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Writer's pictureSara Kavanaugh

The Positive Gene Podcast - Season 2 
Episode #4 - Thriving with Nutrition: The Role of Diet in Hereditary Cancer Risk with Oncology Dietician, Alison Tierney



(Links mentioned in the episode are located at the bottom of the page)



SARA

Hello everyone and welcome back to the Positive Gene podcast, where we unravel the complexities of living with hereditary cancer risk from the patient's perspective.  I’m your host, Sara Kavanaugh and today's episode is a special one as we dig into the role of diet and lifestyle and managing hereditary cancer risk.  We have a very special guest with us. Her name is Allison Tierney.


ALISON

Thank you so much for having me. It is a pleasure to be here.


SARA

So Allison is not just any dietician. She is a board certified oncology dietician and a cancer thriver herself. With a decade of experience in oncology nutrition, Allison has dedicated her career to empowering cancer survivors and individuals with hereditary cancer risk. She champions plant based nutrition and lifestyle medicine as tools to take control of one's health.  Her personal journey through cancer has only fueled her passion to support others in their fight against cancer risk and risk reduction. 


So thank you for being here. Welcome to the show. I am so excited to have your expertise and personal insights today. I tried to carry this on my own in the first season. And now I'm really wanting to dig in and reach out to, you know, the subject matter experts to really give us a sense of some of the challenges that we may face as hereditary cancer previvors and survivors that are experiencing some of the same challenges that we may. So let's get started and just talk a bit about your background. Obviously you've talked in your past podcasts and on your website about your personal journey with cancer and really what led you to specialize in oncology nutrition.


ALISON 

Yeah, absolutely. Thank you so much for having me again. It's an honor to be here and share my story and also knowledge to help empower other previvors and survivors in this really difficult journey. And so, my journey all started actually with this extensive family history of cancer. And that's really where I was very interested in nutrition. My nutrition interests originally sparked with sports nutrition, but then after my mom was diagnosed with breast cancer. My grandmother was diagnosed with breast cancer. My grandfather was diagnosed with liver cancer. My godmother was diagnosed with breast cancer. And my other grandmother unfortunately passed away from lung cancer prior to me being born. And so there was so much of this cancer risk. And I always wondered how nutrition could play a role to help prevent or reduce the risk of cancer in the first place, help them during the course of treatment, and then also help in survivorship to reduce the risk of recurrence. 


And as you can imagine, I wouldn't be standing before you as an oncology dietitian if we didn't find that we can help reduce our risk with a healthy diet and lifestyle. And that's kind of where it all started for me. And I went to school for business first, and then went back to school to be a dietitian. And I went to school and told all my professors and advisors, I want to be an oncology dietitian. I want every experience possible.  And I wanted everyone to know that that's what I wanted to do because I wanted the experience. And unfortunately, we don't actually learn a lot about oncology nutrition in the undergraduate degree as a dietitian. You really have to seek out the information and education yourself. So I was able to get an internship with a well-known cancer center and became employed right afterwards. 


And that's actually where things started for me on a personal level when it came to nutrition as well. Cause at that same time I was experiencing infertility and my husband and I were trying to get pregnant - I have polycystic ovarian syndrome or PCOS. And at the same time I was doing a lot of my own research in cancer and nutrition as a way to just, how do I better my care for my cancer patients? Cause I was working as an outpatient oncology dietitian in a cancer center and I really kind of stumbled upon this plant predominant diet.  That was when I was like, oh my gosh, the research here is so profound. It is so incredible. And there's so much here. We don't quite learn that in school. And so I was diving in further applying it for my patients, but then also starting to apply it for myself. And, obviously we're going to be talking about cancer primarily in this podcast, but I had such great results and you know, spoiler alert - I have two kids after two times of infertility and feel very, very blessed to have that…


But then, what I joke about and it's also kind of, serious too is, but, you know, my career took a really ironic twist when I was diagnosed with cancer myself.

I was 33 years old and how we found it was actually just a lump at my OBGYN’s annual visit  days after  days after finishing breastfeeding with my second child, and it was just during that routine breast exam. And it was kind of both me and the physician were kind of nonchalant about it. Like, oh, there's a lump there. Oh, you just finished breastfeeding. No big deal, right?  And I was nervous about it. And so I went home, kept feeling the lump, kept keeping an eye on it. I had a lump between my pregnancies that I did have ultrasound and it went away. And that was ultrasound it pretty quickly because of my family history. And then this time around, it didn't go away after a cycle.  It didn't get any bigger that I noticed, but it wasn't changing or going away either. So I asked my doctor if I could have it looked at, let's do another ultrasound piece of mind. And lo and behold, that ultrasound turned into a mammogram and a biopsy all within a few hours of each other and a diagnosis of breast cancer within 48 hours. And it was happened all so quickly, which I am actually very grateful for from the standpoint of, I know some women that timeframe from like ultrasound to mammogram can be long or mammogram to biopsy and biopsy to results. And it happened so quickly. And I'm very grateful for that. So, that's how it all kind of started. And my original diagnosis was DCIS with microinvasion, which means that the tumor was still within the mammary gland, but had left a tiny little bit, which is called that microinvasion component. and that's the original diagnosis, but was not the diagnosis after that.


SARA

Okay. Wow. That's a lot. I mean, new baby, career, and getting this diagnosis, and in your line of work. You're helping people just face those realities on a daily basis. And that's a lot of weight to carry already. I imagine if I were in your world, I would carry that weight for others too. You know, so I can imagine how difficult that time was for you. 


ALISON

Yeah, it was really hard. I love being an oncology dietician. And you're right, the weight is, it can be very difficult. You have to have really good ways to manage the emotions and those relationships that you develop with your patients. And it's very tricky. But as you can imagine, I became the patient. And what also was really interesting and kind of crazy about my story is I was diagnosed on a Thursday, on that next Friday, right the day after, I boarded a plane all by myself and I was the main breast cancer nutrition speaker at a medical conference that weekend. And I did not tell anybody but one person that weekend that I was just diagnosed with breast cancer. I did catch myself on stage -I don't think anybody noticed - but I said something about us referring to breast cancer survivors.  And at that point I really didn't have enough information. I was just diagnosed. I had no idea what was in store for me. And my family really told me like, “you don't have to do this, you can call and tell them, you're not gonna make it, they're gonna understand”. And I was like, "no, I think I need to do this”. And for me it was nothing's gonna change between this Friday night flight and my Sunday night flight. Like there's literally nothing I can do. And I was really glad that I did do that conference because there were some eye-opening things for me in terms of lifestyle and so forth that, for example, stress. I have not carried stress well in my life and something I've worked greatly on since my own diagnosis. But then when I returned, I had my surgery appointment with my breast surgeon on Monday. And that's when she said, you need to have a mastectomy where the tumor was located. That's really the only option. You can't have a lumpectomy. You won't be able to save your nipple, but now you need to decide, do you want a single mastectomy, double mastectomy, are you going to have reconstruction? And if so, what type?  And me and my mom, who was in the room, who is a breast cancer survivor as well, and my husband were in the room and we were kind of just taking a back and my mom describes it as like a blow to the face. She's just like, I just wasn't expecting that. And so I had decided that I was going to do a double mastectomy at that point. And I just kind of thought, you know, there is family history I’m 33, even though they say, you know, the risk of it coming back or or a new diagnosis in the other breast is the same as anybody else walking down the street. I was like, nope I'm just gonna be done with this and that was before I did discover that I do have a genetic mutation. 


And so later I did go through genetic testing which I qualified for as a 33 year old with a cancer diagnosis.  And it came back positive and I was actually surprised. I remember when the genetic counselor called me and she's like, “well, we got your genetic testing back”. And I was like, “okay”. And she's like, …”and it's positive”. And I was like, “wait, what?” And I think I was surprised because I know the percentages in terms of like how, like genetic cancers and so forth is actually relatively low. But I was surprised, but it did make sense, right? I had this extensive family history. My mom was a breast survivor already and a thyroid survivor.


And so anyways, that recommendation would have been to have a double mastectomy then once the mutation came back positive. And I was actually really grateful that I had already made that decision, that it wasn't me having to reevaluate again, and I already felt comfortable like this is what I'm gonna do. So I ended up having a double mastectomy with a diep flap reconstruction. And the diep flap reconstruction is where you use your own tissue to recreate the breast.


And then it was in the surgical pathology that came back that it was not DCIS with microinvasion - It was indeed invasive ductal carcinoma, meaning it had spread beyond the mammary gland and into further parts of the breast. And there was actually not just one tumor, but there were two tumors and there was a potential, like the radiologist and the pathology was wondering if there was a third there. So a very good thing, very good decision for me to have that surgery, but it was...Another blow, right? It was, we thought we were going to have surgery. They tested my sentinel lymph node, which is the closest lymph node to the mass. Thankfully it was negative, which meant that I wouldn't have radiation. 


And then we kind of thought me and my husband were like, okay, we did this big surgery and now we can kind of move on. And then the pathology comes back. The pathology reveals this new diagnosis.  We wait for more information, which means the prognostic factors, whether it was estrogen receptor or HER2 positive. And this is where my experience as an oncology dietician was starting to be like too much because I knew what was gonna be happening, right? I knew if I tested positive for HER2 that I was gonna be having a year of infusion in front of me. And that's what happened. I was tested positive for triple positive. I had three months of chemotherapy with immunotherapy. And once I finished that, I then had nine more months of immunotherapy, which I finished in August of 2023.  So I'm only actually a few months out of finishing cancer treatment and, you know, navigating life as a cancer survivor and somebody with this genetic mutation, which is a CHEK2 mutation. I'm sure you talked about that on your show as someone who has CHEK2 as well, but increases the risk for colorectal, kidney cancer, breast cancer, thyroid cancer, and prostate cancer for men.


SARA

Yeah. Well, thank you for sharing your journey thus far. And I guess I didn't realize too, that it was that recent, right? So, you're still sort of in this adjusting as a survivor and as somebody who is supporting others in this journey as well.


ALISON

Yeah, yeah. And I have really long hair still because I was able to cold cap through treatment, which is probably throws a lot of people off too. So I know you're you have this video, but this is my chemo hair growth right there. It's so it's curly so you can see the difference, right? And so my husband and I that's kind of like our gauge of how long I've been out of chemo at least. And I had very great success cold capping during chemo. So that actually throws a lot of people off, especially when I was in chemo. They're like, wait, you what?


So I was very fortunate to have cold capping and be successful, but it also kind of brought some hardship from the standpoint of how I felt on the inside didn't match the outside and then the expectations people had of me because I didn't look like what I was going through.


SARA

Absolutely. My best friend who I'd mentioned had just recently come off of her treatments, I mentioned her specifically because she did the cold capping as well. She has very fine hair. So she did cut it really short, but she didn't lose her hair either.  I flew out to see her when she was getting one of her chemo treatments early in the process and kind of helping her go navigate the whole process of cold capping. It's just not easy. And she's under several blankets and trying to keep herself warm. She's like, “it'll be worth it”.


ALISON

Yeah, that was something honestly that was really hard because I hadn't had worked with patients before that had cold capped, but not on a close enough level where I was talking to them about what this experience was like, et cetera. And it took me a while to talk about my cold capping experience because I know that there are so many individuals that don't have the opportunity or the access to do it. And then even for some that do have the ability to do it and the access, it's not always successful. And so I have felt kind of one of those like guilty experiences - I had access, I had ability to it, and I had great success.


So like, how can I talk about the hardships of this when I am so grateful at the same time? But then I reminded myself that there were other people that would go through this experience and how helpful it could be to talk to them about maybe some expectations of maybe what they might experience with cold capping and that component of - I chose cold capping because I didn't want to look sick, right? I didn't feel sick, I didn't wanna look sick, but then it's like this really weird mind game because now you're sick because of the treatments and you feel so unwell.

And there were parts where I wish I said, “oh man, I wish I should have just lost my hair. I shouldn't have done this”. Because of that outward reflection and those feelings, you know, now I get to be here months later out of chemo and say, “you know, I am so happy”. But yeah, it's a really interesting journey. And I decided, I think it is important to talk about because there are real people that will go through similar experiences. And if I had been able to talk to somebody about that beforehand, it probably would have been really helpful for me.


SARA

I think having others here……your experiences and the things that you did, which one major thing we're going to dig in today was the sort of the nutritional considerations.  But the other things that you just shared now that you did to help own your experience, right? And maybe you're working in with oncology patients sort of enabled that, I think some of its personality, right? I think there's an element of…You’re one of those people who's going to either speak up, take action, or you're going to just rely on your medical team - they’re going to make the decisions for you. Right. And part of my podcast experience is enabling people to feel empowered, ask the questions, take action, right? And if you're not comfortable doing that, find somebody who is, right? Bring that person to your appointments with you. If you're not really sure and you don't know what questions to ask. Like you had your mother in the room with you and she was that sort of anchor for you, right? And she could speak up and ask the questions because she had that firsthand experience. So I would definitely encourage people to do that if you can, right?


ALISON

Yeah. Well, and even just like the other part of that is, you know, being able and willing to speak up when I still was concerned about that lump and get that act like “this doesn't feel right”, you know?  And my mom and my husband are so adamant that most people would have just waited till their next annual appointment to revisit it and I didn't feel comfortable with that. And I also say that my line of work, I really think did help save my life in that perspective, from the perspective of - I had enough knowledge, but also experience with the fact that I was not too young. I had worked with plenty of women that were my age, right? And I had this extensive family history and I knew those things. And I think my work is something that saved my life. And the people that I've had the opportunity to work with that came before me were part of that story. And it'd be, I don't, I, you know, of course I can't know if I wasn't working in this, would I have spoken up? Um, but I'm so glad that I did.



SARA

Yeah, absolutely. I think there's something when you're, because in my mind when you were just talking through that, I'm picturing us sitting at the edge of the table in the doctor's office and they're like, well, let's wait until six months from now or whatever. And there's something inside you, this little thing that maybe makes you a little uncomfortable. That's the moment to speak up. It's not waiting a little bit longer to go, “oh, maybe something will change”.  If your heart is racing or you're starting to get uncomfortable in your skin in that moment, speak up because it's going to make a world of difference.


The less time you have between getting clarity on what is happening, the more peace of mind you'll have. And that stress and anxiety that wears on our bodies so much will...you know, won't have time to proliferate, won't have time to create other issues down the road, right?

ALISON

And I tell people all the time, listen to your intuition. If your gut is telling you something is not right, seek, seek more questions, more answers. And I think a lot of people are scared to speak up to be like, “oh, well, what if it turns out to be nothing? I don't wanna be that patient that…”, and it's like, no, no. If it is nothing, awesome, right? But if, and that's how I describe it for my lump is every time I felt it, had this over come like just this anxiety about it. And I was like, this is not right. Like my gut was telling me something is not right. And so I always tell people trust that intuition. And you know, as a dietician, I like to say, trust your gut literally and figuratively, right? If something is not, is telling you something's not right, something's probably not right.


SARA

Yeah. And it's okay if everything turns out okay, you don't have to feel embarrassed or ashamed for making an extra appointment. It's perfectly fine. 


Okay, let's, let's talk through then those key nutritional considerations, right? So things that you had in mind, you were probably already knew in some of these things before all of this happened, right, which is ….that might have made a really big difference in terms of your long-term prognosis. But yeah, let's talk through some of these nutritional considerations for those with hereditary cancer risk.


ALISON

Absolutely. Yes. And you know, I think something to be said about that. I was doing most, if not all of these things that I recommend. I will say that I was not doing them all perfectly by any means, and I'm still doing many of them. I'm just doing them better than I used to, right. And I think it sometimes can be really hard to, I was the person that when people found out that I had cancer, they're like, “What? You are like the healthiest person I know. How could you have cancer?” And I think, that I had a little bit of imposter syndrome, if that's the right word for it, when I was diagnosed, to be like, okay, here I'm promoting risk reduction and now I have cancer. But again, sharing that story, which is so similar to many people that are diagnosed, that they are very healthy, you know? And they still come across this diagnosis.


And again, sharing a story like that, so you can, so other people can feel less alone in that has been helpful for me and hopefully other people that I've been able to interact with. 




But really when we look at the recommendations to reducing the risk of cancer when it comes to nutrition and also lifestyle, one of the biggest recommendations that I like to point out is there is recommendations that are called the Third Expert Report that come from the American Institute for Cancer Research and World Cancer Research Fund.


And this is a report that comes out every ten years and experts from around the world scour the research and information available about nutrition, physical activity, and cancer. And the goal is to really truly reduce the risk of cancer worldwide. And one of the primary recommendations with strong recommendations, because the other part is that they actually rate the evidence available, right? And when they can confidently rate it with strong evidence, that becomes a recommendation.


And the recommendation is to follow a diet that is heavy in fruits, vegetables, whole grains, legumes, and they get it a usual part of the daily diet. So when we talk about plant-based nutrition, it really is following what I would like to call a "plant-forward diet”, and someone may choose to be vegan, vegetarian, completely plant-based, and that is totally appropriate too, if that's something that somebody wants to do. I always tell people, you do not need to be a vegan or vegetarian to incorporate these really great foods into your diet and reduce your risk. But what the biggest thing to know is that we want to try to eat as much whole unprocessed plant foods as much as possible. And it's really a matter of what your diet looks like most of the time, rather than some of these small little instances where we might have some other products. So that's kind of the big overarching goal is to follow a more whole food, plant based diets.


And there are more specific recommendations about diet and nutrition within these recommendations and one of those big ones is to eliminate, hopefully, processed meats. So processed meats, I think people are becoming more familiar about this and more aware. However, it's still not widespread knowledge. You know, I live in Wisconsin, which is like the land of beer, cheese, and sausage, right? And so there's a lot of Wisconsinites - we love our sausage, right, which is a processed meat.  So processed meat would be lunch meat, ham, hot dogs, sausage, et cetera. And unfortunately, these foods are what are considered a group one carcinogen, which by definition is known to cause cancer in humans. It is on the same list as smoking, okay?  And some other like really scary things, keeping in mind, they’re not the same, but they, we do know that process needs increases the risk of cancer, in particular, colorectal cancer is the big predominant one there. So we do recommend to try to eliminate or drastically reduce the amount of process meats that are consumed. 


The other one that makes that group one carcinogen list, people don't like me being the bearer of bad news, but it's alcohol. Alcohol is also a group one carcinogen, meaning that it is known to cause cancer in humans and there are different risks depending on the different type of cancer diagnoses. But for example, in 2015 the World Health Organization declared that no amount of alcohol is safe for a breast cancer survivor. So there are different recommendations.  A lot of people are like, well, what if I do want to drink alcohol? What is a safe amount? And I think across the board, there are different recommendations.  I usually tell people if you don't drink, don't start. There's no real benefit or reason to do it, from that perspective. But however, the AICR and World Cancer Research Fund recommends moderation, which is considered one drink per day for women and two drinks per day for men… Professionally and personally, I still think this is a high amount. And if we see a little bit further, you know, if we can reduce that to about three drinks per week, that would be more beneficial, but honestly - the less, the better.   So, these are some of the biggest recommendations when it comes to cancer, and I'm happy to go into further ones, but wanna give the opportunity to stop there and ask any other questions.


SARA

We'll put the resources that you mentioned in the show notes. Because if you're like me, I'm immediately like, okay, I want to go read this. Because for me, hearing it's one thing, reading it is another. And then implementing, right, is the third kind of leg of the stool. And that can be hard for some, right, when you have small kids at home and they wanted we eat ham and cheese croissants all the time. That's my daughter. You know? And so she's six and she loves Starbucks ham and cheese croissants, you know? Hey, we'll find a modified version of that to appeal to her. 

 

But then the alcohol thing, right? My sister lives in Northern California. We love to do a winery or two while we're there, you know? And you're right. There's a mindset of moderation. And you mentioned those standards of one drink a day or nothing. And that to me, those are very, very far apart in my mind. And even like you're saying, if folks could lobby for a better solution to like you said, even just recommending no more than three a week, that would solve a lot of health issues overall, we're not just talking about cancer risk, but we're talking about other health issues that come with consuming alcohol, like obesity or alcohol related deaths, right? And so there's, there's a lot of benefit I could see there.


ALISON

Yeah, yeah. And I think the other thing about alcohol that's tricky and that how I like to counsel my patients is trying to seek and understand why do they drink alcohol, right? Because for some people it is truly because they're in a social setting and that's what you do. They might not even enjoy it that much, right? And so if that's the case for an individual, I definitely want to help walk them through different opportunities to show that like you can still be social without alcohol. And for me personally, I've never drank alcohol. And so I've navigated that experience a lot. And so it's kind of boiling down to why do we drink? And then if it's like, I really just love that glass of wine. I like what it tastes like. I like the ambiance around it. Then we talk about different solutions about how it can be a part of their nutrition approach. 


And also again, what does the rest of the diet and lifestyle look like? I think that's a big piece of it too. So it's kind of bearing down a little bit further into the reasons as to why. And I think a lot of times we forget that nutrition is actually a lot more mental than it is physical, right? Like what is the thing about the ham and cheese croissant, right, that your daughter loves, right? And maybe some of it is going to Starbucks with mom and the experience around it, right? 


So, that’s what I work with a lot of patients on too, is not just like, "don't eat this!”. It's okay, let's investigate further why, and then maybe we can understand something else that would be a better solution for you. 


And kind of what you mentioned already, when you're like, “oh, I wanna dig into this content” , is one of the biggest things for me in terms of how I teach is helping people understand the why, right? Like we can, I could go in about process meats all day long about the why, right? And I think that's an important thing to cover it, you know, at some point is, it’s the nitrates, the heme iron, et cetera. However, if we can talk about the why, I think that's so important and motivating to people and understand.


If I simply just tell somebody don't drink alcohol and don't teach them, okay, that acetaldehyde is actually the carcinogen, meaning it increases cancer risk, or going in for a breast cancer survivor or somebody that has a mutation that puts them at high risk for breast cancer talking about how alcohol can increase estrogen in our body, which can drive estrogen positive cancers. 

If I can help identify the why for an individual and then take it step furthers and help them understand the what and the how, like how do I make this a realistic implementation in my life, that is a game changer, right? So I do think that those pieces are missing when it comes to educating people about nutrition, but that's what us as dietitians do. And so it goes so much farther beyond then don't drink, don't eat processed meats, do these things. It's okay, let's motivate somebody as to why and take it step first.


SARA

Wow, Allison, that's huge. I just think in my own mind, like, making any kind of major lifestyle change, you're immediately thinking about how painful the process could potentially be. But when you have that basis of understanding and really investigating the why and helping to find a solution, you've overcome so much just in that simple phrase, right?



ALISON

Yeah. Well, I mean, I always tell people, I don't need to tell most people that vegetables are good for you, right? But if I can tell you that broccoli contains this phytonutrient called sulforaphane, that is one of the best cancer fighting properties there is, you might be listening up a little bit more about trying to incorporate broccoli. And then the next step about teaching them, okay, what can I do to make the sulforaphane more beneficial? How do I get more of those cancer fighting benefits?  Well, by cutting broccoli and letting it sit exposed to air for 40 minutes, you allow that conversion to happen and heat no longer destroys that conversion. So you can cook it and still get those great benefits, right. And so that's the what and then the how is like, “OK, here's how we make broccoli taste delicious, even if you hate it”, right? So those are kind of like those full steps to making it part of somebody's life.


SARA

Yeah, that's great. Well, then let's make that switch. This is a perfect segue to my next question - plant-based nutrition. So how does plant-based nutrition specifically benefit previvors?


ALISON

Yeah, definitely. So really when it comes to recommendations for reducing the risk of cancer development, they are actually the same recommendations for previvors or individuals that are looking to reduce their risk of cancer and also the same recommendations for somebody that has already had cancer and is looking to reduce their risk of recurrence. Where the recommendations differ for nutrition among the spectrum of previving through treatment and survivorship is really in that treatment component.


So we are still going to be recommending a plant-forward, a plant-based diet during the course of treatment.


However, it's really important to be working with an oncology dietician during treatment because there can be recommendations that can change from one day to another based on the side effects that a patient is experiencing. So as you know, we were just talking about broccoli. I love broccoli, love recommending broccoli.


However, if my patient is experiencing diarrhea as a result of their chemotherapy or their radiation treatments, I'm gonna say no broccoli right now, right? And it's because of the understanding of like, okay, we need to slow the bowels down because we're losing electrolytes and hydration and that can put us at risk for so many other issues. So knowing that spectrum of where nutrition can be beneficial is in all three places, previvor, survivorship, also during treatment and survivorship.


But really the front end and the back end are the same recommendations. So really these recommendations are going to be the same for a previvor and a survivor. And how plant-based nutrition can play a role in reducing the risk of cancer. Oh my gosh, Sara, we would need so many hours for me to talk about this and I love it so much, but I will definitely cover the big parts of it. 


So one of the things about plant-based nutrition is that when you're plant-focused, right? The biggest thing is what you're including in your diet that cannot be found in animal products, okay? So some of those are phytochemicals. Phytochemicals are plant-based nutrients that are only found in plants because they are phyto or plant nutrients. These phytochemicals have been shown by research to show that they can positively impact the biological processes in our body that help reduce the risk of cancer, like reducing inflammation, helping to regulate the hormones, which is important in hormone-based cancers, helping to prevent DNA damage, which is like the known culprit of like starting cancer. So for example, many of the mutations out there are actually, there's a mutation somewhere in the gene that causes this DNA damage to happen more or be unable to repair DNA damage. That's how a lot of these mutations work. So phytochemicals can prevent DNA damage from happening and reverse DNA damage that has already occurred, right? Like, who doesn't want that, right?


SARA

I wasn't even aware there could be a reversal process, right? You just think in your mind, oh, it's damaged. What can I do?


ALISON

Yes, exactly. And that, yeah, for sure. So these are phytochemicals. They have so many great, incredible benefits only found in plants and also fiber.


Fiber is more than just having a healthy bowel movement. We have discovered in over the last decade or so, you know, it's definitely learning more and more every day about our gut microbiome and how beneficial the positive bacteria in our gut microbiome is in terms of reducing inflammation, helping with mental health, right?

Anxiety and depression, which stress plays a role in the cancer development, right? So fiber is so huge. And also the other thing is that it contains, because of plant-based nutrition, actually contains something called non-heme iron. So heme iron is iron that's found in blood, like heme, right? So animal products have heme iron. They also have non-heme iron, but they have heme iron.  Plants only have non-heme iron and heme iron unfortunately is linked to increased cancer risk because of what role they play in damaging DNA and also like increasing oxidative damage for example. 


So there's so many of these really great benefits in terms of what plants provide that animal products can't ,right?  And then when we're reducing the amount of animal protein in our diet again doesn't necessarily mean you have to get rid of all of it.  But when we're reducing that, we're reducing our exposure to heme iron. We're also reducing our exposure to something called heterocyclic amines, which are these carcinogens that are created when animal proteins are cooked at a high temperature, right? So for example, cooking on the grill. So it's about what is included in the diet and also the things that we are either eliminating or reducing in the diet that really provides some really great protection.


Sara 

Okay, those are great examples. And I consider myself to be somewhat aware, but you have mentioned two things that are actually new to me that make perfect sense. Honestly, they make perfect sense. And I think you take some of that, like manage how much meat you eat as much as you can, or at least I do personally, but it's by no means perfect diet and I do have certain things that I enjoy as well. But when you put the science behind it, for me that's important. 


Now I have that basis of understanding. So thank you for explaining that. Now you mentioned how important our gut health is, the gut microbiome is huge and all of the research that's coming around has really been profound. So let's talk about that mind-body connection.I know we talk a lot about, I think the phrase is like, “your gut is your second brain” And so that mind-body connection. Dealing with stress and your microbiome and different things like that are going to be affected by that. So how can nutrition affect us in reducing anxiety and fear that may come along with some of the challenges that we're facing?


ALISON

Yes, 100 percent….So for me, and what I find for a lot of previvors and survivors is one of the great things about nutrition and how beneficial it is in helping to reduce our fear and anxiety about cancer is truly by focusing on the things that we can control. As individuals that have genetic mutations, we can't control our genes, right? There's nothing we can do about it, right? And we can sit kind of...and you know woe is me about that and be really upset about it.  And to be honest, it's not fair, it sucks, it really does…




These are the cards that we were dealt but when we can focus on the things that we can control like our nutrition, like our physical activity, whether we meditate and how we deal with stress and when I say how we deal with stress, it's not to say like “oh let's just get rid of all the stress in our life”, that is not possible. 



There is always going deal with stress and how we manage it is an incredibly important piece, okay? So the way that I see it, and I believe a lot of the people that come to work with me is that I want to control what I can control and that itself is empowering. So I always like to talk about “control the controllables” and try - And I say try because I know how hard it is to not be able to do it completely - but try to let the rest go, right?


I can't change my genes. I can't change the environment around me at like as much as I would like to, right? When it comes to like pollution or environmental contaminants, but I can control the products I use in my home. I can control those exposures and so forth. And I think when it comes to nutrition and why it can reduce the risk of anxiety and so forth, starts with controlling the controllables, right? And really putting that you're in the driver's seat for these things. And that's where we want some of that control back, right? I'm a type A personality, I want all control, right? And I recently put a post on my Instagram and I'm also a faith-based person, right? I believe like this is all in God's hands, right? But I have a post of me like, not me, a picture of a woman like kind of creeping behind the door and I have the comment of saying like, “Hey God, just me checking in on that thing that I said I would let you be in complete hands. I just wanna see if there's anything I can help with, right?” And really from this standpoint of like, I understand how hard it is to let go of complete control. So let's empower ourselves with the things that we do have control of. 


And then the next part about that, when it comes to like the gut microbiome and so forth, is you're exactly right in that scene that the gut microbiome is like our second brain, it's also been thought that it should be considered its own separate organ, right?


We are more bacteria than we are, like we have more bacterial DNA in our body than we have human DNA, which is mind blowing, right? But one of, yeah, well, one of the biggest things about our gut microbiome is that is actually where, I believe it's % of our serotonin or that happy neurotransmitter, for example, is actually produced in our gut, not our brain, right?

So when we think of, different anti-anxiety or anti-depression medications, they're SSRIs, or selective serotonin reuptake inhibitors. So they're working on the serotonin in our brain. And they can be very helpful. They can be incredibly helpful. But if we're missing out on the part about our gut and not maximizing our gut health and missing out where 90% of that serotonin is produced.  We're missing out on a really huge benefit that could help with our mental health and our anxiety and depression as well that when it comes to this. So those are some aspects about how I believe nutrition can play a role and also where research shows that it plays a role in helping to reduce our risk of cancer using stress reduction, anxiety reduction, et cetera.


SARA

Wow. So you made me think of something here that, and I haven't shared this on my podcast yet, but I've alluded to it, dealing with what I had to over the last year and a half or so. I had a lot of anxiety and stress, and I was a little worried about like the long-term effects of having that anxiety and doing what I could to manage it, if you will.


And I had my physician prescribe me for the first time in my life, and I am 49 years old, a very low dose SSRI, I'm on Zoloft.  You know, I waited a long time through all of this to start it. And once I got about a month or two into it, I was like, my brain………stop doing this at night. The wheels were constantly turning and I was letting it get ahead of just enjoying life and being present and being in the moment. And I needed something to kind of pull me back and lessen that stress. I didn't want it to go away because I think there's a healthy mindset that you can manage this. I needed a boost.  And I'm to the point where I would like to do more nutrition wise. And, I've made some, other lifestyle changes, because I’m in surgical menopause, I now do strength training versus running, just pretty big changes for me. Cause I've been a runner for 30 years but it was enough to go, okay, this is where I'm at in my life and I need to make these changes.  Getting off of, say, Zoloft, because I feel like I've now to the point, and I, who knows if it's the meds saying this or if it's really me saying this, it kind of makes you wonder. It is a super low dose, but still and so it took me a few months to actually come to terms with the fact that I was agreeing to do this, right. It took me a while and she convinced me…


ALISON

I can really relate to that. I really can.


SARA

Okay. Oh, that's good. Yeah. So, if what I'm hearing you say is there are ways that I could, you know, ease myself off of that, because that was a long-term plan. It was something to just get me through, you know, a period of time.  I don't want to make any recommendations to anybody, I'm talking about myself personally, and having a conversation with you about this, that there's an opportunity to really reevaluate my nutrition and see if there's an opportunity there, right? I love my carbs, I love chocolate, I drink coffee every day.  There’s certain things that maybe could use a little, a little help. Right. So, maybe you can kind of take me through as an example.


ALISON

Yeah, absolutely. And I think that it's so great that you share this, Sara, because I think there are a lot of individuals out there that have hesitation to starting an anti-anxiety or anti-depression, but maybe think it's probably a thing that they should do. But I think the problem with it is there's so much stigma around it, right? And I will be the first to tell you, I'm also on Zoloft and I have a long history of anxiety and I too really struggled with starting an anti-anxiety medication. And I think it has a lot to do again with that control, right, like, “no, I can control this, I can do it on my own”. And I remember telling my husband and saying, like, “I don't want to do this”. And he said, and I said, “why, why do I need this type of thing for something?” He said, “because some people are just wired like this”. And my response was, “I don't want to be wired like this.” Right? But I will say, that it was honestly one of the best decisions of my life to go on that medication.  Honestly, it was a low dose as well. And I've been through a couple of different ones over the years. And it makes me feel like the Alison that I am, right? And I think one of the best things, I actually started the anti-anxiety medication right before, while I was trying to get pregnant and going through infertility and my OBGYN said, “by doing this, this is one of the best things that you've done for setting yourself up for motherhood.”  Right. Cause all of those, I mean, motherhood in itself. Oh my gosh, a whole ‘nother podcast, right? And when she said that and made me feel so much better about that, about it. And I had actually weaned off and this sounds so crazy, but during, in the middle of chemo, I had gotten off of the anti-anxiety med that I was on. And then I started Tamoxifen a few months later, because I'm an estrogen receptor positive. So I take Tamoxifen for  years, mimic some of those side effects of menopause, which mood alterations is one of them for sure. So keep that in mind, Sara and other people that are listening - it’s not just you being crazy. Like it is some of those hormone fluctuations, right? And there was, I noticed that it was kind of progressing and not to say that there wasn't anxiety there, like pre-existing, but it got worse and worse and worse. And there was one weekend where I was very depressed. I knew that wasn't me. And thankfully, I feel like because of the work that I've done in the many years on my mental health, I was able to recognize it really quickly and say, this is not me. And my husband, we went in for an acute visit with my oncology team. And they said, well, how long have you been on the Tamoxifen for? And I said, well, six weeks and they're like, this is why it can be so difficult for women. Like this is a lot of the tamoxifen talking, right? Cause of those hormone changes and hormone alterations. And I agreed to starting Zoloft and I feel like myself again, right? And I think there are other people that are listening that really struggle with that and are trying to find themselves…it is not losing to take an anti-anxiety or anti-depression medication. In fact, I think it is a sign of strength for you to seek out help and understanding. And for me, like the minute I was diagnosed, I made a vow to myself and that vow would be, I will ask for and accept help, right? Because again, I wanna do everything myself and that was one of them, right? I am accepting the help that Zoloft has given me to be the Alison that I want to be.  Cancer faced me, I faced my own mortality so early in life, way earlier than I ever expected.  And I don't want anxiety and depression to cloud my experiences in watching my kids grow up. And that was one of the things that I talked to with my oncology team in that visit is, nobody ever, there's never good timing to go through cancer, but I've really struggled that my kids were so young.


I couldn't pick up my youngest daughter for 15 weeks and put her in her high chair and change her diaper on the changing table, right? And I remember crying and the appointment saying, "I'm missing so much and I know it”, right? And I don't want to do that anymore. And so, and I share this openly and vulnerably because I think that it does need to be talked about. And I do talk to a lot of people about I think it's a sign of strength and I don't know when I will get off Zoloft. I don't know if it's something that I'll be on for the full ten years of Tamoxifen.


But I also know that I'm supporting myself in really other important ways through diet and exercise that plays a huge role in my mental health as well.

So I'll get off my soapbox about anxiety medication if it's necessary, if it's needed. I think as a dietitian, my approach really is like… I don't think there's anything wrong with medication, but from the standpoint of like, we can't just throw medication at it and not fix some of the other lifestyle components of it, because we're not really gonna get the true benefit if we don't have both together. And that's where I come in as a dietitian, I feel like let's bring together the best of like, the medical world, the conventional world, the Western medicine, and like these really important, like foundational health things, and bring them together and be like, holy cow, this is a force to be reckoned with and use it appropriately.


SARA

Yes. Yeah, absolutely. And I appreciate you saying that because I think it's important to highlight there is a holistic approach. And I'm not talking like holistic medicine, holistic nutrition. I'm talking like the whole person element here where you're right, you can take this medication that will make you feel like the best version of yourself, you know, as you're dealing with just life's challenges. But supplementing that or enhancing might be a better word with nutrition and lifestyle and other elements. And I think what's interesting too, that you're highlighting here about your own practice is you're not just handing somebody this prescription, if you will, for you, it's food is medicine, right? And just giving them that checklist, you're incorporating a lot of the whole person. And I think that's really important. Like when we go into our appointments with our doctors, sometimes they're just gonna look at, you know, what's in your chart, right? And not really look beyond that. And so I think for our listeners to just bear that in mind and speak up about those things, what are other things that I can do?   And I know nutrition is not a huge element of our primary doctor's experiences. I hope that it's going to be over time. You know, I listen to like Dr. Mark Hyman and people like that who left the traditional field and went over into more functional medicine and are really incorporating those elements such as nutrition and lifestyle changes. So maybe you can speak to that a little bit too.


ALISON

Yeah, I mean, honestly, that's one of my frustrations as a dietician as well, but I also, I think the important thing here is, okay, number one, it is not a requirement of medical school to have a single course on nutrition, okay? Not even a single course. There are more that are incorporating it. I think that's a very good improvement. Yeah, there was a survey that was done that found that a huge percentage of people looked to their physician for nutrition advice. Yeah. Six out of seven physicians when they graduate medical school do not feel adequately equipped to discuss nutrition with their patients. That's a problem, right? But I think the problem lies not, there's, okay, there's a lot of issues and I don't pretend to know all the answers. However, I think what's important is for our physicians to have a baseline understanding about how nutrition can play a role, but most importantly, be able to create the right referrals to the people that know that information. And the reason why I say that is not just to toot my own horn as an oncology dietician, but because I want my oncologist to know the cancer, the treatments, the all of that, like the back of their hand, right? And mine does, and I feel very thankful for that, but mine does not understand the nutrition component.  But if they can speak to it enough to say, hey, nutrition is really important, it's gonna help reduce your risk, or if they're in the current course of treatment to say, it can help make sure that we reduce side effects, improve quality of life, maintain your body weight, which is so important for it, right? If they can understand those levels and say, “hey, I'd really love for you to see our oncology dietician where they can talk further about this”. Because physicians do not have time. They do not have time to learn the research. They do not have time to discuss it.  And there's issues with that, right? Just like the medical model from that standpoint. But if oncologists or other doctors and physicians can simply share that part of it, right? And being like, “I'm not knowledgeable, but I know somebody that is”, right? And be able to make those appropriate referrals. I think that honestly is one of the best solutions moving forward. And of course, the hard part is that, you know, insurance often doesn't cover visits with a dietician. And I think that needs to change as well. And that's really hard.  I was just on a podcast with an oncologist and she was interviewing me about my story and that was so fun, but I was able to flip the script and say, can you tell us why oncologists that we could get into this if you want to. But I said, because we were talking about this topic at the time, “why are oncologists still telling people to avoid soy when we know the overwhelming research to show that it's actually very beneficial?” And I appreciate her vulnerability and exposure. She said, “I used to be an oncologist said that said it didn't matter what you eat, just eat whatever you want”. And she said, “…and now I know better”, but those are the individuals that seek out further information, seek out new further education, and that's not the majority, right? So I think it was helpful and lovingly for me to hear her say, like we don't know the answer to this. Because the number of patients that have come to me and said, but why did my oncologist tell me this? And it’s...  I don't want to throw their oncologist under the bus, but it's your oncologist doesn't know. You know, take it from someone who has four years of undergrad training in nutrition, a master's degree in nutrition, oh, and an extra board certification with thousands of hours experience and a board's exam that I need to take every five years to make sure I know my stuff, right? Like I don't pretend to know what oncologists know, but I do know my nutrition, right? And so let me handle the nutrition and let them handle, you know, here are these treatment guidelines.


SARA

So along those lines, you have "lifestyle medicine” mentioned in your website. And I had to look that up and got a gist of what it was. But what is lifestyle medicine and how does this work alongside nutrition? And if we want to talk through even more within the cancer prevention world, so fill me in there.


ALISON

Yeah, absolutely. So lifestyle medicine isn't actually a thing. It's not something that I made up on my own by any means. There actually is the American College of Lifestyle Medicine that is designed to teach healthcare practitioners, physicians, nurses, and NP's, pharmacists, dieticians, you name it, about lifestyle medicine. And the definition of lifestyle medicine, I'm not quoting it perfectly but truly is using the whole person health and six elements of lifestyle medicine to help treat and manage the diagnoses of chronic disease. Now, what I think is important and also prevention, right? So prevention, treatment, management of chronic disease. And what I think is also very important to mention about lifestyle medicine is that lifestyle medicine practitioners are not necessarily not using conventional medicine. They still are, but they're using it in very….  the ways that I was just talking about before were like, okay, we're gonna be using this medication to manage, but here are these lifestyle changes or recommendations that we want to couple it with that may reduce your need for the medication or the amount of medication you need or get rid of it completely, right? So it's not completely getting rid of those recommendations, but really bringing in this whole person health. And so there are six elements of lifestyle medicine. 


  • The first and foremost is nutrition and a plant predominant diet.

  • The second is we also have exercise/physical activity

  • stress reduction, 

  • proper sleep, 

  • avoidance of risky substances, which is things like smoking, alcohol, recreational drugs, et cetera. 

  • And lastly, social connectedness.  And this is a part that I think is not talked about enough, talked about a little bit more post pandemic here and how important that interaction with our peers and so forth is. 


So these are the six components of lifestyle medicine. And I do think that the American College of Lifestyle Medicine is actually one of these really incredible drivers of making sure that physicians are more knowledgeable about nutrition and whole person health and making this part of their practice. So it is a field that is definitely growing. I think the last that I heard, you know, they started with maybe a hundred or  physicians and now they're in the thousands of people and then there's actually a board certification that you can take to become certified in lifestyle medicine. That's something that I'm actually planning on taking later this year to be certified in lifestyle medicine. So that's what lifestyle medicine is and what I love the most about it because I tell people all the time, I'm a dietitian. Of course, I'm going to talk about nutrition. I'm a nutrition nerd, but it does not mean that we should ignore the other pillars of health that are just as important, right? I'm just going to use the example because I don't believe there's such a thing, perfect diet, right? But your stress was out of whack, you didn't exercise, you had risky substances, you didn't have any social interaction, like your health could still be very poor, right? And so it's really about trying to optimize all these different areas and to help reduce the risk of developing chronic disease. And if there is chronic disease present, how we can help manage and treat that as a whole person.


SARA

That’s huge!


ALISON

It’s so cool to see. Like when I go to these medical conferences that are focusing on lifestyle medicine, I have so much hope that the model will change and that things are improving. And they are improving. I will say that, slowly, right? And so we're not seeing this in the big medical model right now. But I do think the work is being done and that's positive.


SARA

Yeah. Now, what do you think is preventing this from being more widespread adapted within the health care system?


ALISON

Money. I think that reimbursement rates and all that plays a huge role, right? And oftentimes physicians are designed to get patients in and out as quickly as possible for those reimbursement rates. And I think that's one of the big, huge issues and where our model needs to change. And people have probably heard it before. Like we don't really have like a healthcare model. We have a sick care model, right? And there's not enough of that preventative work that is being done.


And that's why, you know, that's part of the reason why I do it, the work that I do, I want it to be not just a reactive, but a preventative way to help reduce our risk. And when unfortunately we may encounter a diagnosis, OK, now what do we do about it?

SARA

Yeah, exactly. And I hope that with this podcast, will help this and other podcasts and other folks like you that are out there trying to do this work to bring the awareness to prevention opportunities - anything that we can do to reduce our risk.  It's going to go a long way and it's going to, maybe it's just a grassroots effort that we're going to have to work harder to maybe see more widespread adoption of some of these changes and this lifestyle medicine. I love it. I think it's a great approach and I'm somebody who likes structure and you put these, what did you say, it was six things, right? If I posted those, you know, there's my structure, right? You know, and maybe not everybody's built that way, but for me, having that checklist, that mindset, you know, could make a difference, even if you just make small changes.


ALISON

Yeah. And those are your controllables too, right? These are six pillars that are all completely controllable, right? And so I think that's what I love about it too. This is within our control and that's empowering, right? You know, nutrition, physical activity, sleep, those are all within our control.


Sara 

Yes, absolutely. Well, thank you for sharing that. We'll make sure we put the links out there as well. I saved that one or I bookmarked that one because I was really fascinated when I saw it on your website. 


Okay, so I just have one main question here - So it really is a two-fold question, right? How do we manage feeling overwhelmed with making these changes? And then maybe what are some of the simple tips that people can walk away with today?


ALISON 

Yeah, absolutely. I love this question. And I think that it is different for everybody in how they approach this.


However, what I will say is that, let's say someone hears this, you know, and they're like, okay, “I need to adopt a plant predominant diet. And that's very overwhelming to me”. It is to most people. I do want people to know that.

But the point is, is that you do not need to flip your diet 180 degrees overnight.  There are a select few people that can do that. And I've seen it happen, but that's not the majority. That wasn't even me.  When I started switching my diet to be more plant-based, I did not grow up this way. I think a lot of people assume that I've been eating this way my whole life, which is not true. I grew up in a family where I would say we ate like a healthy standard American diet, right? We tried to reduce red meat. We didn't do a lot of fast food, right? My mom made most of the meal, right? We followed a healthy approach, right? But...The things that I eat now are, gosh, not even close to what I used to eat, but it didn't happen overnight. So I started by slowly reducing, okay, every night for a meal or for dinner, I would have a glass of milk with dinner. I stopped doing that, right? I would just have water instead, or I would use a non-dairy milk in my oatmeal or my cereal, right? These really small switches that over time can make a huge difference. 


So first and foremost, start slow.  There is no reason that it has to be drastically changing overnight. 


The second tip that I really like to recommend is focus on adding before you necessarily subtract, right? So if we're looking at our meals, let's, where can we add more fruit? Where can we add more vegetable? Where can we potentially add some beans? If you're not used to eating beans, I didn't grow up eating beans, but now I love them. So an example that I give, let's say you enjoy spaghetti, right?  You can still have spaghetti and what if you had still, you could still have ground meat in your sauce, but maybe you also add a can of beans, right? And you're still getting that flavor that you're used to, but we're still adding the fiber from the beans and some of those really great phytonutrients that we talked about. So it can be those really simple tricks. And I think sometimes when we think about eliminating or subtracting from our diet, that's where it becomes overwhelming if we can simply just focus on adding.


I'm gonna add more fruits, I'm gonna add more vegetables, I'm gonna add more greens in places that I can. Then, you know, the secret behind that is that it starts crowding out some of the other things because you also start to experience satiety and fullness and people start noticing like, hey, I'm really satisfied, hey, I'm achieving a healthier weight. All the really great things that come from a plant-based diet too. 


So it's really about not doing it overnight and focusing on adding before you subtract and being willing to try new things. And I think that's what's hard for a lot of people. They didn't grow up eating beans or they didn't grow up eating tofu and many of these different things. And, you know, or even just trying some of these dishes or these meals when you are at a new restaurant and they have tofu on the menu. And I'm gonna try that because I'm gonna order it by someone who already knows how to make the tofu. I like to joke that when I first bought tofu, I admittedly, kept it in the fridge, looked at it for a really long time, and then I looked at it and I'm like, oh, it's expired, I can throw it away now, right? And it was like in that pre-contemplative and contemplative state, like I'm gonna do this, I'm gonna try it, and now like, gosh, that's like a huge staple in our diet at our house. So keep that in mind, just be willing to try new things and ask for help. Like if you have a friend that makes tofu and enjoys it, like “hey, can you teach me how you do that?”


I think those are some really important big tips and it doesn't have to be an all or nothing approach. So start by adding and wherever you can add more fruits and vegetables, start there.


SARA

I loved the beans added to the spaghetti, right? And for my kids, I would probably have to like puree it, like add it to the sauce. But I think that is definitely achievable. And that's a great tip. And again, adding the fruits and vegetables and greens where you can, I think those are not insurmountable. So thank you for those tips.


All right, so Alison, this was amazing. Great conversation. I can't thank you enough for joining us today. And this has really been invaluable to me personally, but I hope to my audience too, just these insights are incredible. Your expertise, your personal journey is really inspiring. 


So I know our listeners will take away as much as they can from the conversation, but they might want to reach out to you and maybe look to you for some guidance. So where can they find you?


ALISON

Thank you so much again for having me. It's just, it's a true pleasure. And I'm just, as you hopefully can see, I'm very passionate about nutrition and sharing the knowledge, but people can find me I'm most active on social media on Instagram, which is my handle is @wholesome.cancer.nutrition.  I am most active there. I'm somewhat active on Facebook, but not super active. And then also my website www.wholesomellc.com.


You can find more about me. I have blogs and recipes. If you want to learn more about my programming, I work with individuals that are previvors throughout the course of treatment into survivorship. Anybody that's truly interested in learning more about plant-based nutrition, again, you don't need to be vegan or vegetarian, but adopting more of those practices to help reduce the risk of cancer initially and in its recurrence and just really helping to live a healthy life and honestly the plant-based diet transformed my life in so many ways I can't even describe. So I'm here to help encourage people to do that and figure out how to do it with the why,  the what and how.


SARA

Well, it's been incredibly helpful and I really appreciate what you're doing to help this fight against cancer and really helping to empower individuals with the work that you're doing. I can't imagine just how incredibly beneficial it is for your clients and the knowledge and expertise that you're bringing to the world is just amazing. And I'm thankful for you and I'm thankful for your time today.


ALISON

Yes, thank you so much, likewise.


SARA

All right, and to our listeners, thank you for tuning in. Remember, knowledge is power, and I hope you feel you got a lot of knowledge out of today. And in our journey with hereditary cancer risk, just remember to stay informed, proactive, and being positive is key. 


Don't forget to visit my website, sarakavanaugh.com for more resources. We'll have a transcript of today's episode.  I'd also love for you to follow me on Instagram @positivegenepodcast, and you can stay up to date on the latest episodes, any supporting information. For instance, from today's episode, I will certainly be highlighting this when during and post this episode being launched, and I am looking forward to hearing your comments. 


So until next time, stay informed, stay empowered, and remember you are not alone in this journey. 


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