that would pump my heart. I was not a candidate for IV for a balloon pump device, which helps to pump because of previous radiation, because of the size of my body. And then they were really concerned about doing any sort of a, it's called an LVAD, like a left ventricular

assist device that helps to beat the heart because of other various issues. So I was pretty much getting so sick in the hospital waiting for my heart, that they were going to have to put me on full life support, something called ECMO. And that was the day that they found my matching heart. It was really interesting because my colleague, dear friend, Dr. Parag Patel sat at the head of my bed, and you would think, Rich, when they tell you, we found a matching heart after 18 years of living this life, that you would just be like, oh, my gosh, you found a heart. But in that moment, I just paused.

I was like, oh my gosh, what does this mean? You know, I'm going to lose like these blissful. I mean, I had the most beautiful childhood. Am I going to lose the memories of my daughter of being a baby and being a little girl? And am I going to lose the memories of my husband who passed away? It's like real things that you start to process. And then the next thing you said is, Don, I have to share something with you. Your donor is an IV drug user with hepatitis C.

That was really hard for me to accept. I had a colleague who actually said your personality will change. And I think there was such a deep lesson there because, you know, our words are so strong. And in that moment, I had such judgment on what that means. And I've learned so much from that. And it was a few hours that went by because he said, I want you to think about it. And you don't know. So she had an appetite to see that you could acquire other things.

You could acquire HIV. You can acquire a lot of things. And a few hours went by. And I had this total knowing. It was just this feeling, this wave of energies came through me that this heart is meant for you. And so I remember going down to receive my heart. And I had eye contact with one of my best friends, Dr. Bashar, Sariapaglio. And I knew everything was going to be okay.

I knew in several days I would wake up to the beat of a new heart. I remember as I went under anesthesia, every surgery before that, you know, I'm Catholic. I make the sign of the cross. I pray, really, please, let me be alive. That's when I didn't do any of that. I just prayed for the donor family. I knew everything was going to be okay. It was so powerful.

There were complications after my surgery. They actually had to take me back to the operating room and reopened me. I hemorrhaged. They had to give me 12 units of blood. They did not think I was going to make it. All the radiation I had had in my chest, it was just so friable that I just oozed. They never found the bleeding vessel. So it was a few days later I woke up after this kind of,

double surgery. And I just remember the most profound thing. My hair was brushing against these crisp white linen sheets. And it was just this harmonious sound of my hair. And it was like in sync to this powerful beat of my new heart. And I remember it was as if every single cell in my body was just oscillating this higher vibrational frequency. It was almost as if I could like float. My energy was just so high and my body was warm feeling for the first time in so many years. I didn't know what that felt like. And I never felt my heart for 18 years. I didn't know you can feel your heart in your body. Like I was like, oh, it's like I'm alive. It was the most fascinating experience. You're given a lot of medications and I had a dream and I've never shared this dream

publicly, but I had two dreams. This first dream, was a very dark, fearful, terrifying dream and it was of drug trafficking. And it was my body, but I remember I was in a very dark place with these red lights and these harsh sounds, and I was trying to crawl away from this person, and he was grabbing my leg and grabbing my leg.

I remember waking up and just praying, please don't let this be my new existence. And I feel that my donor was addicted to IV drugs because perhaps she was exposed to, human trafficking or some sort of trafficking. That's the only thing that I could imagine. I'm not sure. That's wild. It was wild. So then the next day, I had another dream. And I was told on that day, on this day, that I now had a hepatitis C and my viral loads were a million. And the insurance said they weren't going to cover the medication until I got discharged from the hospital. I was having all these other complications. So now I have very high doses of hepatitis C in my body. I'm thinking, oh. So I was mad. Probably one of the only times in my life,

honestly, that it was mad. Like, I just don't get mad. But I was pissed. I was like, what do you mean? Isn't this something you guys should figure out? And you have all these steroids. So I go to bed, have another dream. In this room, I wake up in this dwelling place.

Concrete block dwelling place. And there's this window, and I look out the window to look for my car. It's not there. There's this chair. And I'm like, where's my purse? Not there. like total awareness in this dream like a sensory experience. Both of them really weren't dreams.

They were more like sensory experiences. There's a door, and I remember crawling out the door just like I did in the dream the night before. Crawling out the door, only this time it wasn't hands pulling me back. It was blades of grass. Do you remember as a kid you'd be playing in the grass and the grass would be kind of sticky, almost cut your leg? It was like the grass was pulling back. I flip over.

There's these cumulus clouds going over me. And in the distance were these families love, unified harmony, like the new world. And then this word came over me and it said grace. And I woke up in that moment and I thought, I'm going to name my heart grace. The very song at that moment, instrumental song playing was titled Grace. And I opened my email because I thought, you know, I certainly couldn't sleep then. And the email waiting for me was titled Full of Grace. What do you make of all this?

It just set the stage for me to be in this position to help others in their moments of hardship. And whether it's me sharing my story, reaches someone so far across the world that we never would have met, great. But there is that listener out there that maybe this connects with them, and I hope it does. But grace is powerful, right? It's this virtue that's within each of us to be able to get through trials. And oh my gosh, it's just helped me get through this. And it was interesting, Rich. So at the finish line of that marathon that I ran on my one-year heart transplant anniversary, there was this massive.

construction sign. And guess what construction company's name was? Grace construction. Grace construction. It was so cool. We're connecting all the, uh, the, the, the red string is going from one thing to another here. It was beautiful. So it's just been this beautiful life. And, you know, so this donor heart of me, you know, and what I was fearful of is, you know, what your personality changed. It did change. It changed for the better. A lot of things changed for the better. I live with like conviction and knowing and purpose and meaning and intent and like just this tenacity and it's just like so cool where before I used to be maybe a little more shy. Not anymore. That's hard to imagine. Well, it's certainly working because you're an energizer bunny. Like you have a lot of spunk and energy. You know,

clearly it's clearly you're not at 8% anymore. You know, I think you're, you're firing on all cylinders. This episode is sponsored by BetterHelp. It's February now, which if you're, if you you're in a relationship is a month that kind of sneaks up on you and puts you under the spotlight. Whether you're married, you're dating, you're single, or somewhere in between, we're all still learning how to navigate connection, communication, and what we actually need in our relationships. And I don't know about you guys, but I'm ill-equipped to do that alone. I need to talk it out, preferably with a professional because therapy is just such an effective tool to sort out my thinking and emotion so I can make the best decisions, which is why millions of people turn to BetterHelp.

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slash Richroll. This episode is brought to you by AG1. You know it, you love it. One thing I've noticed about this time of year, especially February, is that all those routines that you promise to adopt or to adhere to in the new year, well, they tend to get a little wobbly around this time of year. January starts out with all this motivation and structure and then, you know, life happens. Travel, late nights, people in town, work stuff stacking up. And suddenly the days, the days, don't quite look as clean as they did a few weeks ago. And for me, that's where the small, consistent things matter the most. And AG1 is one of those anchors in my morning. It's not about doing something dramatic or reinventing everything. It's just simple, super easy, convenient, just takes a minute habit that I can maintain no matter what or how scattered the rest of my life happens to be. One scoop in cold water first thing. And that's my baseline. The way I think about it is this. AG1 is a daily health drink that helps fill in common nutrient gaps.

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So with this unique set of life experiences that you've had, when a patient comes into your office or you're having a consultation and they've just. been hit with the news you never want to get, what is the first thing that you say to this person? How do you bring them into the fold and begin the process of treating somebody who's on the receiving end of very scary news, like perhaps the scariest? Yeah, the last thing you want to have is toxic positivity, right? And I certainly don't have that. I acknowledge that there is suffering in all of this. This suffering is real.

It is scary and it's true. And so I just hold space for them and they're unique. need and meet them where they're at. You know, what can I help you with? That's the first thing I ask them. What can I help you with? You know, and it's not always about what you would expect. It's not always about eating better, exercising more, avoiding toxic substances.

Sometimes it's just talking about what's meaningful in life. What are you fearful of? How are your relationships? You know, those are some of my most powerful visits with patients. but it's exactly that. A lot of times they put blame. You know, a lot of individuals that come to see me, they already want to be healthy. A lot of them were already healthy and they get cancer, right?

So it's that question, why did this happen? You know, and they want answers. And sometimes that need to look for answers is very turbulent. And so I really try to talk to them about, is there a lesson here? Is there anything that we can look for for meaning that's going to deepen our life? because I feel when I see that turbulence, I feel it. You know, it's like that empathic element that all of us have. It's however a little more sensitive.

It doesn't deplete my energy, but I'm sensitive to when I honor that because I like it, it helps me be a better healer. But if I sense that turbulence, I really want to help that patient work through that. Turbulance over anything. I have someone coming in who live the perfect lifestyle, and they're so turbulent because they're so fearful. I want you to live that healthy lifestyle because you want to elevate your existence, not because you want to be held hostage to it, if that makes sense. So I really try to dial in to kind of that heart-centered energy and where it's at.

Is it that place of still acceptance understanding and going to move forward, or is this place of just resistance? And those in that place of resistance, I want to try to work with them. And that moment of vulnerability to try to ease up on that slowly, surely. I think it's just so important. There's a four-hour podcast in just what you shared right there. There's so much to kind of tease out of that. But the notion that somebody comes to you, they've just received this news, perhaps they've been doing everything right.

And there is that sense of injustice or like guilt. Like, what did I do wrong? And I think in part that's fueled by our information. landscape where it's like, you know, you open up social media and it's like, here's how you cure cancer, here's how you'll be 100% bulletproof, you know, health-wise or whatever, if you do this or that or, you know, take this supplement or whatever it is, right? Meaning that it's all on us. And there's no room for the fact that, you know, sometimes shit happens and you can do everything right, and you can get diagnosed with cancer and it's nobody's fault, right? But

the self-flagellation that I'm imagining that probably a lot of people are doing when they come to you matched with the deep discomfort with the uncertainty of it that's driving like I need answers and I'm going to go on the internet or whatever and you know tell me what it is so I can get into action is a means of not having to contend with the acceptance piece let's use an example so the woman that I shared with you, called, I had the conversation with her in the airport, and then I spoke with her again this morning. She feels over the holiday she wasn't eating as good, and that's why her cancer came back. You know, this isn't the case. You know, cancer is very complex. And I have this belief. I can't back this in science, but an understanding and knowing of someone I'd gone through.

I so feel like everything that happens in our life was almost like predetermined, right? We're put on earth in this trajectory of what we're going to experience, including our decisions to eat healthy or not, all of that stuff may be predetermined. It's our job to just show up for ourselves in that moment in our most authentic truth and what that means. That may not be clear for many people, but working with them to try to find that knowing and find that understanding. For the person out there that has that question, who has cancer, who did everything right, and you're beating yourself up, the good news is this, and it's hard to find any good news. I understand that. we know, like myself, taking good care of yourself your whole life, and God forbid, you get this cancer diagnosis, there's improved outcomes. We also know in people who decide to finally start living a little healthier life because they have education that's coming forward to them. There's so many cancer programs that give this education that it's never too late to change. You know, and so I think that this can be a very hopeful message both ways. We're not God. I mean, we cannot control everything. And when it comes to lifestyle, when it comes to cancer,

When it comes to our genes, there's so many little hits that our body takes. And you can't live in a bubble. And if you're saying that you eat the perfect diet, now that's your ego speaking, we actually don't know what the perfect diet is. You know, one day we may be able to bio-individualize nutrition, but we're really not there yet. We know what would be the best source of diet, but there's just not a perfect diet. You know, exercise, yes, you need to move your body. Toxic exposures. Yep, you should probably try to avoid them.

But, you know, we also get in a car and we drive, we speed. I mean, there's risks and harms and everything we do. And I just don't think we should live that way. I think we should do our best. I do think we have a responsibility to take good care of our body. I mean, it's our vessel. And if you want to feel good, you have to take care of your body. So, one, taking care of your body so you can experience the vitality and the harmony of life.

That's how you get there. Number two, taking good care of your body to reduce the risk of these diseases. And we know that seven out of the 10 top chronic diseases are preventable with lifestyle. That's significant. We know when it comes to cancer, the statistics are, you know, 50% of those are potentially preventable from the World Health Organization. But if you really step back, you know, 5 to 10% of cancers are genetic. 5% to 10% are family history. So that means 75% to 80% of cancers are happening because of things, not because of genes in our family history.

They're happening because of external causes. Pollution, environment, nutrition, sleep, toxic exposures, et cetera. It goes on mom. What I like about your approach to this is that you have this integrative philosophy of care. It's not one or the other. You have, on the one hand, the conventional oncology treatment approach, you know, radiation, chemotherapy, and the like.

While on the other hand, you are also incorporating and weaving in equal measure these evidence-based lifestyle changes with your patients, which provides a level of kind of agency, I think, with the patients. Like, there are these things that you can do, and here's what the evidence and the science says about how they impact your ability to weather the conventional treatments or, you know, prevent these things even happening in the first place, or to put yourself in the best position to,

you know, avoid a recurrence. It really is. You know, the science is so deep and it's such an honor and a privilege and joy to witness what I witness in my patients. I am so proud of them for not just my patients, but all of the individuals that reach out to me that get the messaging about taking a little better care of themselves. Cancer is a teachable moment. You know, we should flip the script on cancer, heart failure, disease, and make that an opportunity

to learn to live a healthier lifestyle and have joy over it. You know, this is your life. You're showing up for yourself. It's actually so exciting to do it. And when I see my women in some of their sickest moments, chemotherapy, radiation, these surgeries, and they meet me in their first visit, and their vitality is a little bit down. And then all of a sudden they're having all these treatments,

but they're starting to take care of themselves. And when you would think in the middle of chemo that they'd be so depleted, but their essence is actually elevated because for the first time, they're practicing these lifestyle behaviors that are very powerful meaning to them. And it's, again, they have agency over this. And it's very, very, very exciting to see. There's many different forms of chemotherapy. So there's some that just really are harsh on women. And, you know, I share when it comes to the cancer treatment, we know that if you do eat better during chemotherapy, it seems to reduce fatigue. That's very, very important. We're still following those.

outcomes data during the actual treatment, what that means. Many of the chemotherapies now have immunotherapy. You've had Dr. Will on here many times. We know that gut microbiome is powerful for immunotherapy. And the best way to optimize the gut microbiome is with food is medicine, with nutrition. So, you know, for the majority of chemotherapy's partnered with immunotherapy, you definitely want to take part in improving the nutrition during that chemotherapy. It can be hard for a lot of people to want to take that on.

understand that, but I see with my patients, it gives them autonomy over their disease, and they love that. It gives them their own ability to kind of be their own CEO, if you may, of their health while their doctors are doing everything they are doing. They're able to show up in that way. When it comes to exercise with cancer, oh my gosh, it's incredibly powerful. It's incredibly powerful during chemo. And I get to the point where I force, we forget to just use this word, but I joke about I always said, I'm going to force you to exercise. And I do. It doesn't mean blood, sweat, and tears, but walking. Even if you can only walk five minutes, three times a day, they've got to move during chemo. Exercise during chemo improves outcomes. There was an amazing study with even colorectal cancer

patients that showed that in colorectal cancer survivors, it showed to be almost as as important as the chemotherapy. So you match the two of those together and you start to really ignite cure. And that's where we're at. We want to cure you. It doesn't mean that eating healthy and exercise can replace these treatments. It means we march it right alongside treatments to mitigate the toxicities to improve your vitality during treatment and then to enhance the treatment outcome

for a cure after. It's just incredible, but the exercise data is profound both during and beyond the cancer diagnosis. People have more energy and it gets rid of that brain fog when they exercise during treatment. So very, very powerful.

And it's fascinating. The YMCA Livestrong program is a free, supervised exercise program for cancer patients throughout the United States. So if people have a YMCA in their local community, this is a wonderful thing to take part of. And generally, their domestic partner also gets a free membership, which is really cool. It may be different for different YMCA's. But I like to throw different resources out there because it's expensive being a cancer patient. And if you can find some of these free resources to help you exercise under supervision,

it's wonderful. So. I want to make sure I heard you correctly because you just said a lot of of things, but I'm pretty sure you said that the evidence suggests that exercise is just as powerful as chemotherapy in terms of driving positive outcomes. Did you actually say that? I actually said that this was a study that was published last year in colorectal cancer survivors. It was a powerful study. And it wasn't a study to replace the chemo. It was just showing that, wow, these numbers actually are on par with the benefits we see from chemo. So it is to take exercises exercise is medicine, just like we say food is medicine. These numbers are incredibly exciting. For breast cancer patients who really subscribe to this more healthy lifestyle of working on a

normal body composition, exercise, eating healthy, they improve outcomes from all causes after breast cancer. Do you want to guess a number? I don't know. It's probably some, based upon that expression on your face, it's probably an outrageous statistic. 58%. That's a massive number. How is that possible? I would not have imagined that. I know.

And this is why every single cancer center needs to have individuals there to support their cancer patients to work better at body composition, to help your patients move and exercise and to help patients understand the importance of eating healthier. It doesn't have to be perfect. This is about progress, not perfection, but really getting excited about this. And Rich, this is why I'm here today. I mean, you know, I ate healthy my whole life, including during chemo, including during heart failure and beyond. Exercise during all this. Even with heart failure, I really tried to move my body, even when I couldn't. Even if it meant I'd sit there and just do some calf raises, you know, or some arm curls with just my arms, I always kept on trying to move my body.

Yeah, you mentioned, you know, these lifestyle medicine pillars kind of in passing very quickly. Obviously, nutrition and exercise, which we've spoken a little bit. bit about the avoidance of risky substances, restorative sleep, stress management, social connection. I want to get a little bit more granular on the nutrition piece, this idea of food is medicine. And I've heard you say that food is the leading cause of death in America. This is crazy. So in 2022 in JAMA, the leading causes of death were all linked to food.

That was in their 2022 publication. You know, we know it in America. I mean, the average American diet is 60% ultra-processed foods. You know, and so this new food pyramid flip, everyone's talking about it extensively. I was going to ask you your thoughts on the new inverted pyramid. Well, you know, I think, number one, no one really follows a food pyramid. So everyone's making a lot of attention to it, but I don't think anyone really looks at the food pyramid anymore. But the one thing I think was great about it.

I always like to focus on the positives. Thank goodness for talking about ultra-processed food. because it is a big concern. The ultra-processed food is weeded out anything healthy. So if we can get rid of the ultra-processed food and start to introduce more whole foods, that's a step in the right direction. I love that.

Also getting rid of sugar, you know, they emphasized in the upper right-hand corner where the vegetables and fruits, it was partnered very closely to the meats and stuff. They did talk about increasing the recommendation for protein. I actually agree with that. I do think people need enough protein, but I think they should have drilled down before they drill down on the protein to the importance of fiber.

Because very few Americans are actually protein deficient, but pretty much every American is fiber deficient. And there wasn't really as much highlight to the fiber importance. And the reason I want to just bring this up is last year in 2025, there were incredible studies about fiber. There was an umbrella review with over 17 million individuals. So, okay, I want everyone listening. you're hearing this food science research out there because there's so many opinions to first ask, was this study done in humans? That's number one. Number two, how many people were in that study? And number three, what are they comparing it to? Those are all very, very important questions. 17 million individuals. This is like so exciting as a physician and a scientist. And all of us in food science

love hearing this study. It gave us class one evidence. This is the strongest evidence we have in medicine that the fiber, those with more fiber versus less fiber, those with more fiber, had up to a 28% reduced risk of dying from heart disease. It also had the same reduced risk of pancreas cancer and diverticular disease. Now, the study also showed us reduced risks of cancer and dying from all causes, et cetera. But it was a class one. evidence for those three things that I just listed at the top. Very cool. Also in 2025, there was another cool study. You know, we're into this era of GLP-1s. I'm not against them. They have beautiful anti-inflammatory properties. This is a moment to quiet the food noise.

You know, a lot of people are addicted to food. Why? Because they're ultra-processed. They're hyper-palatable, so everyone, you know, these foods were created to addict you. And the GLP-1 shut that down. So good. The food pyramid's going to try to get rid of those fake foods. The GLP-1s try to quiet that food noise so people have a little better control if that's what they need, and they can learn to eat healthier over this time. But what this other study in 2025 showed us was that in individuals overweight and obese, there was about 1,700 individuals in this study, is that it helped to improve metabolic markers. We know that 88% of individuals in America are not metabolically healthy. This is a major problem, and I think metabolic health is one of the things

we really need to drill down on. When you eat, what is your blood sugar doing? What are your triglysteroids doing? What is your overall, as we were sharing before we started talking today? What are these metrics looking like? And so the study showed, yes, that it improved not just control of body weight, body composition, but also it lowered insulin. It lowered A1C.

It improved the lipid profile. So fiber for that as well. And then cancer. We're talking about cancer. So we're getting back to the cancer discussion. But what's good for the cancer patient is good for the average person. Yes. Is basically what I'm gathering from looking into all of your recommendations.

And so the fiber in the study last year showed a 22% reduced risk of cancer and a 17% risk of dying from cancer. And so you bring up such an important question. You know, I have women coming in and they have all these competing mortalities when they're diagnosed with breast cancer. Heart disease, fatty liver, diabetes, sleep apnea, they're depressed. They get breast cancer and they want to see me. and they're willing to change.

What are we doing wrong in medicine that individuals with all these other health conditions have never been talked to about living healthier? The number one reason we die is heart disease. The number one reason breast cancer patients actually, you know, when they're cured of their breast cancer, they die is heart disease. Both men and women, heart disease is the number one killer.

But we just don't have these programs, you know, to really engage people and to make them active participants and enjoy it. Well, also medicine is so hyper-specialized that it's not interdepartmental, in that way. So there's no cross-pollinization of advice and expertise from, you know, the oncologist to the cardiologist. You're right. It's just so segregated and the system is reactive. You know, $4.1 trillion in health care and 97% is dedicated to sick care. There's no money going back to this

preventive care and we just can't catch up. And, you know, so people get the disease and we try to get them to eat healthier to exercise more, but it's still reactive. We need to get more active in the preventive phase. But the problem is developing behaviors that people enjoy and their willingness to do it. And this is why cancer is that teachable moment. It's their why, it's their meaning and their purpose. So it's that opportunistic time to pivot change. And so in my practice, grab them at the time of diagnosis and get a meat and healthier moving right away. Yeah, you said 95% of cancer patients are not getting the recommended daily allowance of fruit and vegetables. So when you talk about, I mean, that's what fiber is, you know?

So, like, how is that possible? This seems also to be a very easy fix. It's such an easy fix. So, you know, when I meet with people, I say, listen, I want you to hear, and I say, hear my chirpy voice. So everyone listening, hear this little high-pitched voice of mine. Number one, get rid of the ultra-process foods. Number two, every single time you eat, any time you eat, make half of what you're

eating come from a vegetable and fruit. So easy. I'm certainly not counting my vegetables and fruits. okay, I had two at breakfast, I had one at lunch. That would drive me nuts. Like, let's keep this simple. So just make half what you're eating, come from vegetable and fruit. And that's pretty easy.

And they all do great with it. So they're all getting seven, eight, nine, ten. It's not going to hurt you to eat more. You have unlimited amounts of vegetables and fruits you can enjoy. What are your top five or ten foods to focus on and why? You know what my number one is going to be. So my favorite food, if I was dying tomorrow and you said, Don, we're sorry, it's over.

I'd say, okay, well, bring me a good meal, and I'd want purple sweet potatoes. I love purple sweet potatoes. And I think purple sweet potatoes are really cool because there's a lot of phytonutrients. And with the anthocyan, there's 150% more than just in berries. So let's just put those purple sweet potatoes up there at top because they're Don's favorite. But what I would say is there's four food components that actually are masterful at turning on tumor suppressor genes. So the cruciferous vegetables are powerful, and especially if we sprout them, and I know you've done interviews with Doug Evans, so folks should really go listen to that interview. But sprouts are powerful,

not just in terms of the bioavillability of the nutrients, but also for the energy of food. People don't pay attention to this, but food is energy. And if you're eating this live food and especially growing food, like sprouts or seeds, it really is wonderful for our vital existence. So number one, let's throw up there, the cruciferous. Very exciting. They're also great at detoxifying. Of course, fibers are great at detoxifying, but crucifers are great. You have turmeric. And you have turmeric. And you don't need to do turmeric as a pill. Just put it in your cuisine. You know, a lot of folks aren't able to take turmeric because of drug interactions.

You don't need to. Just put it in your food. The gut microbiome loves it, and it's just a wonderful seasoning. Soy. I mean, I should have probably put soy number one. People are probably shocked. I didn't. Soy is powerful.

It's the biggest myth. And you know why? Because the studies were initially done in rodents. So that's why when we first started talking and said, always asked, was a study in humans or rodents. So, yeah, rodents in the study several decades ago, they developed tumors in their mammary tissue. in their breast tissue. We are not rodents. We do not metabolize soy the same we do. We have decades of data to show us that soy not only is safe from a breast cancer standpoint, it's protective.

This comes out of the American Institute for Cancer Research. Karen Collins has a really nice column on the myths about soy that, yes, it is safe. There was an awesome study that was published by the American Cancer Society in 2022, their update on physical exercise and nutrition. dedicated three paragraphs to soy. And what they showed us is that breast cancer survivors who had more soy versus those that had less, those with more soy had a 25% reduced risk of breast cancer returning.

This is most predominant in those women's the most aggressive breast cancer, is the estrogen receptor negative breast cancer. So this is a wild myth. Yeah, those are astonishing statistics, sorry to interrupt, but why is this myth so persistent? You know, it's just people got into this, this old literature and this old data that just hasn't been, you know, dismissed. And unfortunately,

doctors get at best six hours of nutritional training. They just don't have time. And at best, they get that in their medical years. And now they're years into their practice and they don't get it when they're doing their continuing medical education and or they're not taking part of it in their own lifestyle. Now, I think that's all changing. You know, I think with the American College of Lifestyle Medicine, I think there's more and more education coming forward to physicians about nutrition so that they're getting more and more knowledge. And for men, men are not going to grow breast. We know that soy is suggested to reduce the risk of prostate cancer. Soy is suggested to reduce the risk of lung cancer and non-smokers. And it's incredible for that gut microbiome. And, you know,

if we think about the power of the gut microbiome over cancer as it ignites the immune system and the stronger your immune system. I mean, really, the immune system is like this massive feature that we should really acknowledge when it comes to healthy aging, longevity. And people just just don't really, you know, give it a little, give it as much of an accolade as it deserves. But that gut microbiome is a harness to that. So the soy is really tremendous for it. Cruciferous vegetables.

Tremaric soy. Tumeric soy. Purple sweet potatoes. Well, the other one that turns off those term is the EGCG coming from green tea. So green tea is very powerful. The top four was the cruciferous, the etamame, the turmeric, and the EGCG with green tea. Then we have the purple sweet potatoes, the berries.

I absolutely love, love, love, love, love, love. Beans, and I love beans because they're high in fiber. They're an awesome plant protein. You can say beans, split-piece lentils, whatever you prefer. Very, very powerful. And we know that plant protein, when you can flip it out for animal protein, is going to help to reduce that risk of cancer in many studies. So I shouldn't say many studies, but coming out of that NIH-AARP study,

it showed us some very, you know, interesting findings when you're able to try to reduce some of the animal protein for some plant protein. Not here to make people vegan necessarily, but we do know that if you can try to switch out some of those proteins, it's a favorable thing to do. You know, going down the list, mushrooms have a lot of health benefit that I think people ignore and they don't pay as much attention to. Even those simple little white button mushrooms tend to have some aromatase inhibitor activity. You'd have to eat a lot of them. But mushrooms are something that people don't always include in their diet and actually a pretty unique source of protein in some situations coming to market now more and more with some of the mushroom roots and such that are

out there. Bottom line, I think the important thing to highlight here, Rich, is that it's a wide variety of the vegetables and fruits that you get. That's the key. The more variety, the better. So keep on just switching all those things around as much as you can. I love beats. I love those highly pigmented, colorful vegetables and fruits is what I would really, really recommend to people. I could like go on a really long list. We are brought to you today by the wonderful folks at Go Brewing. A few years ago, there was this guy, his name's Joe Chura, and he called me up out of the blue and asked if I would speak at this event that he was hosting in Illinois called Go,

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cancer survivors. So keep in mind, these are observational studies. So these are studies that they look at a group of individuals and they follow these patterns. So it doesn't mean that this is a direct cause and effect sort of thing. But T. Colin Campbell says something very cool. He says, hey, there's enough data out there that when you have enough numbers, that correlation eventually equals causation, you know. So there is definitely some critics out there when I gave that statistic that said, you know, you're kind of giving false hope. I said, well, this is what I'm going to say. And I got very firm to these individuals because these were physicians that feel like, you know, is that giving false hope? If it was to potentially harm a person, if I was talking about a pharmaceutical, that would

be different. But since berries will never hurt you, they can only benefit you, I certainly think it's very exciting to share this data. Why would we not? Particularly when there's other studies out there that are similar in design. This was a very well-done study out of the nurse's health study, over 8,000 women, and it showed that those breast cancer patients that had two servings of berries a week, for every two servings, there was a 25% reduced risk of breast cancer-specific survival. You know, there's also, like, cool studies with coffee. You know, coffee is another cool one.

That would have been at the top of my list. I know I tend to, like, go on. Thanks for letting me go on. Because when I'm like, Rich, I get so excited. Yeah, clearly. I'm getting that. Keep going. So coffee is like really cool.

And, you know, it's the one thing that when people come in to see me, you know what they say, I stopped having coffee and I stopped having wheat. And I'm like, well, you kind of don't need to stop either of those. Let's talk about it, you know. So when it comes to coffee, there was another cool observational study that showed that breast cancer patients who had three cups of coffee after their diagnosis had a 25% reduced risk of breast cancer specific mortality. So that's not my point for necessarily sharing it, but bottom line, coffee helps a whole lot of things.

It's always linked to kind of living longer on Earth. You know, so it is an observational study. So maybe coffee drinkers. Do you drink coffee? I do. Yeah, I love coffee. So there's a fun fact. So it's the chlorogenic acid in coffee that's very favorable.

And then there's been recent research to talk about the gut microbiome coffee drinkers have an organism, a microbe in their gut microbiome called Losinobacter. Tim Specter shared this with me. It's really cool data. Lossinobacter. I don't know a cool organism. Like, we have more loss in a factor than the non-coffee drinkers. I feel very entitled.

So it's very cool, though. So if you put dairy from a cow into coffee, it reduces your ability to absorb that chlorogenic acid. So that's why plant milk is going to be more favorable. Try to get your coffee light or medium roast because you'll have more chlorogenic acid. The more roast that goes into it, the more you kind of burn off that chlorogenic acid. But I think coffee is great. You know, if you get palpitations from the caffeine, then you'd want to do a decaffinated version of it. Some coffees, you know, there's some concern about molds, so maybe we need to be

mindful of that. I know I personally am, but that's hard in some situations. I certainly don't worry about it when I go to a grocery store. You control what you can control, right? Is that kind of thing. But I definitely like talking about coffee. I think you like talking about anything that excites you. It all makes sense. It's all very logical. Essentially, what you're saying is, you know, eat these foods that are high in fiber. The fiber serves to improve the health of the gut microbiome. The immune system for the most part is seeded in the gut. And so what serves the microbiome serves your immune system.

You want all of these antioxidants, all of these phytonutrients, a high, you know, a high ratio of nutrients to calories. And these things all inform each other. And obviously, you know, this anti-euroxidivist. inflammatory approach to eating is in service of cancer prevention and even recovery from cancer treatment,

cancer and cancer treatments, right? What you're advocating for is essentially a whole food plant-based diet or a plant predominant diet. And I'm curious about how that approach is received by your patients, many of whom I would imagine might be kind of coming in thinking, hey, everything I read and I've heard

is advocating for a ketogenic approach to treating cancer. Isn't that the better way to go? Yeah, there was a great review by Irvi Shal and Neil Anger at Memorial Sloan Kettering that asked this exact question, what is the best dietary pattern for cancer patients through to survivorship, and it shows that the whole food plant-based diet is the best, or a plant predominant diet is the best, including that for metabolic control.

You know, it was really interesting. We have access to this AI search engine called Open Evidence, and it goes through all of the peer-reviewed journals. And so I put in there, tell me about the long-term effects of a keto diet. Tell me about the long-term effects of a carnivore diet. Tell me about the long-term effects of a whole food plant-based diet. We have no long-term effects that we can comment on for a carnivore diet. There could be harm because of X, Y, and Z, because you're not getting enough fiber. Right. Same thing with keto. You know, maybe there's some immediate metabolic control, but long term, we don't have the data. We don't know what it means to have those higher levels of animal protein that individuals are consuming. What about a keto-like diet if you could do it more with a plant predominant flare or do more safer sources of animal protein, maybe, and I certainly do use that in individuals who have metastatic cancer, especially metastatic cancer with the brain with seizures. There's some situations where maybe a keto diet does have some, um,

value. There are some chemotherapy's that there's some suggestion that maybe there's some value, but again, you tilt them away from such the heavy lard, butter, ultra-processed like bacon and ham and those sorts of things. And you instead try to use fish and maybe some turkey and those sorts of things, avocado, nuts and seeds. It's not going to be truly a keto diet, but you can do your best. But at the end of the day, what this through the AI showed us is that with a plant-based diet, Yes, it's always linked to 10 to 20% at minimum, reduced mortality from all causes when you do the whole food plant-based diet. We see this over and over and over again. So it was pretty cool to look at that.

We just don't have long-term evidence with the above. So when my patients come in and they've been told to do the keto diet, when you share it with them the science. And in medical conferences, we talk about the science. Why do we not do that with the patients? And I do that with every one of my patients. I talk about the studies. I break it down on terms that make sense to them, layman terms. The truth is, Rich, when I talk to doctors, I break down more in the layman terms, too, because they've never had the education and nutrition.

And so it makes more sense to them. They enjoy it. It's more fun. And it's something they can apply to their own family. So I want the doctors we teach to be healthier. I want the patients to teach to be more healthier. And so the women do really good with it. Again, it's a teachable moment.

They seem to onboard well. I really keep a close dial in to their energy during the visit. And I try to use my emotional intelligence if it seems. like they're getting a little bit overwhelmed. And I share with them that this is going to take more time. You've got to show up for yourself. You may not be able to spend as much time on social media, watch TV, involve your kids. Take the kids to the grocery store with you. You're going to be reading the labels. This is important. It doesn't have to cost more. It is definitely going to take more time. And so I'd like to just put that up front and I want you have fun doing it.

You know, I enjoy going to the grocery store and I'm there like forever. You know, it's just what you do. And you think you and I kind of know when we go to the grocery store? No, because there's always new products. And so it created novelty out of it. I really work with patients with appropriate food swaps. So if they're doing, you know, toast with butter, well, okay, I try to maybe flip into a healthier form of toast. I love the Ezekiel bread. The sprouted breads are so wonderful. They're actually a complete protein, which is kind of cool. Not that we have to worry about necessarily getting complete proteins at each meal, but it's neat when you can. And then use some avocado on it. Avocado is so settling for cancer patients during treatment, especially if they're

having some GI distress. So it works really lovely for them. If they need to up the protein a little bit, hemp seeds, three tables since the hemp seeds has 10 grams of protein. That's pretty cool. You know, they could put some microgreens on it. Some of my patients do eggs. I try to limit it to, you know, preferably no more to two, up to four, but if they're doing a lot, I just dial them back by 50% at first and let them just navigate from there. You know, meeting them where they're at, dialing back just a little bit of maybe we don't want to get excess of and moving forward. The egg research is really hard to talk through. It's just not clear cut. It is a whole food. So I really talk through patients with that. And it's always going to be what are they going to replace it with? You know,

and you do need some protein. So my patients, a lot of them do have some eggs. I think it's really important to look at what is the food that we want to get rid of and what would be a healthier form of food that can be similar in palate and texture and taste to make that swap. And there's so many. And by the way, you can use AI. You can go in chat GPT. I love eating, you know, a soft taco with beef and what cheese and blah, blah, blah. The AI will tell you, why don't you try it like this? You know, try using some beans with the seasoning. Instead of using the cheese, why don't you try putting some avocado because it's going to be creamy and it works really good. In the hierarchy of foods and substances to avoid what tops the list and how do you go down from there? That's great. So

number one, ultra-processed foods and what does that mean? You know, so I basically say, we're going to read the labels and when you see those ingredients that you just have no idea, you can't recognize them or your great-grandmother couldn't recognize them, those are the ones you really want to avoid bringing into the home if possible. I really want them to avoid adding sugar if possible. On the ingredient list, if there's oils, I mean, I think this whole seed oil debate needs to be put to rest. I'm not really worried about seed oil, but the oils that we put into packaged foods is usually industrialized and it's junk. And they're usually putting that oil into the food to make it more hyper-palatable and it's going to be more calories that have

no nutritional value. And again, going back to every time we put food in the mouth, it's an opportunity to nourish the body or to potentially harm the body or to get unnecessary calories. So I typically when the oils are on the ingredient list, I want them to scrutinize that oil and what kind of oil is it? How high up on the list is it? Those are the main things on the ingredient list that I want people to avoid. When it comes to red meat, it's pretty clear from the American Cancer Society, the American Institute for Cancer Research, yeah, you need to limit it. I mean, this is evidence guided practices. This isn't my opinion here. This is based in the evidence that for cancer survivors, we want to prioritize plant protein. That's in every recommendation out there.

And so try to swap some of that red meat for plant proteins, whether that's edamami, tofu, tempe, beans, quinoa, you know, sprouted bread, et cetera. And what do you say to the person who is new to eating plant-based or predominantly plant-based who has concerns around protein? because you did mention when we were talking about the inverted food pyramid, like, you know, that you believe in, you know, you believe in making sure that everyone is getting an adequate amount of protein, and now you're saying, and you're going to have to get it from plants now. So what do you say to that person to make sure that they are feeling good

about their protein intake and kind of know what to eat? I really appreciate that question. So, you know, the guidelines with the recommendation is 1.2 to 1.6, grams per kilogram of ideal body weight is what the recommendation is for protein. So your kilogram would be your body weight divided by 2.2. And then they can do that calculation. So I don't really strive to make people plant only unless they really want to. I think it's very hard for most people to become plant only. So most of my patients will do a plant-based breakfast. They're usually doing soy milk, like with overnight oats. And you know, most of the overnight oats that my patients are

preparing is 30 grams of protein. People just don't realize how much protein you get from plants. I think it's hard if they're not doing soy to get to their protein goal. So it seems to make it much easier to get the protein goal for most folks. You can certainly do it, but I find my patients have an easier time if they can use the soy. For lunch, it's typically very, very easy. I use a lot of grain bowls for patients at lunch or soups that would be higher protein for patients at lunch. And again, they're usually doing beans at the lunch hour to get their protein there. And then usually a combination of nuts and seeds and some of the hemp, like we talked about if they sprinkle it on top. Nutritional yeast is another cool way to really up that protein

content. And so many people aren't even aware of nutritional yeast. And then I get pretty traditional with my patients. You know, if dinner time is with the family and they enjoy having a little bit of fish or some turkey and even some red meat, it doesn't mean that you can't have red meat. The American Institute for Cancer Research Guidelines are about 12 ounces a week, actually. It's way more than I would personally recommend to my patients. And you know, the interesting thing, Rich is my patients coming in. None of them are doing red meat much. They're doing it at max once a week. Number one, it's expensive. Number two, they just don't desire it. So it's not something that I see Americans are overdoing at this time when it comes to red meat, typically in my own personal practice.

So dinner time is where if they're going to opt to do the animal protein, I typically say three to four ounces. We don't want to overdo it. That's a pretty small serving size. So if you're doing a grain like a wild rice or a quinoa, ancient grain, add some bean into that when you cook it. and then again, half your plate is going to come from the vegetable. That makes it so easy for them. They're like, oh, I can do that. This is easy. Dairy, you know, there was a beautiful study that really opened my mind up to dairy.

And I know some of my plant-based friends, they get, they're a little disappointed when I have a little more of an open mind to allowing some of the animal protein into the dietary patterns of my patients. But I just think that when you're doing all, when you're getting all the things you need, like the fiber and the vegetables and fruits, it's not. going to hurt you if you get a little bit of animal, he's just not, if that's what the patient pervers. And I'd rather the patient be in harmony with their nutrition. Food is love, and you need to make sure that they can still cultivate that in their home. So with dairy, the dietary

pattern for healthy aging was published last a March. It was a beautiful study. And it talked about the fact that, again, the ultra-processed foods, that the ultra-processed foods are going to contribute to a 32% more likelihood of not aging healthy. So we've beat that into the ground. Everyone got that one. But what it did show is that eating a healthy dietary pattern can help you age healthy by up to 86% more likelihood. That's cool. Like that's a super cool study. That is like, should be at the pinnacle of what everyone looks at.

But guess what was part of that? Low fat dairy in moderation. So I love that. So, you know, if my patients to hit their protein goal, it's getting some Greek yogurt, this is awesome because it's great to get some fermented foods. And I didn't put that on my top 10 list, but we're going to add that. We should do this way. We should just keep on adding. I don't know how we were out.

I'm supplementing it. I'm going to keep adding. I'll remind you afterwards. So yeah, so fermented foods, you know, you want to try to get three servings a day. And that's really hard. I don't do it. I'm not good at that. I try.

I try to be very intentional. But for patients consuming dairy, low fat dairy moderation, I try to get them to do the fermented. Kiefer, I'd rather them do goat or sheep if they can. That's pretty hard for a lot of people to find it or to afford it. It tends to be a little bit more expensive. One of the interesting things that you recommend for, you know, your patients is to undergo a fasting, mimicking diet. Now, like this is starting to stack up.

Like if you are diagnosed with cancer and you're in this integrative approach and you're doing radiation or some type of chemotherapy, and you're also trying to master your lifestyle habits and you're, you know, you have zero energy because you're getting beaten up by these treatments, but, you know, Dawn's telling me I gotta exercise and I gotta swap out my comfort foods

for these healthy things, like it starts to get a little overwhelming. And then on top of it, it's like, oh, well, why don't you do this fasting, mimicking diet also? Yeah. Like it's a lot. Yeah. I think it's important to acknowledge that, right? It is. And so it comes across that way, but you know, when I meet with them, it depends. Some of them want to go all in right away.

And this is a physician who's new to lifestyle medicine and working with patients. You need to really dial in to the patient in that visit and really use your emotional intelligence to know, know how far you should push that patient because you don't want them to tilt to the point they're turbulent. And so it's been this, it's joyful. I have so much fun with them. And Mayo Clinic gives me 90 minutes to meet with my patients. And this is the allocated time I need. I could never do it in less time to have that communication in a way that we can understand each other and I can help them. I can understand what their patterns are. And sometimes we just fix breakfast, you know. And sometimes if it's going to be a lot, then I just say, hey, let's try to get half that plate vegetable

and fruit. And again, during chemo, you know, I tread pretty lightly. If it's going to be hard, depending on the chemo regimen they're getting, then we just do our best. It's really into the survivorship phase that we really drive forward with this. But it's been amazing. And, you know, the majority of breast cancer patients during treatment gain weight. And if we can try to work with them with being aware of not going towards comfort foods

that are high in calorie and they're not going to feel as good on those foods anyways, then it's a good time to do it because it's harder to lose that weight afterwards. So, you know, I kind of made that joke when I was talking to Simon Hill, and it's true. It's like every friend and church member brings you macaroni and cheese,

and I don't know what it is, but it's like, I think that's what every cancer patient wants. It's like the worst food in the world. Because they're thinking, well, that's what they give them at the hospital. Yeah, that's what they're... And it's also comfort food. It's like, oh, it feels like. like love.

Yeah, it feels like love, but there's a lot of great ways to do it. And so this is where, you know, I just have a bunch of recipes and share it with them that, hey, this is an easy way you could do this and enjoy it. But you ask the question about fasting, mimicking diet. And so I use a fasting and mimicking diet actually during the chemotherapy week. And so with the prolon, they have the five-day kit, but they also have the one-day kit. And so if anyone's listening, you need to talk to your healthcare team if this is something you want to do.

there's been research to show that with certain chemotherapies, not all chemotherapies, but the chemotherapies we use for breast cancer, that fasting can help individuals to mitigate some of the toxicities, because what happens is when you fast, your healthy cells get out of the way. They go to sleep. But the cancer cells, they don't know what you're doing. They kind of, if anything, there's some theory that may be they get irritated. You know, maybe it's even an opportunity for the cancer to kind of find them easier because they're irritated.

They're kind of a little more on alert. So what we do with the prolon, what I love to do because people are still eating, is they would do the prolon one day kit for three days, two days before chemo and the day of chemo. And that's really nice. And so if women are doing certain chemotherapy regents like the Adriamycin, cyclofosomy, the ones that really kind of make them just not feel well, they don't want to eat anyways. A lot of my patients have opted to use that and they feel great. And they really restore their energy and feel better days after their chemo and doing that. So it's very individualized with my patients that want to do that. It's not. for everyone. It's very dependent on the chemotherapy regimen that they are going to be given. The chemotherapy regimens are running weekly, I only do the ones that they're running every two weeks or every three weeks, and if the patient is interested. When it comes to fasting, I think it's great for individuals that could do a 12 to a 13-hour fast. There was one breast cancer study that showed 13 hours seemed like to be the sweet spot. So, you know, the Americans kind of have it wrong, though. A lot of times we want to eat until 10 night, and we don't eat

to like one in the afternoon. Breakfast is critical. Every study always shows that if you don't eat breakfast, is linked to increased cardiovascular disease mortality. So we want to encourage breakfast. We want to encourage more of like a circadian rhythm eating. You know, his sun's going down. You don't need as much energy, so you shouldn't need as much food.

So try to stop your food intake close to sundown by 7 p.m. And then start eating by, you know, 8 or 9 a.m. That's ideal for patients if they can do that. I personally can't fast. I wake up super early and I like that my coffee with soy milk first thing in the morning. So I'm not good at it. And I just accept that. Like I know I'm missing the opportunity maybe to be the healthiest version of myself.

But that's okay. I don't judge it. I just do my best. I love my mornings the way. I love them. And I think that's how each of us have to approach our lifestyles. We do what we feel we adopt. That is aligned with us and we move forward.

But I don't know if you do a 12 hour past each night, but it's very hard for me. I'm really committed to overcoming my habit of late night eating and eating dinner late. And this is a big deal for me because it's my Achilles heel. And I can tell you that in this new year, I have not every, look, it's not perfect, like there's been nights when I'm out or whatever,

but for the most part, I've been eating my final meal by around five o'clock at the latest. Wow. And it has been pretty dramatic in terms of the restfulness of my sleep and the vitality that I experience the next day. But I have like incredible hunger pangs. Like I just wanna devour everything in the middle of the night. And like I can see with my wearable

what's happening to my stress levels throughout the night when I do that. And the impact on my sleep has been pretty significant. So it's improved. when you're not eating, when you're stopping your food by 5 p.m.? Yes, but this is not easy for me. This has been very difficult.

I think it's hard, especially with your athletic, with your cardiovascular. But I'm not like doing, the thing is like I'm not exercising a lot right now because I'm still in my recovery from spinal surgery. So perhaps it's different when I ramp that up. Like I am exercising, but it's pretty modest. So it's not driving like intense calorie needs.

But the problem, The problem is my appetite is still, it's pretty consistent, whether I'm training a lot or doing nothing. And so I have like, you know, I have like these appetite, you know, these overwhelming cravings for food that I'm trying to manage. I understand what you're saying.

And I'm kind of the same way. I mean, for me it's the morning when I wake up early. I need something like as soon as I wake up and I've tried, I'm like, no. See, I don't have that at all. Like I'm not hungry at all in the morning. I wish I wasn't. Yeah, I am.

You mentioned that your appointments with your patients are 90 minutes. This is not the typical experience of the average person when they interface with the health care system. What is it that's different about what you've been doing with the Mayo Clinic as compared to traditional, you know, traditional kind of health care? How are we going to fix this broken health care system?

I know. It's a hard question, Rich. And I mean, it's something that hits really close to home because my visits were 90 minutes. and it's something that even at Mayo Clinic, they realize that it's not sustainable in that time. And as a physician, I know I need that time. And how I structured my practice was it was a 90-minute visit,

the first visit, and then, you know, patients would be able to go, you know, many, many, many months, six to nine months before they'd see me back. Or many physicians see their patient in a short window time, let's say 15, 30, 60 minutes, however, but they see them back, you know, much more quickly, or they see the nurse practitioner back. That wasn't how my practice model was,

so it worked really well for me. But because of reimbursements, it's something that, you know, Mayo Clinic was no longer to do with the 90-minute visits. So they needed to cut that visit time in half. And it wasn't something that really aligned for me. So I am, my last day at Mayo Clinic is actually January 31st, which has been very emotional for me. My patients are like my heart and soul. And they are my purpose and my meaning.

And they're how I got through my hardest days because I could work. You know, people never realized it. But when I was no longer able to exercise and really move much, even in the hospital, I would still see my patients on telehealth. So this has been really hard on me. But I just know that to cut back my patient appointment time, I would not be able to have these conversations. Like you said, how do patients accept that news?

How do they get more into a plant-based diet? It's because we talk. We have conversation. I meet them where they're at. And it's not about making a plant only. It's about let's just tilt towards a healthier diet. A lot of times it's more like a Mediterranean-style diet that's whole food-based. Give them recipes.

We have fun. It's playful. We're also doing exercise and all the other pillars of life. style medicine in that discussion, plus optimizing their cancer treatment strategy, whatever that may be, and optimizing their health-related quality of life. So there's a lot that we did in the visit. There's accountability. There's follow-up. There's engagement. You know, these people are being looked after and they know that, you know, they're being looked after, which is very different from you do the appointment and I'll see you in six months. And yeah, here, you should probably do

these things, but nobody's really paying attention. I agree. And, you know, health care just doesn't value the importance of this sort of practice. And so, you know, it's hard for any, even the best in the world health care institutions to just, you know, when you have a physician seeing a patient, there's about 15 individuals underneath them lifting up that practice in terms of scheduling, keeping the computers, all these things. It seems like it's just a physician, but it's really not. It's a lot to be able to have a provider in a clinical setting. And so this is really opening up this opportunity for me to,

be in this space to help to democratize wellness where you can get this voice out there to help more individuals. And it's going to come to informing policy. So how do we do that? So I am the new chief medical officer for Fountain Life where what we do there is it's advanced multimodal testing, early diagnostics, doing this advanced testing to find disease states early. And what we find is that out of all the individuals screened, about 14.4% of them have what would be considered a potentially life-threatening finding. 14.4%. Yeah.

Whether it's cancers, whether it's aneurisms, very significant. So in this setting, they go on to get care. But of course, they're also going through the strategic, all the healthy people

of living these healthy lifestyles, having interventions and following them longitudinally. So it's very, very exciting. There's AI analytics looking at this massive amount, billions of data points. It's so incredibly exciting.

But then to have this ability, to follow these healthy numbers, which is what no one does. You know, when do you get all this testing and then you get to follow it for years? And so it will help to educate us to understand the importance of these interventions, the importance of downstream reduction in cost if we find things early, or if we can put them on the preventive track from day one, and how that can help to offload the current cost of where we're at in health care. Right.

Where are we at right now in terms of insurance reimbursement for this stuff. We're nowhere. And people are suffering. Yeah. And the morbidity mortality. It's expensive. And so it becomes, you know, something that only the privilege to have access to.

And that needs to change. So my goal, I won't be seeing patients anymore. But it's really, I am on this mission to democratize wellness. I'm very excited to do it. I will still be doing education to try to help people and to try to understand a platform. And that's why I love just being this, you know, very practical voice. I pride being a double board certified physician. and most of what I'm proud of

as being a lifestyle medicine physician to help people step into their aliveness. Like, right? I mean, every minute, every breath we take, we're closer to death, but our job as doctors is to help our patients feel alive, feel good, experience their vitality,

not just quickly write a pill, write a pill, and keep them putting band-aids over every single problem. No, elevate them. Feel great. And to witness what I've witnessed in my patients has been just a dream because I know it's possible.

If I can do this for individuals in their sickest moments, there's no reason we can't do it for everyone else in the world. So, you know, this is a major lift. I'm just one voice. There are so many doctors out there that are really in this path of trying to elevate this message and to help people be inspired to try to take part in their wellness. This is the first generation that's starting to cut back in their alcohol consumption. The youth of our country are very interested in their wellness because they've seen us suffer in our chronic diseases. So it's going to be pretty exciting, I think. But it's fun to see the young kids taking part in their wellness and exercising more regularly.

It's these generations currently that we're tackling. Yeah. I never thought for a second about my long-term health when I was a young person. It is an amazing shift. And I think we're on the precipice of so many interesting breakthroughs technologically. I mean, the diagnostic capabilities with the advent of these new artificial intelligence. technologies, I think are revolutionary. And I think downstream of that,

there's this domino effect of tools that are gonna become available. Just early detection alone, you know, could revolutionize health. And so it's exciting that you're on the cutting edge of that. I think it's cool. I do wanna talk a little bit about, we've talked about our food and nutrition,

like our dialing in our diet. But there's another kind of diet that I think it's important to dial in, which is our information diet. And I think when you think about cancer, that is mana from heaven for less than savory, you know, let's just call them grifters, shilling all kinds of snake oil, because there is nobody more vulnerable

and desperate than the cancer patient. And so this is a real problem. And I'm interested in how you think about, educating your patients and what it is you want to say to the broader public about how to curate your information diet so that you're getting good information. I mean, there's just all kinds of insanity out there. And if you're just scrolling on social media, you know, there's all manner of, you know, drink this, eat this, this supplement, and it will prevent cancer or cure your cancer. I mean, I think was it Mel Gibson who was on Joe Rogan and basically said he had friends who

who took ivermectin and they became, you know, it cured them of cancer. Unlike, you know, the biggest media outlet in the world. So how do you think about this and what is it that you want to say about it? Yeah, thank you for giving me space for this. Because it is a vulnerable population and they are taken advantage of. And, you know, here's a good example. There's a supplement out there that's called apricot seeds or B-17 latrtle.

You know, it's linked to cyanide. And so, you know, they tout it as being something that can help cure you. And so everyone goes and takes it. But it's not just about being taken advantage of. It's that some of these things can actually harm you. Individuals taking the ivermectin, sometimes they pair it with a veterinary grade medication called fbendazol. And it's just, in my practice, I have not seen personally benefit from ivermectin or fbendazol. There's a lot of questions I have about ivermectin. I've never written a prescription myself because there's too many other things we can use that have evidence to help.

to increase the quality of life during chemotherapy. So I was co-author on the Integrative Therapies with the American Society of Clinical Oncology Guidelines during and after breast cancer diagnosis. It was really fun to dive in and to see how scant the evidence is. This is the other problem. It's very hard to get the evidence

because these studies are very hard to be funded. I have written so many grants that have been denied for so many studies in my career that is just hard because you're competing against pharmaceutical companies that have billions of dollars and with a nutraceutical, you really don't have money to back you for these expensive studies. So it's hard to get the science off the ground.

So number one, you've got to make sure it's safe. Number two, you've got to ask, you know, what in the literature showed this to be safe? Was it an animal study or was it a human study? It's usually animal studies. So if it's an animal study, I just want to rely on it. I just don't think there's safety data that would allow us to move forward with it if that makes sense. You need to talk to your medical team. Most National Cancer Institute designated cancer centers,

have integrative medicine specialists, part of that cancer center that meet with you to review what it is that you want to take. And within your set of symptoms, what modalities would be safe, have some evidence to say, hey, why don't you try this instead? The one, so there's therapies out there that are just easy. I mean, there's some that are just so valuable during breast cancer, any cancer treatment. I'm sorry, I keep on saying breast cancer is just second nature for me to do that. Acupuncture is one of them. Again, it's this financial talk. Toxicity, though, it's expensive being a breast cancer patient, cancer patient, and all of a sudden, you add on acupuncture. But it is a modality. It can be very beneficial. Many private paid insurers are now starting to cover acupuncture.

Medicare, unfortunately, only covers this very minuscule amount, so it's usually not enough to cover it. But acupuncture is very safe. Mind body therapies. There's absolutely no harm to acupuncture, mind body therapies. These are things that we want people to consider. And like you said, not these therapies out there that may otherwise ignite harm. There's so many out there. a case recently of a family out here in California. There was someone that was offering them this dendritic cell therapy. It's a therapy also being done in Mexico. And the dendritic cell therapy would have been illegal because it's not FDA approved. Not only was it illegal, they were in charge them $1.2 million to give them this therapy. And it wasn't even legitimate because you only give it to someone who has active cancer and this individual no longer had active cancer. They were in remission.

So it was, I felt so honored that I was called to say, what do you think of this therapy and to be able to say, no, you're unfortunately being taken advantage of. We don't want you to do this. You know, and this is a woman who is much older and it's the older population oftentimes has taken advantage of. So this is just please seek out an integrative medicine specialist to review these questions with your other options. Many pharmacies, if your cancer center does not have an integrative specialist, many hospitals. Many hospital. hospital pharmacies have an expert in the supplement space that you can meet with instead. There's always resources out there. So please seek that guidance. How do you deal with the appeal to nature fallacy? Imagine a patient comes to you and, you know, they're in an advanced stage of breast cancer and they say to you, look, you know, I know you're going to tell me to do radiation or chemo or whatever. And I came to you because you also have this integrative philosophy, but I'm gonna dispense with the traditional therapies and I just want to, you know, I'm gonna, I'm gonna do a juice fast and I'm gonna, you know, I'm just gonna focus on all of the,

you know, kind of like holistic nutrition aspects of this because I'm convinced that by, you know, doing what's quote unquote natural, that's the best way to heal me or cure me. How do you balance respecting the patient and their wishes and their, you know, their choices in their agency while also making sure that you're being responsible as a, you know, living up to your Hippocratic oath. It's the hardest and it's very hard, especially when it's a young woman with children

and a husband and you know, you can't rely on the natural things usually as much as you can rely on the conventional things because we have data to show the improved outcomes. This is the importance of finding cancer early because we can use less toxic therapies, we can use less of it, and we have improved outcomes.

And so that's the importance of early detection and screening. So in this situation, it's very important. I've talked to my colleagues about it, that we just give the information. We should not be in the business of changing minds. And I have seen colleagues of mine get upset at patients and the conversations kind of elevate and tone. And that's not what this is about.

The lecturing and the condescension. Exactly. I mean, listen, it's your body. So give me an example of how you would respond to that person. Exactly. So I mean, I usually have them just share with me what their concerns are. What are you scared about with a conventional treatment? And what is it that you're hoping to find with a natural treatment? It also matters a lot, too. How are they living before their cancer? Because most of the people doing this were living perfect lifestyles before, you know, very healthy lifestyles and they want to continue to do natural. I'm like, well, the cancer happened while you were living essentially a very healthy lifestyle. We really need to stop the cancer in its tracks. There is very interesting data that shows that individuals who forego the conventional therapy for all. alternative treatments have a two and a half fold, worse outcome, poor outcome after their cancer treatment. And what usually happens, Rich, is some of these patients that opt not to do the conventional care and they go and they do the natural, the cancer eventually comes back,

and then they eventually end up doing it anyways. And this is what I always see. But they're doing it so late in the process. And so it's more toxic. And so, you know, I typically talk with them and say, you know, I share, I'm fortunate. I have this lived in, I share my story. And I was into natural medicine. I went to naturopathic school before traditional school. I was really into natural medicine. But I knew, with how advanced my cancer was, that I needed do the treatment. And guess what? My existence elevated during my treatment. Like everything. I was not sick a day in my life during my treatment. It's fascinating, right? It's mindset. You know, I didn't allow myself to be sick. I was too busy. I had purpose. I had meaning. I had my medical training.

And so I let him know, listen, if you're going to do your chemo, we could do the fasting. Hey, when we do this fasting, here's the research. We can help to put those healthy, to sleep during the cancer treatment and maybe even heighten the cancer cells and go after the cancer in a way that we have science to show it's going to give you this outcome. While you're doing that, we're going to do X, Y, and Z, you're going to exercise, you're going to meditate, you could do acupuncture. And guess what? At any point, if the treatment doesn't seem right for you, you can stop. But at least you know you tried. Because if you don't try and God forbid the cancer comes back, I'm not saying it's going to, we don't know, but God forbid you go the natural path and it comes back or it progresses and gets worse

and you end up here, then you have blame. I kind of push to the point, and I share with them, I say, I am just so passionate about this because of what I've seen over the years, because of my own living experience, please, please don't take this personal. It seems like I'm trying to push you into this. This isn't my intent.

I don't want to hurt your feelings. I just care about you. I love you. And that's what I'm really trying to just have this conversation about. So I feel if we just connect on like a heart level with patients and let them know that it's really because I care. It's not my ego. It's not like I'm trying to convince you.

It's just because of, where I stand with us that I'm. You're gifted with an incredible mindset. I mean, the fact that you were able to weather all of these experiences with such hopefulness and a sense of purpose and self-belief. And you mentioned, you said like, well, I think I was born with it,

I was ingrained with it and you have your faith and the like, but this is not the common experience. So how do you think about the importance mindset because when I hear your story, I hear somebody who was, was, who survived in large part because of your perspective and this mindset that you had about what was happening to you. But it's difficult to instill a mindset in a patient. Do you find that the ones with a positive affect and that sense of, you know, optimism and self-belief, do better. And for those that come in with a different disposition or perspective,

how do you help those people shift their mindset so they can be in a better position to recover? Love it. So optimism has been shown to improve outcomes by 15%. So it really does matter. So how can you help a patient ignite it? So that's kind of the gift of lived experience. So any of us physicians or health care providers who have had lived experience that have that ability to connect with others, it takes that individual from that place of hope to knowing that, hey, I too can do this. And they can kind of cultivate their own optimism as a result is what I've seen. But there's not everyone that's kind of wired like that. And you have to just honor every individual for their unique qualities and character.

And, you know, let them open up their vulnerability to you when they're ready. and not everyone wants to pivot and shift. So you have to wait for that invite. And most people coming in to see me already in that active phase or trying to move in that direction. But if someone's not asking me for my help, I don't try to change them. Because that's just their authentic self.

And you can't force someone into this. They have to want it and desire it. And when it comes to mindset, it's what matters most. More than food, more than exercise, more than sleep. Yeah. Love, number one, love, harmony, connection, and mindset. And during my heart transplant, I actually used no narcotics. And I get really sick from narcotics.

You had a heart transplant and you did not, well, you were under anesthesia, but when you came out, you had no pain meds? None. Wow. They tried and you know, you couldn't move and I threw, I said, I cannot. It was a very lotus. I cannot, I will get sick. it's how I've always been. And I did. And I vomited and I aspirated. It was big, so like, okay,

she can't. So I used no pain meds. And so the reason I share this is powerful is it was extreme suffering and it was mindset. And there were moments when I thought, I don't know what I'm going to do. I learned how to work with my mind. And so this was when I didn't even have mindset. I was in my most vulnerable moment of despair. And so when we don't think we can, I'm here to say you can. You just, it's hard. It's not easy. But the ability to rise above that trauma, that's how you harness post-traumatic growth. And oh my gosh, that's why I've ascended this escalator of existence that is beyond the possible.

Like, I'm in this other realm. I mean, sometimes, Rich, truly, like, I think about am I alive? Like, I don't know. Like, I'm in this total different existence. with most of humanity. And guess what? That's what extreme suffering introduces us to. And I think you've had a lot of experiences in your life too.

And any of us with adversity, cancer can be a gift. And you just have to work through it and pivot it around. And when you're in that hard time, feel it. Don't run from it. Feel it. Because when you're beyond that moment, life becomes so effortless, so easy. so immensely beautiful. It's just like this bliss state. I just invite patients to just be there for what awaits you because it's very special. And there is a reason that every person who experiences adversity is experiencing it.

And it may not be within you that that lesson is intended for. It may be someone outside of you, but there is a reason. And so just trust that and just kind of ride the wave. But for me, I was actually very happy that I had to go through that because that was hard. So you have gratitude for all of these experiences? You know, I am just so grateful for every single moment. I always say I stay in just the present now because it's just so enriched with the level of gratefulness I have for every single breath. But I do.

You know, there's a cool longevity study even with gratitude. Like gratitude helps everything. And it's so hard, but just pause. You know, when you put your feet on the ground every single morning, first of all, just ask yourself, what excites me about today? What could possibly give me a few goosebumps or chills? Because that's your meaning in life right there. And that's really, really important.

And then right there in that moment, just reflect on one single thing you're grateful for. Even if life sucks, like there has got to be one thing like, okay, I'm grateful because the bet I'm sitting on is kind of soft right now, or I don't know, there has to be something. There's always something that you can find that you're grateful for. To play devil's advocate a little bit here. For me, these ideas are so abstract. Like I had Arthur Brooks here the other day. And he shared, I asked him like what was, you know, the most profound thing that you've learned through your friendship with the Dalai Lama.

And he talked about the Dalai Lama reminding him that, you know, he's one of eight billion or whatever. And it's like, yeah, but we all know this. You know? We all know we're supposed to be grateful. Great. You know, when your feet hit the ground in the morning, like, remember, you know, like, what you're here to do. Or it's like, on some level, like, I'm so cynical that it hits me, like, platitudes occasionally.

And I know that's true. And I believe you when you are saying these things that you're saying, I think for me, and I haven't suffered, you know, a fraction of what you've gone through. And yet it can be so difficult to stay connected to gratitude, to feel. this consistently. You have an experience, an extreme experience that connects you more deeply with those emotions and yet we so quickly snap back into our, you know, like put our blinders back on and we're just kind of like living our lives the way that we always have. So my question to you is like, how do you stay in constant contact with that? Like you're living and breathing

it every day, it feels like. Maybe because I work with patients. so regularly, like it's hard not to fall out of it because I'm always actively working and discussing and guiding. But I think because I was on this brink of death so many times that I really am just so thankful. And I think anyone who has really faced death head on and or died, that you do enter this position of just, it's like an eternal bliss state. It's, just is. And my, it's not about happiness. That comes and goes. That's because of external variables. So this is something innate. It's something within. And I think it's probably hard to teach, but it is teachable because I've seen many, many of my patients able to do this same thing.

And it's also not judging. Like it's just being there with yourself. And I feel like some of what you're saying, like there's a little bit of judgment on that. I think that's hard. I think that's hard to put that expectation on self. So I keep it pretty easy. I just, I've like so in love with life, you know, and I just keep it simple. Like I live actually really simple life. It's kind of funny. I don't always know like all the studies that tell me this and that.

I don't do a lot of reading because I'm like there. You know, and so I'm more there to help guide people about the possible because I didn't rate a handbook to help me with any of this. It was just trusting, quieting the mind, getting. getting into the heart and feeling what the heart was telling me to do. Get out of the head. That's one thing I would say, because that head is very noisy

and it usually will misguide us. Well, you're definitely living your Dharma. You know, when you look through the rear view and the rear view is always 2020, it's so clear that all of, how all of these experiences in your past inform your ability to be this healer in the present, you know? There's a connective through line,

that's really easy to see. And it's like, oh, you're doing what you're supposed to be doing. You know, you're, you are living, you are fully expressed authentic life. Do you feel that way? I do, I mean, I keep it light, Rich. You know, I'm very playful. I'm filled with like all in wonder.

It's almost like I'm stuck in that seven-year-old body that used to watch the Today Show with the Willard Scott, with the nightgown and the heat. Like, I'm just like that little girl. I never lost that, like that childlike spirit. And I think sometimes we want to try to simplify a little bit and just get back to that little psyche some. I just think it comes down to judgment. I just see people are so hard on themselves.

I am too at times. We all are. I mean, that keeps us in check so we could be successful. I mean, we need some element of that. It's not like getting rid of it in its entirety. But when it comes to this whole idea of self-growth, I think people have become obsessed with it. Same thing with longevity. We're like obsessed with it.

And it's, you know, I think that life is probably should be a little less about self and should be more about serving others too. And maybe that's why it's been easier for me. But I just make life a little simple and I keep it playful the much as possible. Before we end on, I think it would be helpful if you could share some wisdom and some insights for the young woman out there. the woman who is just in the beginning phases of her life at the start of her career. Maybe she's, you know, 26 like you were when all of this happened. How should that person be thinking about their well-being with respect to cancer risk? Such an important question because today I actually see a lot of young cancer patients.

My youngest patient is actually 20. And so it's so important, rich, to be aware of your body. And it's also important that when you go to see a doctor with any concern that they listen, make sure they listen. If they don't go see another doctor until you have someone hear your concern. So when it comes to breast health, you know, the American Institute for Cancer Research Guidelines that really march out, 10 things that we should really focus on to be the healthiest version of ourselves.

And we know in those guidelines for breast cancer prevention, when individuals hit five to six of those guidelines, it can reduce the risk of breast cancer by 50 to 60 percent, big numbers. So it's what we talked about today, is that eating healthy, moving the body, trying to avoid those risky substances. It's breastfeeding for women also. Now, I'm not going through all of the AICR guidelines because within the nutrition, that's four guidelines within itself. And we talked about all of those. It also talks about how there's no supplement that's going to prevent cancer. You know, you want to make sure you close nutrient gaps. So if you have vitamin deficiency, you treat it. If you're vitamin D deficient, you get it treated. But there's no magic bullet

as we talked about with, hey, there's a lot of snake oil out there saying it does X, Y, and Z. There's really no magic bullet, so know that. So those are kind of the pillars of cancer prevention. But what's important is if you have a family history, if you have a unique risk factor, to speak with your doctor and your medical team about, is there any imaging that is necessary for you? And women, particularly with family histories of breast cancer, we want those women to start screening 10 years younger than the youngest relative diagnosed.

And when women are really young and they're doing that, oftentimes that may even include breast MRIs. So these are things that need to be individualized. We typically start mammograms at the age of 40. You know, and in those situations with family history, we dial up back 10 years as well in those women. So it's just important that you speak with your doctor, speak with your women's health specialist, to individualize this to you, to individualize it for the family history for

that woman that's listening. But it is just so important, so important to show it for yourself. live that healthy lifestyle. And again, I think, you know, a lot of times the guidelines, when we look at the eating, the exercise, avoiding toxic substances, X, Y, and Z, they never hit on the importance of living a life that means something to you. You know, career, is it just a job, or is it your passion and your purpose? And within your job, because it's what you're going to be doing the most part of your younger years, make sure you find meaning in that, enjoy in that, and connect with the people you work with. And I think all of that is.

It's just so, so important. Conversely, what is the message to the person who's on the other end of the spectrum, who's much older, has lived a lifetime, ends up your patient, and you are suggesting all of these lifestyle interventions. And that person's like, listen, it's too late for me. I've been eating this way, this terrible way, my entire life. I've been, you know, all these habits are ingrained in me. And maybe I can change them and move the needle a little bit.

But is that really going to make any difference at this point after 40 years, 30 years of whatever it is I've been doing? Awesome. Awesome. I have a great study for this one. This is one of my top studies of all time. So if an individual decides to start eating healthier at the age of 60, you can have eight healthy years to your life expectancy. If you start doing that at 80, you can add 3.4 years of healthy life years. That's powerful.

So it's never too late to start. And the most important thing is, yeah, it's great to add some healthy years to your life, but the powerful thing is you start feeling better right away. You have more energy, you start sleeping better, your mood feels better, there's more joy, there's less worry. So this is so important for just experiencing one's joy in life, period. So leaning in and starting to live a healthier life, regardless of what decade of life you're in matters, whether it's at the younger extreme or the older extreme. It's never too early and never too late to start. start. Incredible stuff, Don. I was saying to you before we started that typically, uh, my guests fall into one of two buckets. Either they come in with this incredibly inspiring story of resilience that is, um, empowering for me and, and for the audience. Or they come in with, uh, uh, uh, you know, subject matter expertise with all this knowledge and experience that they share. I don't know that I've ever had somebody who inhabits both of those worlds. Your personal story is super inspirational, but equally impactful and powerful is all of

the incredible information that you shared with me today. And I appreciate you being here. And I think the best way to end this is by asking you if you just had to distill down everything that you've learned in these two aspects of yourself that you want to share with the audience here today before we conclude this conversation. What would that be? You know, really just trust what is your truth? And again, I'm going to go back to this. Don't judge. We're so hard on ourselves and learn to fall in love with yourself again. And that will be your best guide to falling in love with life. Keep it easy. There is no perfect diet, by the way. And I think so often people hear me speak and they strive to do this perfect diet. And individuals come in to see me and they say, you're going to be a little disappointed. I'd do this.

I would never be disappointed. Just do your best. Try to move your body more. Try to limit those toxic exposures. Definitely we don't want people smoking. When it comes to alcohol, you really want to avoid it. You know, there's no health advantage there. Sleep, you got to sleep.

Sleep is when, you know, your entire body is restoring itself, including the brain. and it's going to energize you the next day. But the most important thing that we can do in life is to love and connect with others. And so life is just way too short not to pause and take that opportunity to be with others that are special to us. That's what I would say. Beautiful. Thank you so much. Rich, thank you.

This is just like an aha moment for me to be here with you. And I listen to all your shows and episodes and I have for so long. So I just want to thank you for being that source of hope for me and bringing experts here that allowed me during some of my hardest days again to inspire me to be here today. This is unbelievable. So thank you. That means a lot. I appreciate that. Thank you so much.

Yeah, amazing stuff. And come back and share some more. You will. All right, Dawn. Thank you. Thank you. Peace. Plants.

That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests, including links and resources related to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, My Books, Finding Ultra, Voicing Change, and the Plant Power Way. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube,

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