Episode 35: Dr. Elizabeth Boham, MD, RD on How The Mircobiome, Insulin, and Nutrition Impact Breast Health
Show Summary:
How do insulin resistance, gut health, and diet impact breast health?
These are the topics that we are going to be diving into with Dr. Elizabeth Boham today!
Elizabeth Boham, MD, MS, RD, is board certified in family medicine, with a strong background in nutrition and Functional Medicine. She works with Dr. Mark Hyman at the The UltraWellness Center in Lenox, MA and also speaks on topics ranging from women’s health and breast cancer prevention to insulin resistance and heart health.
Join us for a conversation today about how addressing your gut, hormones, and diet impact breast health and what you can do to support your breast health in the longterm.
Timestamps:
0:00 - Introduction
2:16 - Why Dr. Boham became a dietitian and doctor
8:05 - Tips for cancer prevention
13:02 - Role of genetics in breast cancer
18:22 - Gut health and breast health
25:46 - Insulin and cardiometabolic connections
31:08 - Nutrition
32:56 - Prebiotics and probiotics impacting breast health
37:35 - Unwire bras
39:50 - Pesticides and breast health
42:45 - Skincare and beauty products
44:00 - Dr. Boham’s morning routine
45:05 - Dr. Boham’s book recommendation
46:40 - What Dr. Boham does everyday to cultivate joy
47:55 - How to learn more about Dr. Boham
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Full Episode Transcript:
SPEAKERS: Dr. Andrew Wong, Dr. Elizabeth Boham
Dr. Boham:
I saw this study a couple years ago talking about plastics and the components in plastics and how dangerous they are in terms of cancer and cancer progression and the study had this really great visuals showing how the polyphenols from our plant foods can actually block that action of the the BPA, the plastics, the phthalates that are impacting growth of cancer in the body and that the polyphenols actually can block that.
Dr. Wong:
How do insulin resistance, gut microbiome health, and nutrition impact the health of your breasts? These are topics that we're going to be talking about today and diving into with Dr. Elizabeth Boham. I am Dr. Andrew Wong, co-founder of Capital Integrative Health. This is a podcast that is dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. Dr. Boham is board certified in Family Medicine. She is also a registered dietitian and certified functional medicine practitioner. She works with Dr. Mark Hyman at the UltraWellness Center in Lenox, Massachusetts and speaks nationally on topics ranging from women's health and breast cancer prevention to insulin resistance and heart health. She also shares with us today on the podcast her personal story and journey with overcoming triple negative breast cancer and ways to prevent breast cancer in the future. Join us for a conversation today about how addressing your gut, hormones, and diet impact breast health and what you can do to support your breast health for the long term. Liz, thanks so much for coming on today.
Dr. Boham:
Thank you so much, Dr. Wong. It's great to be with you.
Dr. Wong:
Yes. Well, let's talk about breast health. I know you're an expert in this area and we would like to talk about a functional medicine approach and a functional nutrition approach and we know that you're both a registered dietitian and a medical doctor so first of all, let's talk about some of the background. I think that's a really unique you know, training that you have and maybe your story too, kind of what motivated you to get into Functional Nutrition and Medicine.
Dr. Boham:
Absolutely. So, my background was in nutrition so my undergraduate and graduate degree was in nutrition. I'm a registered registered dietitian and you know, I've always been passionate about nutrition and then, I was working as a nutritionist and I was like you know, I want to learn more about how the human body works and what keeps us well and what makes us sick and so, I was like let's go to medical school and I always laugh because everybody in my family's PhDs you know, I have no medical doctors in my family so I had no idea what I was getting into and I was like, oh this will be fun and it was just so much more about Acute Care Medicine that I had ever you know, imagined. I just had no idea what I was getting into and so you know, part of that was a struggle for me. I mean and now I appreciate the training of course but at the time, it was something I fought a lot and I was in residency. I did my residency in Family Medicine and I was in the middle of residency working nights in the ICU and found a lump in my breast an I have no family history of breast cancer so it was 22 years ago and then, went through all the process and I ended up having a triple negative breast cancer at the age of 30 which of course you know, shook my world. Here I was, all interested in nutrition and exercise and wellness and taking care of myself and then I have this crazy diagnosis with an aggressive cancer at a young age. I was very very lucky I was in the midst of training. I had a lot of physicians you know, that I was working alongside every single day and I had very very very good care and went through you know, surgery. At the time, surgery before chemo so surgery and chemo and radiation and and you know, and got through all that and it was though when I finished my last round of chemotherapy, my mom brought me to a mother-daughter weekend at Canyon Ranch in Lenox, Massachusetts and I met Cindy Geyer and Mark Hyman and Kathie Swift and you know, I had this wonderful weekend with my mom but she then got me kind of hooked up. She went into the medical department for something for herself and got me hooked up with everybody and so, I then did some rotations there and then subsequently at some point after residency training, got a job there and it was at Canyon Ranch where I was sent to the first AFMCP so in 2004 and it was mind-blowing for me because it really helped. It was just just my home of course for you know, for bringing together my nutrition background with my medical school background with my belief in using food as medicine but also really understanding the concept of like getting to that underlying root cause. And for me, at that point in my life, that was so important because I wanted to kind of figure out what was going on with me,why somebody who was who I thought was taking such good care of themselves you know, got this really crazy disease at such a young age and what could I do to prevent it from myself and for my patients. And so, it just became this. It was just my home and I really treasure all the training I've had with IFM and it really has helped me personally with my own health but also of course, with my patients and just understanding you know, in Functional Medicine, we're always trying to sort of treat everybody as an individual, look at how all the different systems in the body are interrelated, understand for that individual person why their body got out of balance and this disease occurred, and what can we do to help rebalance the body and help it heal. And so, that's kind of how I got into Functional Medicine.
Dr. Wong:
Thanks for that amazing answer. First of all, kudos to you for getting through medical school and residency after becoming a nutritionist. I think that must be really hard you know, not dealing with you know, root causes which you already kind of knew about with nutrition but then in medical school, you don't, you know. I went to a school with a great nutrition school tufts you know, but in medical school, it's not like you know, the nutrition course. The one course was not you know, like functional nutrition. It was very much like how do you prevent scurvy or something you know.
Dr. Boham:
Right, right.
Dr. Wong:
I have a very similar approach there or experience I would say and I would say that for me same with you. It's kind of like who you're exposed to, you know. That's how I got to FMPC and doing the certification and everything was through some of my friends, my co-workers. They're like, “Hey, you gotta check this out”, you know. So..
Dr. Boham:
It's just amazing how life takes you on this journey and you know, you can think back and go. That was just how grateful I am that those events occurred, you know. And I always think back to my mom just bringing me to Canyon Ranch for the weekend to celebrate, you know. And it really changed my life.
Dr. Wong:
Yeah. I've been to the one in Arizona. I think it's an amazing place.
Dr. Boham:
Yeah.
Dr. Wong:
I guess the question I have about you know, root causes of breast health, we can kind of go through some of the general biological systems but for you personally, what what did you find to be the biggest movers for you? For you know, your breast health.
Dr. Boham:
Yeah. You know, so like when we're thinking about Functional Medicine and cancer prevention, right, we're always, “Okay. What can we do to create a terrain in the body where cancer is less likely to grow?”. And we know that it's not just that individual cancer cell that we're worried about but it's the soil that surrounds the cells in our body that influence whether that cancer proliferates or grows or it doesn't. And so, for each person, there's multiple different reasons for why breast cancer occurs, right? And we can get into some of this, right. For some, insulin resistance and weight and body fat to the xenoestrogens, the toxins in the environment to our gut health to our genetics and our predispositions to things, our immune system and how well it's working and for me, the areas that I really needed to focus on were one was my detox pathways, you know. I've got some issues in terms of how I detoxify toxins from the environment. I know that based on both some of my genetic snips with glutathione, as well as some of the testing that I had at that point in time so that was an area I really had to work on and focus on and working to lower my toxic load and support my body through that process of detoxification. The other area that I really needed to work on was my digestive system. I actually was on multiple rounds of antibiotics as a kid. I had urinary tract infections that started probably around the age of 5 and went till I was 16, 17. At that point in you know, 52 now so back then I just had lots of antibiotics, you know. I get infection, I get antibiotics, I get infection, I got antibiotics. I was on multiple rounds. They never really found a reason. By the time I had further testing done, I didn't have any reflux. That was a concern but I definitely had a lot of rounds of antibiotics which you know, shifted my microbiome of course you know, which resulted in changes in my digestive health and set me up for for some issues. And you know, that, we do know there's some associations with people who've had lots of rounds of antibiotics and risk of cancer. They've seen it with breast cancer, they've seen it with some other cancers like colorectal cancer and it's not all teased out but I think it's fascinating and is it because you know, my immune system was just not as strong and that's why I kept getting these infections or was it just that that vicious cycle we so often see in Functional Medicine, right, where you get an infection, you treat it with an antibiotic but then of course, we destroy all that good bacteria which sets us up for another infection, right, and we kind of go down that vicious cycle we so often see with our patients and which happened to me. And so, I would say then the third thing that I really had to work on was how I handled stress. So, in terms of personalized lifestyle factors you know, I was pretty good with my diet and exercise routine and I was pretty good sleeper even though I was in the middle of residency, I tried really hard. I love to sleep but the way I was interacting with the world and handling all the stress around me, the anger I felt for being you know, where I was at that point in time like I definitely didn't have the healthiest of mindset and I'm sure it influenced my immune system and how well I could handle disease at that point in my life so those were the three areas that I really had to focus on.
Dr. Wong:
Yeah. And it sounds like from like you said, personalized lifestyle factors for some people that might be stressed but for others, it could be their nutrition or their sleep and kind of looking at each person like with the biochemical individuality that we know from Functional Medicine.
Dr. Boham:
Which is what's so fun about Functional Medicine and practicing Functional Medicine is you know, getting to know your patient and figuring out for them what is the areas that we need to really focus on and I love doing that. It's just such a fun job.
Dr. Wong:
I think for the listeners, too. Let's kind of tackle the genetics piece first because most of the time at least when I'm with patients and I know this is something that is really very accessible or understandable to the public is often people kind of wonder well I have 1hypertension or I have diabetes or you know, they might have a history of you know, cancer like you said or you know, or the family member, dementia so they want to know you know, kind of what their risk is based on genetics and almost like they're assuming that genetics is predicting their future. So, what is the role of genetics with breast cancer? How important is that?
Dr. Boham:
Yeah. It's such a great question. I mean when we're looking at the BRCA gene right, so those are the genes that are high impact genes but low frequency so not that common in you know, in terms of people having genetic variations. I can't off the top of my head tell us percentages but we think that less than 10% of breast cancers have that BRCA mutation which again, these are high impact genes. If you have a variation, if you have a BRCA mutation either BRCA1, BRCA2 and now we're learning about other high impact genes that your risk of getting breast cancer is much much higher than the the average population but there's a lot of more low impact genes, right, where they are much more common. They're much more common in the population and they don't have as much of a risk but depending on our lifestyle, that can really influence how they're expressed and there's also research showing that when people have multiple different low impact their very snips or variations in their genes. That can also impact their risk as well so what I think is important to recognize about our genetics is there's no gene that sort of says okay you're gonna go on to get this disease. It's really always this connection with our genetics and our lifestyle that influences how those genes express themselves. And so, that's something that we do a lot of. We'll look at some of these low-impact genes and some have to do with glutathione production,glutathione activation in the body, methylation processes in the body and those can be areas where we'll see some, you know commonly, some variations in people who are at higher risk of cancer and areas that we can work on through lifestyle that can influence the expression of those genes. So, for example, you know we know about this tumor suppressor gene, right, which is a gene that suppresses the growth of tumors and we know that epigenetically, meaning that our lifestyle can influence how well that gene works. We know there's things like EGCG from green tea you know, that phytonutrient that's found in green tea and sulforaphane which is found in you know. broccoli and you know, the cruciferous vegetables that can actually influence and increase the tumor suppressor gene function in the body which then of course, lowers risk of cancer so we can definitely influence the expression of our genes through our lifestyle.
Dr. Wong:
And these are things that people could do daily, right? They could have a cup of green tea, some cup of cruciferous.
Dr. Boham:
Absolutely like I definitely recommend people try to get in some cruciferous vegetables most days of the week- broccoli, cauliflower, cabbage, kale, brussels sprouts. And then in terms of green tea, some of the research is saying you know, maybe two to four cups but remember cups is just an eight ounce so it can be doable to get a sufficient amount of the EGCG and that has a lot of different properties in the body in terms of its anti-angiogenic which can prevent the growth of blood vessels to the cancer cells, it lowers inflammation in the body, and it can feed the good bacteria in our gut and the one thing I'd say with green tea is try to get organic as much as possible and I love getting it in the leaves of green tea or the ground green tea not in most of the time, not in tea bags especially. You want to avoid those tea bags that you know, there are some tea bags now that actually have plastic in them. The last thing we want to do is be pouring hot water over a plastic tea bag so you know, pay attention to the sourcing of your green tea and you know, make it in a healthy way.
Dr. Wong:
I just got some matcha powders so I'm gonna try that out.
Dr. Boham:
I love it.
Yeah, in the morning. And then, you know, I think Mark Hyman said it really succinctly, he just said it was funny and I'm curious your thoughts about this but he said that with Functional Medicine, it basically boils down to four words, ‘Just eat real food’. I thought that was really funny. He said that in one of the conferences, you know.
Dr. Boham:
You know what, I think, you know, I love nutrition as I said. It's been my you know, my passion my whole life but sometimes the field of nutrition drives me crazy because there's there's so many people on different sides of like we should eat this way, we should be keto, we should be paleo, we should be vegan, we should be, right?
Dr. Wong:
Yeah, yeah.
Dr. Boham:
And the most important thing when you know, if you're sitting there getting frustrated about okay what should I eat, just eat real food like you said. Avoid things with labels on it, right? Real food.
Dr. Wong:
Yeah, yeah. That's great. Let's talk about the gut microbiome and you had mentioned that that was one of the areas you needed to work on. How does the gut impact breast health I suppose in relationship to the immune system, right?
Dr. Boham:
Yeah. I mean there's a lot that's being teased out you know, in terms of how our gut microbiome is influencing risk of different cancers including breast cancer. It's interesting they've also found a microbiome in breast tissue and so, they've shown that women who've had breast tissue removed for non-cancerous reasons, that breast tissue has a very different microbiome than when breast cancer is removed which is fascinating and what does that mean, right, and how does that again that question of how does antibiotics impact somebody's risk or when when we are shifting the microbiome in an unhealthy way, how does that impact our risk of different cancers? But one of the areas that we know some about, we need to know more but when estrogen like when your body has used its estrogen and it's getting rid of it, one of the ways it gets rid of it is through the gut and through the stool, right, you excrete it and estrogen gets bound to glucuronic acid and then, it gets excreted from the body. And so, there's this enzyme that they've been looking at, beta glucuronidase, and beta glucuronidase will cleave that glucuronic acid estrogen compound and then allow that estrogen to get reabsorbed in the body. It doesn't get excreted like it should. And so, that can influence risk of of estrogen levels in the body which we know does have an impact on risk of breast cancer. We know that there are multiple different studies to show you know, that as our you know, estrogen levels do impact risk of breast cancer whether it's because you know, you started getting your period younger or you go through menopause later or even you know, high certain types of hormone therapy as well as the xenoestrogens, those estrogens from the environment that can influence estrogen levels in the body and all those things can have an influence in terms of a breast cancer risk so eliminating that estrogen from your body after it's done it's important job is really important and one of the ways that we eliminate it is through the gut, through the stool and so that's one of the associations that they can show this is, okay maybe this is one reason why our gut microbiome influences our breast cancer risk. And so, when we can test for high levels of beta glucuronidase, some stool tests do that and it can often be an indication that okay this person has some dysbiosis, they have an imbalance in the good and bad bacteria and we need to work on fixing that. In the short term, we can use something called calcium d’glucarate which can help with eliminating that estrogen but that is something that you want to think about in terms of overall health and cancer risk.
Dr. Wong:
I think that's so incredible because you know, this gets beyond and I would love to hear your thoughts about you know, when to get mammograms, when to get MRIs, even what you think about breast thermography but from a perspective of true prevention or true kind of looking at diagnostics much earlier than you know, someone might be getting breast cancer let's say. I mean looking at a beta glucuronidase would be a really good idea, right? Looking at them?
Dr. Boham:
Absolutely. I mean really all of our screening is helpful and important to do, you know, in terms of finding cancer early. That's not really prevention, right? That's just screening. And so, when we're talking about true breast cancer prevention or true cancer prevention you know, it is not just getting your screening test, right, it's okay what do I need to do to actually prevent this from happening as much as I can, right? And so things like paying attention to gut health, working to lower inflammation in the body, working to create a terrain where cancer is like less likely to grow, working to keep insulin levels low which I think is probably one of the biggest things we can work on with all of our patients and every person you know, listening to this can work on because we know that high levels of insulin is tied to many different types of cancer, definitely breast cancer as well so you know, working on improving insulin sensitivity is really important.
Dr. Wong:
Yeah. Let's take a deeper dive into insulin. First of all, we know it's a hormone. What is insulin and why is it so important in terms of things like estrogen metabolism and breast health?
Dr. Boham:
Yeah. So you know, insulin is the hormone that helps our body take our food and get it into the cells so it's used for energy so you eat a meal, your blood sugar goes up and then the body produces insulin and that insulin works to get the food, the nutrients, the calories where it needs to be, where it needs to go into the cells. And so, insulin is a really important hormone but the problem is when we start producing too much insulin and that's this whole process called insulin resistance where the body is making more insulin to do the same job. The body's not listening to his insulin as well and so it starts to make more insulin to do the same job and keep the blood sugar in the normal range and so you know, when when people develop type 2 diabetes, typically, they have years of insulin resistance beforehand before they develop that type 2 diabetes and in terms of how many years, it really depends on the person, right? It can be 5 years, it could be 25 years of having this time of the body over working to keep its blood sugar normal and the body can continue to produce more and more insulin and keep the blood sugar normal up into a certain point and then depending on your genetics and multiple other things, then you can sort of tip into that type 2 diabetes diagnosis. But what we know is that when you have type 2 diabetes and when you have insulin resistance, all of that pre-diabetes time, when you have high levels of insulin even if your blood sugar is normal, that high level of insulin is a growth factor, right? It causes us to gain weight around the belly and get fatter, right? In general, it makes it harder to lose weight and it causes things to grow such as cancer. It's been associated with so many different types of cancer from lung to colorectal to prostate to breast to uterine. There is a definite association between insulin resistance and those cancers to the point that you know, a lot of oncologists will use insulin sensitizing medications such as metformin because they know that that improves somebody's outcome If we can improve their insulin sensitivity you know, if they do have cancer but we can do this of course with lifestyle as well and one of the things that I work on with with all of my patients is what can we do to improve insulin sensitivity and I think that's where majority of people have to work.
Dr. Wong:
That's such a big target. I still am wrapping my head around this even though I've known this for a couple years now is that like 88% percent of people have metabolic syndrome. That seems like a really crazy number to me.
Dr. Boham:
It seems like a great crazy number, doesn't it, you know? But it's important for us as physicians and clinicians to look for it because for some people, it's really obvious and then for other people, it's not as obvious. And so, we'll do fasting insulin to see, you know. I like it to be around five. The literature says no greater than 12 but we definitely want to look at fasting insulin. Of course, you look at blood sugar and hemoglobin a1c. I always look at waist-to-hip ratios you know, waist-to-hip ratios gives us a sense if somebody's gaining too much weight around their belly so for women, it's a waist-to-hip ratio greater than 0.8 and for men, greater than 0.9 but that gives us an indication that there may be some insulin resistance going on. We look at you know, physical exam findings, right, you know, so thinning of hair on the top of the head, hair growth where we don't want it like on our belly you know, so there's things that we really want to look for to see if somebody has signs of insulin resistance.
Dr. Wong:
I'm a big fan of the body impedance analysis. That doesn't lie, you know. It just tells you like hey there's some fat here. Yes. Visceral fat, you know.
Dr. Boham:
Yeah and it's a great way to track people too with using BIA or also waist-hip ratio. I think both of those are really great ways to track our patients and see the improvement that they're making and not just be focusing on the pounds on the scale.
Dr. Wong:
So, there's stress, there's gut microbiome, there's toxins, there's insulin resistance, how do we use nutrition and or maybe we're going to talk about fasting for a second. How do we use nutrition to bring the insulin level down to below five? Which obviously, conventionally, insulin less than 25 is normal which is a crazy number too and that number just doesn't make sense either but you know, and some less than five is pretty low I think compared to what I think is conventionally seen as acceptable, you know.
Dr. Boham:
Yeah, absolutely. So, you know, how do we work to get the insulin lower if somebody has signs of insulin resistance? From a dietary perspective, the most important thing is to eat real food, right? We started with that, pulling away processed food, pulling away the added sugars that are in so many of our foods, working to balance blood sugar you know, working with patients at every meal. You want to have a good source of protein, a good source of fat, and a good source of fiber so you want every meal to have good fiber, fat, and protein so you don't have as much of a spike in blood sugar and then you won't have as much of a spike in insulin. For some people, it means losing some weight, losing some body fat especially that weight around the middle and it also includes things that we want to add to the diet, right? All of those phytonutrients you know, lots and lots of fiber as I said and really watching alcohol. We know that alcohol is definitely associated with breast cancer risk, unfortunately. There’s a linear relationship between the amount of alcohol a woman drinks and her risk of breast cancer and so for for women, it's really five or less drinks a week where a drink is five ounces of wine or an ounce and a half of hard alcohol. You know, those I think are really important areas that we focus on. In addition with insulin resistance, we know that there are a lot of other things that impact, in addition to diet, that impact our insulin sensitivity and that's where exercise comes in. Both cardiovascular exercise, as well as strength training really has an impact on our insulin sensitivity, you know. We know for that day after we exercise, we have improvement in our insulin sensitivity and so, getting out and doing some movement and exercise every day really has a huge impact working to build up our lean muscle mass because the more lean muscle mass that we have, the better our insulin works, making sure we get a good night's sleep, managing our stress you know, doing less you know, working less. Back to the green tea, we know green tea actually improves as you know it's been associated with improvement and insulin sensitivity and weight as well so those are just some of the things we work on.
Dr. Wong:
Thank you, Liz. Work less, eat, drink more green tea and do some squats while watching Netflix at least. You know, get all that in. I think the exercise piece is huge because you also get more energy when you exercise and then, that stimulates you to eat healthier too in theory.
Dr. Boham:
Right, right, right. It's all these vicious cycles, right, or these wonderful cycles.
Dr. Wong:
Wonderful cycles, yeah.
Dr. Boham:
The more you exercise, you get outside, get into nature, see the sunshine, it makes it easier to fall asleep at night. Getting good sleep has a huge impact on on risk of all sorts of different cancers including breast cancer, helps us maintain our weight, and so you know, everything sort of ties in with each other. That's very true.
Dr. Wong:
Let's talk about breast cysts or fibrocystic breast. I mean are there any other kind of conditions which would you know, maybe Functional Medicine Nutrition would impact different other breast conditions.
Dr. Boham:
Yeah, yeah, yeah. So, you know, a couple things that we pay attention to in general is one, iodine actually so iodine deficiency has been associated with more cystic breast tissue and painful breast tissue for some women and one of the things I always caution people about iodine is it's you know, having too little is not good but we also have to worry about having too much so you know, there are some iodine supplements out there that are really really really high doses of iodine which you know, can trigger a thyroiditis, an autoimmune thyroid issue, they can trigger a growth of a thyroid nodule so you know, I usually have people if they're supplementing with iodine to keep it around a thousand micrograms or less a day and you know, often work with a provider regarding that and some women will notice when they cut back on caffeine that their breast tissue is less lumpy and less painful so that's an area that we'll work on as well and then, working just on estrogen metabolism and mobilization because for some women you know, when their estrogen is high, they'll have more dense breast tissue, more painful breast tissue. They may have more PMS or other things associated with high levels of estrogen in their body and so that's where things like sulforaphane come into place. Sulforaphane comes again from those cruciferous vegetables and it can really help with metabolism and detoxification of estrogens and that can be helpful.
Dr. Wong:
What are your favorite foods that either promote directly a probiotic type of you know, activity or prebiotics?
Dr. Boham:
Yeah. So, you know, the prebiotics, right, you think about just all your plant foods. Fiber, fiber, fiber. Foods rich in the cruciferous vegetables, the glucosinolates actually feed the good bacteria in a really healthy way that create that healthy microbiome in the digestive system and so, that's really critical. Even things like pomegranate you know, can feed the good bacteria in the gut and the pomegranate seeds so really working to get those eight to twelve servings o phytonutrient rich foods in your day is really helpful for so many reasons. And so, when we're talking about phytonutrients, those are the components in your plant foods that create color in your food and you know, you want to get a wide variety of color, right? You want to eat the rainbow and get a wide variety of color in your diet and reach for those 8 to 12 servings. Now, that includes your vegetables, your fruits but it also includes your spices and teas and coffee that are all rich in phytonutrients and have a lot of interesting properties in the body. I saw this study a couple years ago talking about plastics and the components in plastics and how dangerous they are in terms of cancer and cancer progression and the study had this really great visuals showing how the polyphenols from our plant foods can actually block that action of the BPA, the plastics, the phthalates that are impacting growth of cancer in the body and that the polyphenols actually can block that which you know, the visuals were just so wonderful in this research study so I think it just really takes home the fact that you know of course, we always want to work to lower our toxic load from the environment, you know. We want to work on avoiding pesticides and toxins and plastics as much as possible but also, we want to eat a diet rich in all of these plant foods, these phytonutrients, these polyphenols, which actually can decrease the negative impact that these toxins can have in our body.
Dr. Wong:
We need to eat those plant foods, those phytonutrients like you said that have the polyphenols because at some level, even though we are trying to avoid it, minimize, which I agree with you Liz, it's totally important and necessary to do that. It's not totally possible in a toxic world where there's you know, 87, 000 chemicals, you know. There's some element of toxicity that we're probably all exposed to so I think we do have to be proactive about it like you said and make sure that we're detoxing appropriately. You know, detoxing the toxins we are exposed to.
Dr. Boham:
That's why vegetables are so important, right? People, we need to remind everybody all the time why vegetables are so critical, right?
Dr. Wong:
Yeah and I think there are some roles for you know things like keto, for you know reducing insulin and things but I'm really interested in how there might be an effect. I'm curious on your thoughts on this, the effect of eating a more unopposed animal protein let's say without the proper gut microbiome, might activate TMAO, you know. I'm curious about your thoughts about that too.
Dr. Boham:
Yeah. So I think that it is really all about the microbiome and of course the diet but the interplay and every person such an individual there we see that all the time where some people have a diet that's high in animal protein and don't make lots of TMAO and other people you know do have that diet that's high in animal proteins and then they do make more TMAO, right, so there's other things at play here and and I'm sure the microbiome is so critical.
Dr. Wong:
Yeah, yeah. I know there's more research that needs to be done on that. There's just certain things we don't know yet so it's all evolving but I guess I’m wondering about also, I think our listeners may be wondering about too, how do you protect our you know, for breast health especially. Is there a role for lymphatic detox? Is there a role for things like not wearing bras and making sure you're having general movement in the breast area? Is there anything to that?
Dr. Boham:
You know, it's a great question in terms of supporting the body's natural detoxification system and how the lymphatic system impacts that detoxification system and so you know, that question about the underwire bra and how that impacts somebody's risk has always been you know, looked at and not you know, not really well figured out I don't think but I do agree that exercise and movement, dance and and movement in the body and exercise is really critical for movement through the lymphatic system and helping the body get rid of toxins and the body has this really amazing detoxification system. I mean we are set up to get rid of these toxins we're exposed to as well as toxins our own body makes. I mean we are set up to do that and so you know, through the lymphatic system, through the urinary system, through the gut, through the liver, right? We've got all, through the lungs and breath, right? So, we've got this whole system that helps us get rid of these toxins and so, we just want to support it and so you know, massage, lymphatic massage, movement, dry brushing. Yeah, maybe really helpful to help us mobilize some of these toxins. Saunas you know can really help with mobilizing some of these toxins we're exposed to, sweating when we exercise helps us mobilize toxins, eating lots of fiber right so more and more fiber binds to the toxins that we can then eliminate from our gut, drinking sufficient water. All those things really help us and help support that detox system.
Dr. Wong:
Some of these are very basic things but as you mentioned before, very powerful you know, very very helpful for people so I think a good take home is that you know, it doesn't have to be all fancy necessarily. It can definitely be something that people can do day in and day out. Really a big fan of sauna and we definitely talk about that here too. I think for the toxins just to kind of go back that you mentioned BPA and plastics, are there any other toxins like what about glyphosate? Is that associated with with poor breast health at all?
Dr. Boham:
You know, I haven't seen a lot of research on that but I’m sure there is some association you know, and I think we have to do more research in that area because we know how much that impacts our gut health and how that's going to impact our overall toxic load. I definitely pay attention when I'm working with people on pesticide exposure so choosing organic. We do know that women who you know, eat more organic food have a lower risk of breast cancer. There was this sister study where they looked at almost 40, 000 women and saw that association you know, a few years ago. We do know that so pesticide exposure is important to focus on you know, avoiding pesticides and herbicides on our lawns you know, choosing organic. I definitely think plastics are really critical to try to lower in our environment you know, switching to glass, storing your food in glass you know, avoiding plastic as much as possible, using a reusable glass water bottles or stainless steel water bottles and you know, working to really avoid the bPA because that has definitely been associated with increased risk of breast cancer and so, that's one that we know a lot about but I do think some of these other plastics that have taken the place of BPA are probably going to end up being just as concerning. We know parabens, another xenoestrogen, another toxin from the environment that can impact that estrogen receptor and impact our hormone balance are important to avoid. Parabens are found in our moisturizers, our makeups, shampoos even and you know, even crazily, I can't even believe it's in food.
Dr. Wong:
Why would they put parabens in food?
Dr. Boham:
I don't know.
Dr. Wong:
It doesn't make any sense
Dr. Boham:
Oh, it’s crazy,
Dr. Wong:
That’s not gonna sell more food and that doesn't make any sense.
Dr. Boham:
My husband like brought home some soft tortillas but he didn't have time to get them from the normal place that he gets them. He picked them up from like just a shop that makes tacos, soft tacos. He's like oh, can I just buy some of your tortillas so he brought them home and I'm looking at the label and it actually had paraben in it and so, I did a little more research myself and I realized they're still using it in some foods, mostly processed foods, some tortillas, some muffins, some processed foods. Crazy why we're putting this stuff in our food and obviously, why so many people have probably metabolic dysfunction going on.
Dr. Wong:
Yeah.
Dr. Boham:
Right?
Dr. Wong:
And same with our skin, right? The moisturizers and creams that we put on, that if they have parabens in it, that's like bad food for our skin essentially and I find personally, it's hard to take that away from people if they get loyal to a brand you know, of skin product. I don't know. What's your secret to kind of just you know, getting rid of that toxic skin care product let's say.
Dr. Boham:
Yeah. Well, I think just getting educated, right?
Dr. Wong:
Yeah.
Dr. Boham:
Just understanding how this is impacting your hormone receptors in the body and how that really impacts everything from fertility to cancer risk, right? And then you know, giving people some good options and there's more and more great options out there that are clean you know, great companies that are really doing it the right way, environmental working group is a really great resource for people to help them sort of sift through these crazy long labels where you know, that methylparaben might be hidden like 40 ingredients down.
Dr. Wong:
Yeah. And if there's 40 ingredients, it's probably not something you want to buy, right?
Dr. Boham:
Very true.
Dr. Wong:
EWG skin deep I think. Thank you so much Liz for being on today. I know that you know breast health is such a big topic. Thank you for sharing your personal story with us and a Functional Medicine and Nutrition systems biology approach to breast health. This is really invaluable for listeners so I want to thank you for that.
Dr. Boham:
Oh, thank you so much Andrew for having me. It’s really been a lot of fun.
Dr. Wong:
Thank you. Yes, thank you Liz and we do ask some fun closing questions for all of our guests. I hope you don't mind if we ask you about your morning routine if that's okay?
Dr. Boham:
No.
Dr. Wong:
Morning routine is a really important part of health you know, I feel, we feel like.
Dr. Boham:
Absolutely, absolutely. So you know, for me, I get up and get going in the morning so typically I get up you know, if I'm going in to see patients, I get up at five usually and I get up and I work out first thing in the morning so I do exercise first thing in the morning. I get it done with. I love exercise so it's actually really a lot of fun for me and then I have a yoga flow that I do after my exercise routine and I also really like breakfast so those days that I'm really getting up and going, I'll have breakfast and I'll get out the door so my mornings are really get up and go kind of thing but at least I get everything you know, I get that stuff done and then more in the evening is when I'll do some relaxation exercises.
Dr. Wong:
I think after seeing a lot of patients, you probably won't feel like doing that whole routine in the evening. Yeah? It'd be hard to do.
Dr. Boham:
It's true like I get home and I'm like okay, I need some break.
Dr. Wong:
It's so great to get it done in the morning. I agree, try to do that as well. What book or podcasts are you enjoying the most right now and and why do you enjoy it?
Dr. Boham:
You know, I just finished reading ‘Homegoing’. I really like historical fiction which I was finding quite funny because I really didn't like history in high school but I was such a Math and Science person but now, I love historical fiction and this book ‘Homegoing’ by Gyasi, Yaa Gyasi.
Dr. Wong:
Yaa Gyasi, okay.
Dr. Boham:
And she is Ghanaian and actually my husband's from Ghana.
Dr. Wong:
Yeah.
Dr. Boham:
So I think this is why it sort of sits with me a lot but it's about these two sisters that are born in Ghana in like the 18th century and it follows their multiple generations and one sister then is brought over as a slave to the United States and you follow all of her ancestors and then the other sister stays in Ghana and we see how-
Dr. Wong:
That’s so cool.
Dr. Boham:
What happens with her family and her ancestors and I've been to Ghana a few times and so it really is a great book. If anybody has it, it's gotten a lot of attention.
Dr. Wong:
I have to ask. We have a friend here that's a drummer. We do some drum circles sometimes. He's from Ghana so I'll have to ask him if he's read that book.
Dr. Boham:
Yeah. It's really fun and it's really just great to sort of understand the different cultures like the US versus African culture.
Dr. Wong:
Yeah, that's awesome. And then, what do you do every day to cultivate joy? Joy is another you know, big aspect of health. I think you know certainly for general health but also certainly breast health as well.
Dr. Boham:
Yeah. You know what helped me the most when I was going through treatment for breast cancer, I started to keep a gratitude journal and that actually changed me so much. I can't even explain how much. It changed me. It changed my brain and like yeah I used to be you know, my brain would go to this negative place so often. When I started to keep a gratitude journal, it took some time but I did you know, I wrote down three things I was grateful for every day and you know, when I was going through treatment, it was sometimes really hard for me to do but over time, it became easier and easier for me to find things every single day that I'm grateful for. And now, it just comes much more easily to me but that gratitude journal as well as just you know, recognizing what I'm grateful for in that moment every day has really shifted me so much and it definitely brings me joy.
Dr. Wong:
Thank you. It's such a game changer. Thanks for sharing that. I agree with that too. Well, Liz, how can listeners learn more about you and work with you? I know you're a medical director at UltraWellness, right?
Dr. Boham:
Yeah. So, I work at the UltraWellness Center in Lenox, Massachusetts so we see patients there and so, the UltraWellness Center website is a great place to learn more. I have my own website drboham.com where you can also learn more about me. I have a free ebook on breast wellness because I made a DVD a few years ago on breast wellness and Functional Medicine approach to prevention and I made it into a short ebook online so if
you go to my website drboham.com, you can download that free ebook and learn more about this subject.
Dr. Wong:
Thank you and the DVD is still available, correct?
Dr. Boham:
It is. For people who have a DVD player, it is still available on Amazon through my website and actually, it is also on Vimeo so you can and you can get that link through drboham.com too.
Dr. Wong:
Got it, got it. Okay. alright. Gosh, it's kind of weird how we're kind of getting past the age of dvds. I'm getting kind of millennial ourselves.
Dr. Boham:
Isn’t it crazy how the world changes?
Dr. Wong:
I know. Yeah. Have you gotten into Tik Tok yet or is that the next step?
Dr. Boham:
I don't know. I haven't. You know, sometimes my people send me things to watch.
Dr. Wong:
Right, right.
Dr. Boham:
Which is fun but that's about as far as I've got.
Dr. Wong:
Yeah, yeah, yeah.
Dr. Boham:
Right? I gotta stay young.
Dr. Wong:
Yeah, that's funny. Thanks so much Liz for being with us today. It's been a lot of fun and we'll talk again soon. Thank you so much.
Dr. Boham:
Oh, great to be with you. Thank you so much for having me.
Dr. Wong:
Thank you for taking the time to listen to us today. If you enjoyed this conversation, please take a moment to leave us a review. It helps our podcasts to reach more listeners. Don't forget to subscribe so you don't miss our next episodes and conversations and thank you so much again for being with us.