Ep. 272: Dr. Dawn Mussallem - Expert Diet, Supplement, and Mindset Tips for Breast Cancer Patients (Part 2)

Episode 272 • 24th October 2024 • PLANTSTRONG Podcast • Rip Esselstyn

Rick Esselstyn: 00:00:00

I'm Rick Esselstyn and you're listening to the Plan Strong podcast.

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My plan strong family.

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Grab your pens and paper because the doctor is in the house.

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We're back with Doctor Don Musalem for part two of our series around Breast Cancer Awareness Month.

Rick Esselstyn: 00:00:20

And you won't want to miss a second of this episode.

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It is super valuable.

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Today she shares her recommendations around supplements, Herb spices, and her favorite whole foods that aid in the prevention and healing from breast cancer.

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All that's coming up right after this message from Plantstrong.

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Today you are going to be treated to a front row seat for a priceless conversation with doctor Don Musalem on the lifestyle pillars of medicine that can aid in healing from breast cancer, or any cancers for that matter.

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Even if this disease has never touched you or a loved one, you can benefit from Dawn's knowledge and all of her recommendations.

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Dawn is a breast cancer and lifestyle medicine physician at the Mayo Clinic Comprehensive Cancer center located in Jacksonville, Florida, and she works daily with patients who have received a breast cancer diagnosis.

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Many are coming in on multiple vitamins, supplements and herbs, and dawn works with each of them individually to provide precision patient care.

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What supplements have been shown to aid in recovery while on chemotherapy and radiation?

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Which ones are more cautionary?

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Today Donna is going to dive deep into the science to share her overall thoughts on these and other topics, including her favorite whole plant based foods.

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In fact, if you're listening to this podcast on the day that it's released, which is October 24, dawn is inviting you to attend a free webinar called Hope and navigating the breast cancer journey.

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to: 06:30

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eastern time and it's going to provide knowledge for the journey ahead as well as nutrition, yoga, meditation practices.

Rick Esselstyn: 00:04:46

I'll leave the link to join for free in today's show notes, but for now, let's get right to our conversation with our own Wonder Woman, Doctor Dawn Musalem.

Rick Esselstyn: 00:05:01

It is so good to see you again for part two.

Rick Esselstyn: 00:05:03

Part two of our of our conversation with you during breast cancer Awareness month, saying thank you so much for being, for being part of this series and for coming on for the second time in the month of October.

Rick Esselstyn: 00:05:20

So, Dawn, how are you doing today?

Doctor Don Musalem: 00:05:24

I'm doing fabulous.

Doctor Don Musalem: 00:05:26

There's so many exciting things going on.

Doctor Don Musalem: 00:05:28

It's breast cancer awareness month, as you know, so we're having a lot of energy centered around that at Mayo Clinic.

Doctor Don Musalem: 00:05:34

Did a really excited employee facing breast cancer risk reduction talk yesterday with lifestyle at the core of that.

Doctor Don Musalem: 00:05:43

Had an amazing lunch for our staff of grain, bowls of edamame and tofu, and some whole food plant only, no oil dressing for them.

Doctor Don Musalem: 00:05:52

So it was exciting.

Rick Esselstyn: 00:05:53

And how are the staff receiving this message?

Doctor Don Musalem: 00:06:00

They love it.

Doctor Don Musalem: 00:06:01

They really are.

Doctor Don Musalem: 00:06:02

So in Jacksonville, we currently have a blue zones initiative within our city, and Mayo Clinic is a support quarter of that.

Doctor Don Musalem: 00:06:10

So we are actually in the process of working to be a blue zones certified work site.

Doctor Don Musalem: 00:06:15

So our staff has really been quite engaging.

Doctor Don Musalem: 00:06:18

We got the green light for the farm project, so we are going to be having a farm for our employees to actually get fresh produce as they leave work.

Doctor Don Musalem: 00:06:27

So that's another exciting project.

Doctor Don Musalem: 00:06:28

And so we really focus on a lot of these whole food plant based initiatives.

Doctor Don Musalem: 00:06:32

We have a fitness center for our staff that's open 24 hours a day, seven days a week, free with no charge.

Doctor Don Musalem: 00:06:38

The only day it's closed, I learned recently during hurricane season, is we do close during hurricanes because we figured it's not safe for staff to go work out.

Doctor Don Musalem: 00:06:46

Only for one of my surgeons to post on social media.

Doctor Don Musalem: 00:06:50

Him working out in the fitness center.

Doctor Don Musalem: 00:06:52

When we closed it during hurricane season, we're like, oh, no.

Rick Esselstyn: 00:06:55

Well, and you've had a few of those as of late.

Doctor Don Musalem: 00:06:59

Yes, I know.

Doctor Don Musalem: 00:07:00

Yeah.

Doctor Don Musalem: 00:07:01

Prayers to those families, that's for sure.

Doctor Don Musalem: 00:07:02

We've been fortunate.

Doctor Don Musalem: 00:07:03

We've been quite spared in this Jacksonville area, so we've been very fortunate.

Rick Esselstyn: 00:07:07

Yeah.

Rick Esselstyn: 00:07:08

So last time, you know, I had to run out the door to go watch my son play in a water polo match, and so there was some.

Rick Esselstyn: 00:07:17

There was some ground that we weren't able to cover here.

Rick Esselstyn: 00:07:21

And if my memory serves me correctly, don, last time, you did a fabulous job talking about a lot of the very seminal research that is out there right now regarding whole food, plant based nutrition, and breast cancer, all the positive effects that it can have on breast cancer.

Rick Esselstyn: 00:07:42

We talked about, for example, Neil Barnhardt study and the benefits of whole soy products.

Rick Esselstyn: 00:07:47

We talked about the nurses health study.

Rick Esselstyn: 00:07:50

But today, I want to talk about things like, what's your recommendation when it comes to supplements, sleep, social connections that people can, you know, they can hit the ground and they can implement some of these things, like tomorrow.

Rick Esselstyn: 00:08:08

So, for starters, does that sound good?

Doctor Don Musalem: 00:08:11

Love it.

Doctor Don Musalem: 00:08:12

So important.

Rick Esselstyn: 00:08:13

Great.

Doctor Don Musalem: 00:08:15

A big part of what folks come in asking about.

Rick Esselstyn: 00:08:18

Yeah, yeah.

Rick Esselstyn: 00:08:19

So for starters, then, why don't we start with supplements?

Rick Esselstyn: 00:08:22

And I think I'm specifically wondering, and maybe this.

Rick Esselstyn: 00:08:27

And maybe this bleeds into people that haven't had breast cancer, and they're not breast cancer patients, but just women and men.

Rick Esselstyn: 00:08:36

In general.

Rick Esselstyn: 00:08:36

But what supplements do you recommend for your breast cancer patients who are also hopefully going down the whole food plant based path?

Doctor Don Musalem: 00:08:47

Yeah.

Doctor Don Musalem: 00:08:47

Well, I love how you said that there is no magic bullet.

Doctor Don Musalem: 00:08:50

I mean, that's the quickest thing that I want to make sure that we emphasize here, and the American Institute for Cancer Research says for both cancer prevention and cancer survivors, that supplements are not recommended unless there's a specific indication.

Doctor Don Musalem: 00:09:06

And I just briefly mentioned that, you know, there is this nutrient gap that is a definite risk due to some of the nutrient depletion that's in current crops.

Doctor Don Musalem: 00:09:15

And certainly if someone's having more of a carnivore style diet, they're definitely going to potentially have some of those micronutrient depletions as well.

Doctor Don Musalem: 00:09:23

So to answer your question specifically, that's where we have to really lean in on the science and also being very comprehensive with our evaluations for patients, because all vitamin deficiencies, mineral deficiencies must be corrected.

Doctor Don Musalem: 00:09:39

I would say the number one that I like to at least highlight is as soon as cancer patients get anemia, they automatically think they have iron deficiency.

Doctor Don Musalem: 00:09:50

And that is usually not the case.

Doctor Don Musalem: 00:09:53

In the majority of cancer patients I see undergoing treatment, the cause of their anemia is the chemotherapy, you know?

Rick Esselstyn: 00:10:00

Okay.

Rick Esselstyn: 00:10:01

Okay.

Rick Esselstyn: 00:10:02

Yeah.

Doctor Don Musalem: 00:10:02

And this is a big risk factor.

Doctor Don Musalem: 00:10:04

And I want to really, like, highlight this fact because I see so many women coming in to see me and they're taking iron, and I ask them why, and they say, because I'm anemic.

Doctor Don Musalem: 00:10:12

And so this is an important thing.

Doctor Don Musalem: 00:10:14

There's been cancer research to show that iron supplementation is harmful during chemotherapy.

Doctor Don Musalem: 00:10:20

Iron is, you know, something, part of the reason we stay away from animal protein, you know, so it's really, really important that you do discuss with your doctor why you're taking supplements.

Doctor Don Musalem: 00:10:31

And we want to be certain that there is a true deficiency when you're taking some of these things.

Doctor Don Musalem: 00:10:36

When it comes to the supplements I do recommend, though, the cancer update project from the American Institute for Cancer Research.

Doctor Don Musalem: 00:10:43

This was published within the last two years for breast cancer patients specific in this report.

Doctor Don Musalem: 00:10:48

And they looked at vitamin D, and vitamin D deficiency is very common in our country, and vitamin D isn't really a vitamin, it's really a hormone.

Doctor Don Musalem: 00:10:56

And the levels should be checked.

Doctor Don Musalem: 00:10:57

We shouldn't just guess.

Doctor Don Musalem: 00:10:59

The majority of Americans do come in deficient.

Doctor Don Musalem: 00:11:03

Obesity is one of the things playing into this sunscreen.

Doctor Don Musalem: 00:11:06

People don't spend any time outside, so having your vitamin D checked is imperative.

Rick Esselstyn: 00:11:11

How does obesity play into vitamin D?

Doctor Don Musalem: 00:11:15

It has to do with the dilution of what is basically required to optimize the serum levels of vitamin D.

Doctor Don Musalem: 00:11:22

This is very important because with the American Institute for Cancer Research, they did show that for cancer survivors, following a diagnosis of breast cancer, we could improve overall survival as well as breast cancer specific survival with optimization of normal vitamin D three levels.

Doctor Don Musalem: 00:11:41

What I find in my patients is actually bringing that level up a little bit higher than even that kind of just very barely normal range.

Doctor Don Musalem: 00:11:49

Bringing them up to about the 50 range is where I find in my women with breast cancer is the sweet spot.

Doctor Don Musalem: 00:11:55

That's when I find that these women taking these antiestrogen drugs, which 75% of breast cancers, as you've discussed in our episode and some of the amazing other interviews you've done this month, 75% of breast cancers are estrogen receptor positive breast cancer.

Doctor Don Musalem: 00:12:12

Those women are put on anti estrogen drugs, which can, for some women, cause some achiness.

Doctor Don Musalem: 00:12:17

My patients, the achiness isn't quite as common as I see it reported in the community.

Doctor Don Musalem: 00:12:22

Likely it's because my patients are really adhering to this plant based diet, which is lower inflammation anyways.

Doctor Don Musalem: 00:12:27

But getting that vitamin D level closer to 50, 55, I found that achiness tends to decrease.

Doctor Don Musalem: 00:12:33

It's really quite interesting.

Rick Esselstyn: 00:12:35

And how do you get the vitamin D to 50 in the 50 range?

Rick Esselstyn: 00:12:42

What is your recommended prescription?

Doctor Don Musalem: 00:12:45

Oh, I like that.

Doctor Don Musalem: 00:12:46

That's a good question, because I think a lot of doctors don't realize this.

Doctor Don Musalem: 00:12:49

So if a patient comes in and their vitamin D level in the bloodstream, let's say, is 25, and I really want to get my patients up to.

Rick Esselstyn: 00:12:56

About that, which is what mine almost always is.

Rick Esselstyn: 00:13:01

I'm in the sun and, you know, I'm not obese and I'm like, wow, 25, like, how high should I be and what do I need to do to get there?

Doctor Don Musalem: 00:13:13

So for every: 1000

Doctor Don Musalem: 00:13:20

That's about what you should see.

Rick Esselstyn: 00:13:24

Every: 1000

Doctor Don Musalem: 00:13:30

Yeah.

Doctor Don Musalem: 00:13:30

So I would give you: 3000

Doctor Don Musalem: 00:13:35

Okay.

Rick Esselstyn: 00:13:35

Wow.

Rick Esselstyn: 00:13:36

Okay.

Doctor Don Musalem: 00:13:36

Now it's important that the vitamin D is checked.

Doctor Don Musalem: 00:13:38

So once I make that adjustment, I like to recheck it, you know, generally within, you know, eight to twelve weeks, because you don't overshoot it.

Doctor Don Musalem: 00:13:45

And we do know that there's kind of, we used to call this medicine, we still do like this j shaped curve or u shaped curve.

Doctor Don Musalem: 00:13:51

You do a lot of benefit and risk reduction up to a certain point, but then maybe you enter this area of risk, and if you get too much vitamin D, you run the risk of making the calcium possibly go too high.

Doctor Don Musalem: 00:14:01

There's even been reports when vitamin D gets too high, you may potentially even increase the risk of bone fractures, which is something really interesting to start reading about.

Doctor Don Musalem: 00:14:10

So, you know, have those vitamin D levels checked.

Doctor Don Musalem: 00:14:13

Winter and summer is what I like to do because most people may need a little bit more in the winter, a little bit less in the summer, and I individualize it.

Doctor Don Musalem: 00:14:20

So individualized precision care is ideal if you can work with your primary care doctor, your cancer survivorship team, to discuss it.

Doctor Don Musalem: 00:14:27

So that's supplement number one, vitamin D.

Doctor Don Musalem: 00:14:30

Right, right.

Rick Esselstyn: 00:14:33

I'm just.

Rick Esselstyn: 00:14:35

So any other side effects that you know of from vitamin D supplementation outside of if you get too high, potentially, you know, bones crumbling?

Doctor Don Musalem: 00:14:51

No, I personally don't see it, but again, I don't want my patients really exceeding that 55, 65 range.

Doctor Don Musalem: 00:14:57

Really try to keep them, you know, in that 50 range.

Doctor Don Musalem: 00:15:00

And usually they do a really good job doing that.

Doctor Don Musalem: 00:15:02

And it's really quite interesting.

Doctor Don Musalem: 00:15:04

I usually talk to my patients that notice how you feel as that level goes up, and then that way you can kind of gauge if you notice you feel a little achy again, you know, send me a message and let's check your vitamin D.

Doctor Don Musalem: 00:15:13

And a lot of times there's some consistency with that, which I find interesting.

Doctor Don Musalem: 00:15:17

The other thing I would say is vitamin d three.

Doctor Don Musalem: 00:15:20

A lot of doctors use vitamin d two, and they'll give it just one time a week at a really high dose.

Doctor Don Musalem: 00:15:28

I really like physiologic feeling for patients to get vitamin d three daily.

Doctor Don Musalem: 00:15:34

That's what I recommend personally.

Rick Esselstyn: 00:15:37

And if I'm correct here, the d three is actually a vegan form of d.

Rick Esselstyn: 00:15:44

And the d two comes from lanolin sheep's wool, which is kind of an animal based, is that correct?

Rick Esselstyn: 00:15:50

Is that what your understanding is?

Doctor Don Musalem: 00:15:53

Well, some of the d three can come from animal based sources as well.

Doctor Don Musalem: 00:15:57

So, you know, if someone is vegan, that may be something that they want to explore.

Rick Esselstyn: 00:16:01

Right, right.

Rick Esselstyn: 00:16:02

I know that the d three, because we supplement in our milk.

Rick Esselstyn: 00:16:05

I know that we have a vegan form of d three.

Rick Esselstyn: 00:16:09

So that was, that was very important to us.

Rick Esselstyn: 00:16:12

What?

Rick Esselstyn: 00:16:12

So I would imagine that a lot of your patients are live in Florida.

Rick Esselstyn: 00:16:18

Is that accurate?

Doctor Don Musalem: 00:16:21

Well, actually, you know, my practice is telehealth, so I do see women from all around, and I see some of the patients, even from up in Rochester, which that's almost as close to the North Pole as you get pretty cold up there.

Doctor Don Musalem: 00:16:32

So I see folks from all across the country.

Doctor Don Musalem: 00:16:36

So it's not consistent.

Doctor Don Musalem: 00:16:37

Florida.

Doctor Don Musalem: 00:16:38

But quite frankly, I see just as much vitamin D deficiency in my Floridians.

Doctor Don Musalem: 00:16:42

You know, the majority of them aren't going out to the beach and sitting in the sun without sunscreen.

Doctor Don Musalem: 00:16:46

They're under an umbrella with a hat and their sunscreen on, so they're not getting vitamin D.

Doctor Don Musalem: 00:16:51

And I do for another thing we'll be talking about, as you mentioned, sleep.

Doctor Don Musalem: 00:16:55

I really want my patients, as soon as that sun comes up, I want them to get that first morning sun, no sunscreen.

Doctor Don Musalem: 00:17:02

Try to get their large parts, you know, chest, back, shoulders, face, try to get that in the sun so they get some of that natural vitamin D synthesis, you know.

Doctor Don Musalem: 00:17:10

And again, it's interesting, we're talking about survivors when they look at vitamin D supplementation and cancer risk reduction, reducing the risk of cancer occurring altogether.

Doctor Don Musalem: 00:17:21

We just really haven't seen that data show, we know that people who get natural levels of vitamin D from exercising in the sun the way it should be done, that is protected.

Doctor Don Musalem: 00:17:33

But the supplements don't always pan out to show the risk reduction of the cancer causing.

Doctor Don Musalem: 00:17:37

So these studies I'm talking about are specific for cancer survivorship and improving outcomes.

Rick Esselstyn: 00:17:42

All right, I think we've beaten up vitamin D enough here.

Doctor Don Musalem: 00:17:47

Next subject.

Rick Esselstyn: 00:17:48

Yeah, well, or next subject or next supplement that you would like to discuss?

Doctor Don Musalem: 00:17:57

You know, I think because the majority of your audience is whole food plant only, you know, it's important to bring up vitamin B twelve.

Doctor Don Musalem: 00:18:03

And I typically check vitamin B twelve, but more commonly I do check an MMA with that.

Doctor Don Musalem: 00:18:09

That's a confirmatory test to make sure at the tissue level you are, in fact getting enough vitamin B B twelve.

Doctor Don Musalem: 00:18:16

And I do feel that in my whole food plant only patients, it's important to make sure that they have their vitamin B twelve checked once or twice a year.

Doctor Don Musalem: 00:18:23

Also.

Doctor Don Musalem: 00:18:24

Now there's a lot of fortified foods.

Doctor Don Musalem: 00:18:26

You know, some of the various plant milks have vitamin B twelve.

Doctor Don Musalem: 00:18:29

I use a ton of nutritional yeast.

Doctor Don Musalem: 00:18:31

I'm sure you do, too, rip.

Doctor Don Musalem: 00:18:32

You can get vitamin B twelve from that.

Doctor Don Musalem: 00:18:34

I have my own vitamin B twelve levels checked, and it was high.

Doctor Don Musalem: 00:18:36

When I recently had it checked, I was kind of overshooting it, you know, so I backed off vitamin B twelve.

Doctor Don Musalem: 00:18:41

There was an interesting study that was published by Ambrosome, and what they showed is people who took vitamin B twelve before chemotherapy and during chemotherapy actually had a poor outcome.

Doctor Don Musalem: 00:18:52

A lot of people just take vitamin B twelve just to take it.

Doctor Don Musalem: 00:18:55

They don't need it.

Doctor Don Musalem: 00:18:57

So it's important if you have an efficiency or if you're low, take it.

Doctor Don Musalem: 00:19:01

If you're on a diet that you're not getting it from normal sources such as a whole food plant only diet, then you probably need some b twelve.

Doctor Don Musalem: 00:19:08

But most people overshoot the level over the age of, some experts say 50 to 65.

Doctor Don Musalem: 00:19:14

Definitely over the age of 65.

Doctor Don Musalem: 00:19:15

There's a much more increased risk of vitamin B twelve deficiency, regardless of what style diet you're on, just because of absorption issues.

Doctor Don Musalem: 00:19:23

So again, it's a shout out.

Doctor Don Musalem: 00:19:24

Have the level checked, have your doctor adjusted accordingly.

Doctor Don Musalem: 00:19:27

Sometimes there's absorption issues, so it may need to be done via, via an injection.

Doctor Don Musalem: 00:19:33

I typically in a supplement, I just do a sublingual form for them.

Doctor Don Musalem: 00:19:36

Sublingual pill.

Rick Esselstyn: 00:19:37

Right, right.

Rick Esselstyn: 00:19:39

It's interesting, um, my, my vitamin B twelve is typically between 509 hundred.

Rick Esselstyn: 00:19:44

And we did a production run because of 30,000 units of our oat walnut milk.

Rick Esselstyn: 00:19:54

Um, that's fortified with d calcium and vitamin B twelve.

Rick Esselstyn: 00:19:57

Uh, we have 25% of the RDA of b twelve in there.

Rick Esselstyn: 00:20:01

And literally I had a garage and so I had it on, you know, my cereal, I was drinking it like instead of water.

Rick Esselstyn: 00:20:09

It was crazy.

Rick Esselstyn: 00:20:10

twelve except for that it was: 1350

Rick Esselstyn: 00:20:20

So it got flagged for being too high.

Doctor Don Musalem: 00:20:22

Yeah, I mean, and we don't really know if that's a problem.

Doctor Don Musalem: 00:20:27

You know, it's a water soluble vitamin so you pp it out.

Doctor Don Musalem: 00:20:30

But the question is, should it be high?

Doctor Don Musalem: 00:20:34

I mean, could it cause problems?

Doctor Don Musalem: 00:20:35

This is really interesting in this cancer study to see this, you know, report of increased mortality in people that were doing vitamin B twelve who didn't need it both before and during their cancer treatment.

Doctor Don Musalem: 00:20:47

That's an important part of what that study showed.

Doctor Don Musalem: 00:20:49

It was at both sections.

Doctor Don Musalem: 00:20:50

So anyways, have your levels checked?

Rick Esselstyn: 00:20:52

Yeah, yeah.

Rick Esselstyn: 00:20:54

And do you have a preference as far as taken daily?

Rick Esselstyn: 00:20:58

Weekly?

Rick Esselstyn: 00:21:00

I know some people like: 5000

Rick Esselstyn: 00:21:03

Some people are like 500 microgram once a day.

Rick Esselstyn: 00:21:06

Whatever floats your boat.

Doctor Don Musalem: 00:21:08

No, I do.

Doctor Don Musalem: 00:21:09

I like it daily.

Doctor Don Musalem: 00:21:10

I mean, I like to be as close to physiologic as possible, so it just makes more sense to me.

Doctor Don Musalem: 00:21:16

That's how my style is with practicing.

Doctor Don Musalem: 00:21:18

I have them do it daily if they were requiring a supplement.

Rick Esselstyn: 00:21:21

I like that.

Rick Esselstyn: 00:21:22

I like that a lot.

Rick Esselstyn: 00:21:23

Uh, what are your thoughts on, uh, zinc and selenium.

Doctor Don Musalem: 00:21:28

Ooh, good question.

Doctor Don Musalem: 00:21:30

I check my patients levels.

Doctor Don Musalem: 00:21:31

I find something very interesting.

Doctor Don Musalem: 00:21:34

I find you, I'm taking a lot of blood.

Doctor Don Musalem: 00:21:38

I'm going to make them iron deficient.

Doctor Don Musalem: 00:21:39

I take so much blood.

Doctor Don Musalem: 00:21:40

I'm kidding.

Doctor Don Musalem: 00:21:43

I find a lot of zinc deficiency in my patients.

Doctor Don Musalem: 00:21:46

And, you know, it's funny is because my patients are quite healthy, I find a lot of selenium toxicity in my patients.

Doctor Don Musalem: 00:21:52

So zinc deficiency needs to be corrected.

Doctor Don Musalem: 00:21:55

And so I correct that with, obviously, zinc supplementation.

Doctor Don Musalem: 00:22:00

Selenium deficiency for cancer survivors is something we absolutely don't want, particularly during radiation.

Doctor Don Musalem: 00:22:05

There's been some interesting studies that have shown optimization of selenium, ensuring the selenium levels are normalized.

Doctor Don Musalem: 00:22:12

It seems to improve the treatment effect of radiation, which is very interesting science.

Doctor Don Musalem: 00:22:17

And we don't always have the exact explanation as to why this is.

Doctor Don Musalem: 00:22:21

But this has been an observation, an association they've seen, but we certainly don't want to go into the range that they're toxic.

Doctor Don Musalem: 00:22:27

And so what I find in my patients is they tend to eat a lot of Brazil nuts.

Doctor Don Musalem: 00:22:30

You know, some of these women come in to see me.

Doctor Don Musalem: 00:22:32

They've already tried to onboard, based on webinars and videos and books they've read that, oh, Brazil nuts are good.

Doctor Don Musalem: 00:22:38

Selenium is important.

Doctor Don Musalem: 00:22:39

So all of a sudden, they're having, like, ten Brazil nuts a day, and that's not a good idea.

Doctor Don Musalem: 00:22:44

So have your selenium levels checked, Brazil nuts again, because of this whole nutrient depletion or not, you know, you may only need one Brazil nut versus maybe you need three.

Doctor Don Musalem: 00:22:55

And there's never going to be consistency in that Brazil nut that you're consuming, necessarily.

Doctor Don Musalem: 00:23:00

So I typically say, you know, one up to three Brazil nuts a day, but I don't want my patients going more than that.

Doctor Don Musalem: 00:23:06

I know myself, I love Brazil nuts, and I found this really great brand that's just, it's so, it's such high quality, it's really good tasting.

Doctor Don Musalem: 00:23:15

And they can also optimize ldl.

Doctor Don Musalem: 00:23:16

And I know, rip, you and I were kind of comparing that ldl is way better than yours.

Doctor Don Musalem: 00:23:20

And so maybe that's why there are some reports that, that Brazil nuts help to lower ldl cholesterol, which is kind of interesting.

Doctor Don Musalem: 00:23:27

But you don't want to eat too many Brazil nuts.

Doctor Don Musalem: 00:23:29

And quite frankly, I can't believe they don't put a warning on the bag, because you can really get yourself into trouble with Brazil nuts.

Doctor Don Musalem: 00:23:36

So be cautious.

Rick Esselstyn: 00:23:38

Well, yeah, Brazil nuts, peanut butter ice cream.

Rick Esselstyn: 00:23:47

So no, it's funny.

Rick Esselstyn: 00:23:49

You know, Doctor Gregor, I think started the whole one Brazil nut a day for your selenium.

Rick Esselstyn: 00:23:54

I don't know, probably in how not to die.

Rick Esselstyn: 00:23:57

And it's like, yeah, just have one Pringles potato chip.

Doctor Don Musalem: 00:24:04

I know I keep my Brazil nuts in the freezer, so when you.

Doctor Don Musalem: 00:24:07

In my walnuts too.

Doctor Don Musalem: 00:24:08

So when you eat them, they're like extra crunchy.

Doctor Don Musalem: 00:24:09

They're so delicious.

Rick Esselstyn: 00:24:11

I hear you loud and clear there, for sure.

Doctor Don Musalem: 00:24:14

I have three today, I have to confess.

Rick Esselstyn: 00:24:20

Thank you for your confession.

Rick Esselstyn: 00:24:24

What about algae oil?

Doctor Don Musalem: 00:24:27

Yeah.

Doctor Don Musalem: 00:24:27

You know, I am a believer, you know, there is mixed opinions on this, but the women I am seeing, you figure the majority of women I'm seeing are being put on anti estrogen medications.

Doctor Don Musalem: 00:24:40

They're in menopause.

Doctor Don Musalem: 00:24:42

So there is a lot of thought that women in menopause are not efficient at converting the omega three plant based fatty acids over to DHA or EPA.

Doctor Don Musalem: 00:24:54

So I do recommend that my patients take algae omega one to two pills a day.

Doctor Don Musalem: 00:25:00

I don't think we need to go too high with it.

Doctor Don Musalem: 00:25:02

I also occasionally check fatty acid profiles of my patients.

Doctor Don Musalem: 00:25:06

I don't get chewing the weeds with it, but occasionally I do if I'm a little bit worried about some of their balance of their overall nutritional intake.

Doctor Don Musalem: 00:25:14

And, you know, I would say that not all of my patients are whole food plant only.

Doctor Don Musalem: 00:25:18

A lot of my patients are still having a little bit of fish.

Doctor Don Musalem: 00:25:21

And, you know, if they are, I want to make sure they're not getting too much because I don't want them getting heavy metals.

Doctor Don Musalem: 00:25:26

I don't want them getting microplastics.

Doctor Don Musalem: 00:25:28

The waterways now are so contaminated with so many different toxins that it bioaccumulates in the fish, and then we eat the fish.

Doctor Don Musalem: 00:25:38

So if my patient is going to do fish, you know, I'd rather them do like sardines or anchovies.

Doctor Don Musalem: 00:25:44

But if they're going to do fish, more fatty fish, like wild salmon, I typically say one to 3oz.

Doctor Don Musalem: 00:25:52

That's a little bit like.

Doctor Don Musalem: 00:25:53

That's just like a few bites, right?

Rick Esselstyn: 00:25:55

Oh, it's hardly, it's hardly anything.

Rick Esselstyn: 00:25:56

Yeah, yeah.

Doctor Don Musalem: 00:25:57

One to 3oz, up to three times a week, and that's it.

Doctor Don Musalem: 00:26:00

And that recommendation comes from the environmental working group.

Doctor Don Musalem: 00:26:04

Basically the seafood calculator.

Doctor Don Musalem: 00:26:06

That's super cool.

Doctor Don Musalem: 00:26:07

That looks at your gender, your age, and will tell you the maximum of fish you should consume.

Doctor Don Musalem: 00:26:11

Considering current levels of toxic exposure.

Doctor Don Musalem: 00:26:14

We want to minimize people from.

Doctor Don Musalem: 00:26:16

So I love that, you know, well.

Rick Esselstyn: 00:26:18

And then also when they tell pregnant women to basically stay away from fish because of the different, you know, levels of whatever it is.

Rick Esselstyn: 00:26:28

PCP's, dioxin, mercury.

Rick Esselstyn: 00:26:30

Um, yeah, yeah.

Rick Esselstyn: 00:26:31

How much do I want to be taking in of those things?

Doctor Don Musalem: 00:26:36

I completely agree.

Doctor Don Musalem: 00:26:38

Yes.

Rick Esselstyn: 00:26:39

Um, can we go back just for a second?

Rick Esselstyn: 00:26:43

So to the algae oil, that is a kind of, I would imagine that's a form of the alpha linoleic acid, the, the, the short chain ala.

Rick Esselstyn: 00:26:55

And, and so for the listener, you're saying that conversion from this kind of mother form of the omega three s, some people, it gets kind of gets difficult to get broken down into the longer chain that you said, the DHA and the EPA.

Rick Esselstyn: 00:27:15

And so this is a reason for the algae oil.

Rick Esselstyn: 00:27:23

Help me out a little bit.

Doctor Don Musalem: 00:27:24

Yeah, that's exactly right.

Doctor Don Musalem: 00:27:25

So we believe that estrogen, so when we're young for women, we believe that we're more efficient at doing that conversion.

Doctor Don Musalem: 00:27:32

But as we go into menopause and we're estrogen deficient, without that estrogen present, we may not be as efficient at making that ability to convert into EPA and DHA.

Doctor Don Musalem: 00:27:46

And so if someone wants to be natural and avoid supplements, just have your doctor check your level to make sure it's adequate.

Doctor Don Musalem: 00:27:51

I recently had a woman that really didn't want to take supplements.

Doctor Don Musalem: 00:27:53

We checked her level.

Doctor Don Musalem: 00:27:54

She was fine.

Doctor Don Musalem: 00:27:55

You know, she was doing some different seaweeds and stuff, and she was just fine.

Doctor Don Musalem: 00:27:59

It wasn't an issue for her.

Doctor Don Musalem: 00:28:01

But again, going back to my women on these medications, these aromatase inhibitors that feel achy, there has been some reports that for joint pain, that fish oil can be effective for that.

Doctor Don Musalem: 00:28:12

So I found that two things that I really try to do to help women with those aromatase inhibitor joint pains is get the vitamin d to 55 and do, you know, one to two algae omega a day.

Doctor Don Musalem: 00:28:25

And that has really worked well with my patients.

Doctor Don Musalem: 00:28:27

In addition to regular exercises, you would imagine that I'm encouraging.

Doctor Don Musalem: 00:28:31

And so I do tend to use the algae omega, then usually up to one tablespoon of flaxseed.

Doctor Don Musalem: 00:28:37

But I don't really have my patients do much more than one tablespoon of flaxseed.

Doctor Don Musalem: 00:28:40

I think that's enough for my patients.

Rick Esselstyn: 00:28:42

Yeah, yeah.

Rick Esselstyn: 00:28:43

Wonderful.

Rick Esselstyn: 00:28:44

Thank you for revisiting that.

Rick Esselstyn: 00:28:46

Let's talk about calcium, because it seems like so many women are concerned about getting enough calcium.

Rick Esselstyn: 00:28:53

They're concerned about osteoporosis, osteopenia.

Rick Esselstyn: 00:28:56

And what is your recommendation with your cancer patients?

Doctor Don Musalem: 00:29:01

You know, this is really a concern.

Doctor Don Musalem: 00:29:03

doctor recommends, hey, take: 1200

Doctor Don Musalem: 00:29:13

Like the quick thing to say, right?

Doctor Don Musalem: 00:29:14

Oh, you're getting older.

Doctor Don Musalem: 00:29:16

Oh, you're on this anti estrogen drug, you have lower estrogen levels, and physiologic, you have an increased risk of osteoporosis.

Doctor Don Musalem: 00:29:24

Take: 1200

Doctor Don Musalem: 00:29:30

Right?

Doctor Don Musalem: 00:29:30

So some patients are taking tums or they're taking calcium carbonate, neither of which are very readily absorbed into the bloodstream.

Doctor Don Musalem: 00:29:38

In order to absorb calcium, you want it in a more acidic environment.

Doctor Don Musalem: 00:29:41

So calcium citrate would be a much more favorable or a superior form of calcium for an individual to consume.

Doctor Don Musalem: 00:29:50

Now, with that being said, what I recommend to patients is we know that when it comes to calcium intake, it mattered most when we were kids.

Doctor Don Musalem: 00:30:01

By the way, there really hasn't been solid data to prove that taking calcium supplements as adults really matters.

Doctor Don Musalem: 00:30:09

What is important, you get it in your diet.

Doctor Don Musalem: 00:30:11

I want my patients, I recommended them once a month.

Doctor Don Musalem: 00:30:15

I want them in tune with what they're eating.

Doctor Don Musalem: 00:30:18

Once a month I ask them to do a 24 hours food.

Doctor Don Musalem: 00:30:22

They do this for me before each appointment they have with me.

Doctor Don Musalem: 00:30:25

So they're familiar with doing this.

Doctor Don Musalem: 00:30:27

And I want them to calculate out how much calcium they're getting from their diet.

Doctor Don Musalem: 00:30:31

to: 1000

Doctor Don Musalem: 00:30:36

er it takes to get them up to: 1200

Doctor Don Musalem: 00:30:41

So if I have a woman, she 800 milligrams of calcium in her diet, I ever add a 400 milligram calcium citrate supplement.

Doctor Don Musalem: 00:30:48

If she's getting: 1000

Doctor Don Musalem: 00:30:54

eone in their diet is getting: 1500

Doctor Don Musalem: 00:30:58

I don't worry about it if they're getting it from their food, but I don't want them to overcompensate with that supplement.

Doctor Don Musalem: 00:31:04

That's how I recommend it.

Doctor Don Musalem: 00:31:06

And the patients really like that individualized recommendation.

Doctor Don Musalem: 00:31:09

And I really want my patients try to aim to get it from their food, their plant milk.

Doctor Don Musalem: 00:31:13

I mean, by golly, almond milk.

Doctor Don Musalem: 00:31:15

The majority of them have like 450 milligrams of calcium rip.

Doctor Don Musalem: 00:31:18

I think your milks have 300.

Doctor Don Musalem: 00:31:21

Do I remember that correctly?

Doctor Don Musalem: 00:31:21

300 milligrams of calcium?

Rick Esselstyn: 00:31:23

300, which is 100% of.

Doctor Don Musalem: 00:31:27

Perfect.

Doctor Don Musalem: 00:31:28

450 is high.

Doctor Don Musalem: 00:31:29

It's almost too high.

Doctor Don Musalem: 00:31:30

I don't like it that high in some of the almond milk.

Doctor Don Musalem: 00:31:32

y're getting two cups of that: 3900

Doctor Don Musalem: 00:31:36

They definitely don't need to do well.

Rick Esselstyn: 00:31:40

I think that's a really smart protocol, Don.

Rick Esselstyn: 00:31:42

I like the way you customize it like that, um, with.

Rick Esselstyn: 00:31:46

Especially if people are following, you know, the whole food plant based diet.

Rick Esselstyn: 00:31:49

And they're, uh, they've subscribed to trying to do one to two servings of whole soy products a day, especially, like, tofu that's typically fortified with it.

Rick Esselstyn: 00:32:00

That's a, I think, a wonderful way to be getting calcium.

Rick Esselstyn: 00:32:04

I I know that I've read about, you know, how getting.

Rick Esselstyn: 00:32:08

Sometimes supplementing with calcium or too much calcium can also increase your risk of heart disease, if I'm not mistaken.

Rick Esselstyn: 00:32:18

I think I heard that from Colin Campbell a long time ago.

Doctor Don Musalem: 00:32:22

You're exactly correct.

Doctor Don Musalem: 00:32:24

We don't know the implications of this.

Doctor Don Musalem: 00:32:26

In fact, after my heart transplant, I had spoke with my cardiac surgeon.

Doctor Don Musalem: 00:32:31

We had a long discussion on this, because he is actually whole food plant based.

Doctor Don Musalem: 00:32:34

And we were just having a discussion based on this calcium supplementation.

Doctor Don Musalem: 00:32:38

He was seeing a lot of women coming in, needing valve replacements and having some interesting calcium deposition, like, when he's doing the surgery, it kind of felt different.

Doctor Don Musalem: 00:32:47

So he asked me, what do you think?

Doctor Don Musalem: 00:32:48

I thought, you're absolutely right.

Doctor Don Musalem: 00:32:50

I think it is a definite problem that we're not paying attention to so much that I actually sent a message through to one of our cardio oncologists.

Doctor Don Musalem: 00:32:59

We have a whole section of cardiology that is focused on cancer patients.

Doctor Don Musalem: 00:33:03

And I said, how about we do a study that looks at the hundreds and thousands of patients we've followed over the years on calcium supplementation to see if there was increased cardiac events.

Doctor Don Musalem: 00:33:14

So it's a study we're currently talking about investigating, because I think we need more information to answer this question.

Rick Esselstyn: 00:33:20

Yeah, creatine, that seems to be like the hot ticket these days.

Rick Esselstyn: 00:33:27

And I'm wondering if you think it's justifiably so.

Doctor Don Musalem: 00:33:31

I think it potentially is justifiably so.

Doctor Don Musalem: 00:33:34

And the last thing I want, particularly for women undergoing cancer treatment, is you don't want to lose muscle.

Doctor Don Musalem: 00:33:39

Muscle is precious tissue in your body.

Doctor Don Musalem: 00:33:42

Muscle and bone, muscle and bone, muscle and bone.

Doctor Don Musalem: 00:33:44

But muscle is metabolically active.

Doctor Don Musalem: 00:33:46

You know, muscle is important.

Doctor Don Musalem: 00:33:47

As we age, muscle is just something we must focus on.

Doctor Don Musalem: 00:33:51

You get adequate protein from a plant based diet.

Doctor Don Musalem: 00:33:53

I'm never worried about that.

Doctor Don Musalem: 00:33:55

But could we be missing a little bit of creatine?

Doctor Don Musalem: 00:33:59

So women, it would be 3 grams a day men, it would be 5 grams a day for creatine supplementation.

Doctor Don Musalem: 00:34:04

You really do not have to load.

Doctor Don Musalem: 00:34:06

I don't know if you remember, you know, I used to do fitness contests back in the day and so we would load our creatine at that time and man you'd feel so gross.

Doctor Don Musalem: 00:34:14

You'd feel so puffy when you do that loading phase.

Doctor Don Musalem: 00:34:18

So I don't recommend loading.

Doctor Don Musalem: 00:34:19

But I do think that there could be a role for 3 grams women, 5 grams for men.

Doctor Don Musalem: 00:34:22

There's also some reports that maybe it's important for cognitive health.

Doctor Don Musalem: 00:34:26

What I would say is we need more research to really prove this kind of enhanced benefit of both muscle metabolism as well as possibly cognitive performance.

Doctor Don Musalem: 00:34:36

iet to ever find out a decade: 2345

Doctor Don Musalem: 00:34:46

So I do not feel creatine would ever cause harm.

Doctor Don Musalem: 00:34:49

We have so much research on it.

Doctor Don Musalem: 00:34:50

It's probably the most research supplement out there.

Doctor Don Musalem: 00:34:53

It's safe and nor do you need to spend money on it.

Doctor Don Musalem: 00:34:56

The only thing for women, myself included, I just don't like how it makes me feel.

Doctor Don Musalem: 00:35:00

I feel kind of puffy and I don't like that.

Doctor Don Musalem: 00:35:02

So you know, I do have some of my women taking it, particularly those that are really active.

Doctor Don Musalem: 00:35:08

Like I said, I wouldn't say it's a, I have a, probably about 10% of my patients are whole food plant only.

Doctor Don Musalem: 00:35:14

It may be a little bit higher than that where they don't touch any animal products.

Doctor Don Musalem: 00:35:17

And honestly it's, it's probably higher than that now.

Doctor Don Musalem: 00:35:20

But I would say the majority of my patients are getting just a little bit of fish.

Doctor Don Musalem: 00:35:23

Maybe just one serving a week, two servings a week, just a tiny bit.

Doctor Don Musalem: 00:35:27

And they're getting some creatine from that.

Rick Esselstyn: 00:35:29

So uh, it's funny, I've, I've never taken creatine, but I am going to have one of the foremost authorities on creatine on the podcast here at the end of uh, in the beginning of November.

Rick Esselstyn: 00:35:43

And then just as a way, I'm going to, I'm going to try it.

Rick Esselstyn: 00:35:46

I'm going to try it for a month and see what happens.

Rick Esselstyn: 00:35:49

I know when I was in the fire academy, you know, for six months, all these guys were just trying to get buffed up and everything.

Rick Esselstyn: 00:35:58

And as soon as they started the creatine, they all gained about ten pounds.

Rick Esselstyn: 00:36:02

You know, they, you mentioned Puffy.

Rick Esselstyn: 00:36:04

They looked like they were getting puffier.

Rick Esselstyn: 00:36:06

Not necessarily, you know, more shredded.

Rick Esselstyn: 00:36:09

And every one of them the first thing we had to do every morning was run 2 miles around the track, and we would typically go pretty hard, and all these guys started cramping up.

Rick Esselstyn: 00:36:18

It was the weirdest thing.

Doctor Don Musalem: 00:36:21

So I don't actually see that.

Doctor Don Musalem: 00:36:23

It is really fascinating, the research of muscle repair, you know, regenerating like that ATP, so you're a little stronger to do more sets, to do more reps.

Doctor Don Musalem: 00:36:30

So it should enhance athletic performance.

Doctor Don Musalem: 00:36:33

It should not hinder it.

Doctor Don Musalem: 00:36:34

But the cramping up was interesting.

Doctor Don Musalem: 00:36:36

And, you know, I don't know when that was.

Doctor Don Musalem: 00:36:38

Who knows what else was in that supplement there?

Rick Esselstyn: 00:36:42

This was in: 1997

Doctor Don Musalem: 00:36:45

That's all the same.

Doctor Don Musalem: 00:36:46

I was taking it back then, too.

Doctor Don Musalem: 00:36:48

Yeah, I remember.

Doctor Don Musalem: 00:36:49

So I think these are a little different, but.

Rick Esselstyn: 00:36:50

Yeah, yeah, yeah.

Rick Esselstyn: 00:36:54

What about Berberine?

Doctor Don Musalem: 00:36:56

So Berberine has a really narrow therapeutic window, meaning like, you know, it's like the sweet spot.

Doctor Don Musalem: 00:37:03

You know, if you go too high, you get toxic.

Doctor Don Musalem: 00:37:05

If you're too low, it's not going to even help you therapeutically.

Doctor Don Musalem: 00:37:07

So it's this very narrow window.

Doctor Don Musalem: 00:37:10

I think Berberine is very fascinating, though.

Doctor Don Musalem: 00:37:12

It has the potential to really optimize blood sugar and, you know, possibly even cholesterol.

Doctor Don Musalem: 00:37:18

But I do love it for its blood sugar benefits.

Doctor Don Musalem: 00:37:22

You know, I think that there has been a lot of recent reports that are, you know, floating out there.

Doctor Don Musalem: 00:37:28

So it's a common one.

Doctor Don Musalem: 00:37:29

I have my patients coming in, and they're already on, so it sounds like it's really being sensationalized.

Doctor Don Musalem: 00:37:34

So I typically will say if my patient does have insulin resistance.

Doctor Don Musalem: 00:37:40

Of course, usually we're just controlling this with diet, and I don't need these sorts of supplements.

Doctor Don Musalem: 00:37:44

But in the event there is a sort of situation, then 500 milligrams with usually breakfast and dinner I'll do.

Doctor Don Musalem: 00:37:49

I just keep it pretty simple.

Doctor Don Musalem: 00:37:51

But you must talk to your doctor about this before you start it again because of the potential liver toxicity.

Doctor Don Musalem: 00:37:56

These aren't things I like to start necessarily during chemotherapy, but I have.

Doctor Don Musalem: 00:38:01

I do use it occasionally during treatment for some of my women.

Doctor Don Musalem: 00:38:04

It seems to dampen down diarrhea for some women as well on certain treatments.

Rick Esselstyn: 00:38:08

Right.

Rick Esselstyn: 00:38:08

What exactly is Berberine?

Rick Esselstyn: 00:38:10

Do you know where it comes from, what it is?

Doctor Don Musalem: 00:38:13

You know, I can't answer that for you.

Doctor Don Musalem: 00:38:15

I should know that, but I actually can't answer exactly what constituent it's coming from in terms of what plant.

Rick Esselstyn: 00:38:20

Oh, well, good.

Rick Esselstyn: 00:38:21

We finally stumped.

Rick Esselstyn: 00:38:23

Done.

Doctor Don Musalem: 00:38:24

Oh, good.

Doctor Don Musalem: 00:38:25

Doctor Don Musalem: 00:38:26

We should look it up.

Doctor Don Musalem: 00:38:36

You know, I looked at some expert the other day, and you know what?

Doctor Don Musalem: 00:38:39

They were using an iPad, when they were talking, I was like, oh, that's so smart.

Doctor Don Musalem: 00:38:43

But there is this new database that Mayo clinic supports, Cleveland clinic, all the very large medical centers.

Doctor Don Musalem: 00:38:48

And it gives you.

Doctor Don Musalem: 00:38:50

So it's an, uh, let's see.

Doctor Don Musalem: 00:38:52

From several plants, most notably the genus Berberis.

Doctor Don Musalem: 00:38:56

Man, I could probably just guess that, right?

Doctor Don Musalem: 00:38:58

We could have been like.

Doctor Don Musalem: 00:38:59

So it's an alkaloid derivative.

Doctor Don Musalem: 00:39:01

So it comes from several plants.

Doctor Don Musalem: 00:39:03

That's really interesting.

Doctor Don Musalem: 00:39:04

Berberis vulgaris.

Doctor Don Musalem: 00:39:06

So, anyways, there we go.

Doctor Don Musalem: 00:39:08

And it comes with a few other plants, too.

Doctor Don Musalem: 00:39:09

Yeah.

Rick Esselstyn: 00:39:10

Plants.

Rick Esselstyn: 00:39:11

Plants to the rescue.

Rick Esselstyn: 00:39:12

Plants, plants, plants, plants.

Doctor Don Musalem: 00:39:15

So that search engines called open evidence, it's fascinating.

Doctor Don Musalem: 00:39:19

You know, it pulls from all the major academic centers.

Doctor Don Musalem: 00:39:23

You're getting solid evidence.

Doctor Don Musalem: 00:39:24

It's almost.

Doctor Don Musalem: 00:39:24

It's an artificial intelligence search engine.

Doctor Don Musalem: 00:39:27

So, you know, chat, GPT.

Doctor Don Musalem: 00:39:28

You need to be very careful with.

Doctor Don Musalem: 00:39:30

You can end up with information that's not accurate.

Doctor Don Musalem: 00:39:32

Yeah, yeah.

Doctor Don Musalem: 00:39:33

So it's really cool.

Doctor Don Musalem: 00:39:34

And then when you pull it up, it gives you references.

Doctor Don Musalem: 00:39:37

So it'll go to therapeutic and biologic activities of berberine.

Doctor Don Musalem: 00:39:41

Berberine isolation from.

Doctor Don Musalem: 00:39:43

And it'll give you more studies to pull from.

Doctor Don Musalem: 00:39:45

It's really.

Doctor Don Musalem: 00:39:46

You'll get, like, lost in it.

Doctor Don Musalem: 00:39:47

It's pretty funny.

Rick Esselstyn: 00:39:50

Brave new world.

Rick Esselstyn: 00:39:53

Let's talk about some mushrooms.

Rick Esselstyn: 00:39:55

Lion's mane and turkey tail.

Rick Esselstyn: 00:40:00

What are your thoughts on these guys?

Doctor Don Musalem: 00:40:02

So let's start with turkey tail, because that is another common one my patients come in taking.

Doctor Don Musalem: 00:40:07

There's hundreds of years of research from Asia with the benefits of turkey tail during chemotherapy that show improved health related quality of life.

Doctor Don Musalem: 00:40:16

This is my concern with turkey tail.

Doctor Don Musalem: 00:40:19

It does augment the immune system, so people with celiac disease should not use it, potentially making it more sensitive myself.

Doctor Don Musalem: 00:40:26

People with organ transplants should not use it.

Doctor Don Musalem: 00:40:28

It can augment the immune system to push you into rejection.

Doctor Don Musalem: 00:40:31

So if we have these warnings on this sort of a supplement, it tells us it's working.

Doctor Don Musalem: 00:40:36

So it is enhancing the immune system.

Doctor Don Musalem: 00:40:39

In fact.

Doctor Don Musalem: 00:40:40

Interesting, interesting fact.

Doctor Don Musalem: 00:40:42

That sounds right.

Doctor Don Musalem: 00:40:44

But during COVID this was a concern people, if they were taking turkey tail, the destruction from COVID was like an overdoing of our immune system when it would kind of attack the lung tissue.

Doctor Don Musalem: 00:40:56

And so turkey tail was something I told all my patients, do not use.

Doctor Don Musalem: 00:41:00

This is very risky.

Doctor Don Musalem: 00:41:01

They could use more of a balanced mushroom supplement, but not turkey tail itself, because it augments the immune system so much.

Doctor Don Musalem: 00:41:09

Let's talk about breast cancer.

Doctor Don Musalem: 00:41:11

Could it have a therapeutic opportunity to enhance treatment effects?

Doctor Don Musalem: 00:41:15

Well, maybe, but maybe with risk.

Doctor Don Musalem: 00:41:18

So I am extremely worried about turkey tail.

Doctor Don Musalem: 00:41:22

Used in combination with immunotherapy.

Doctor Don Musalem: 00:41:25

You would think this would be a really great thing because you're augmenting the immune system.

Doctor Don Musalem: 00:41:29

So maybe in old people, maybe it could be okay.

Doctor Don Musalem: 00:41:32

We're helping both things work together.

Doctor Don Musalem: 00:41:34

But I've seen a few young women end up with some autoimmune sequelae, one with colitis, one with a pneumonitis, and both of them were taking turkey tail.

Doctor Don Musalem: 00:41:44

The oncologist sent them to see me to say, hey, what do you think?

Doctor Don Musalem: 00:41:46

Are they taking anything that you're concerned about?

Doctor Don Musalem: 00:41:48

And I started to see this pattern, so I sent a message out to our team that, please, before you start the immunotherapies, ask patients if they're taking turkey tail.

Doctor Don Musalem: 00:41:59

We did a study at Mayo that showed 91% of our patients are taking supplements.

Doctor Don Musalem: 00:42:03

At least five.

Doctor Don Musalem: 00:42:05

And a large percentage of these had directly drug interactions.

Doctor Don Musalem: 00:42:08

And a lot of patients, this is hopeful for them, and they don't even think of telling the doctor.

Doctor Don Musalem: 00:42:13

They just think these things are benign.

Doctor Don Musalem: 00:42:15

But I'm really worried about the harm that turkey tail can cause in combination with immunotherapy.

Doctor Don Musalem: 00:42:19

So I never want patients using it in that setting.

Doctor Don Musalem: 00:42:22

I have had some women with metastatic cancer who are on just longstanding medication management that there is no confirmed drug interaction.

Doctor Don Musalem: 00:42:34

And I do review the drug interactions of different pathways extensively.

Doctor Don Musalem: 00:42:37

And so for some of them, I use turkey tail to enhance their quality of life.

Doctor Don Musalem: 00:42:41

But it's pretty rare because I have so many other things that I can use that I just don't have to worry about.

Doctor Don Musalem: 00:42:46

And what I find with patients is when they take a supplement, first of all, this is expensive.

Doctor Don Musalem: 00:42:50

There's a lot of financial toxicity.

Doctor Don Musalem: 00:42:51

With cancer, you must be careful with the brands you're buying, because some of these brands can have heavy metals contaminants.

Doctor Don Musalem: 00:42:58

If it's not a high quality product, you really don't know what you're getting yourself into.

Doctor Don Musalem: 00:43:02

You could be getting far less than you are actually paying for or far more than you're paying for, and either one can end up to be a problem.

Doctor Don Musalem: 00:43:09

So I want folks to be very, very careful.

Doctor Don Musalem: 00:43:12

I use a database to determine what brands to use.

Doctor Don Musalem: 00:43:15

It's called natural Medicine database.

Doctor Don Musalem: 00:43:17

It's a database that Mayo Clinic provides for me to search what brands would be effective.

Doctor Don Musalem: 00:43:22

It also is a company that goes through or a search engine that goes through and rates them.

Doctor Don Musalem: 00:43:28

You know, which ones may have heavy metals, which ones are safer.

Rick Esselstyn: 00:43:30

Doctor Don Musalem: 00:43:31

And also, I feel consumer lab is another nice search engine for patients to look up some of these questions.

Doctor Don Musalem: 00:43:37

They may have consumer labs has been around for quite some time and that would be more patient facing or consumer facing that membership.

Rick Esselstyn: 00:43:44

Got it.

Rick Esselstyn: 00:43:47

What do you think?

Rick Esselstyn: 00:43:48

Are we good with supplements?

Rick Esselstyn: 00:43:49

Should we move on, or is there anything else that I miss?

Rick Esselstyn: 00:43:52

Anything that you can think of?

Doctor Don Musalem: 00:43:54

I think you hit it.

Doctor Don Musalem: 00:43:54

You asked lion's man.

Doctor Don Musalem: 00:43:55

I didn't hit on that.

Doctor Don Musalem: 00:43:56

So I love shout out Dean Ornish's recent study with his amazing lifestyle medicine application to care.

Doctor Don Musalem: 00:44:04

But he used some unique supplements, and lion's mane was one of them.

Doctor Don Musalem: 00:44:07

So I think lion's mane is going to certainly have a place in the future for cognitive protection, maybe even cognitive enhancement.

Doctor Don Musalem: 00:44:15

Again during chemo.

Doctor Don Musalem: 00:44:17

I just don't like to use supplements.

Doctor Don Musalem: 00:44:19

One of the best ways to ward off chemo brain is exercise.

Doctor Don Musalem: 00:44:22

So I always, whenever it comes to supplements, everything we do in medicine is first do no harm.

Doctor Don Musalem: 00:44:28

You know, as soon as you enter that arena of supplements, you could be entertained the idea of some harm.

Doctor Don Musalem: 00:44:33

So you want to be very, very careful.

Doctor Don Musalem: 00:44:34

There's no way you can hurt yourself with healthy eating, and you shouldn't hurt yourself with exercise as long as your shoelaces are tied and, you know, the lights are on kind of a thing.

Doctor Don Musalem: 00:44:43

Right?

Doctor Don Musalem: 00:44:43

So we.

Rick Esselstyn: 00:44:49

Had to go through chemo, didn't you?

Doctor Don Musalem: 00:44:51

I did, yeah.

Rick Esselstyn: 00:44:53

Yeah, yeah.

Rick Esselstyn: 00:44:53

So.

Rick Esselstyn: 00:44:54

So in that regard, you can probably relate to a lot of your patients that are having to go through chemo in a way that I would imagine a lot of physicians can't.

Doctor Don Musalem: 00:45:05

It really is such a gift that I can be in that space with them.

Doctor Don Musalem: 00:45:09

I would never trade in what I went through, you know?

Doctor Don Musalem: 00:45:13

And when you're going through chemo, there's not necessarily nausea that we are not necessarily, like, overt vomiting, I should say that we see with patients now, but a lot of them have the low level nausea.

Doctor Don Musalem: 00:45:21

They just feel kind of queasy.

Doctor Don Musalem: 00:45:23

They're not throwing up.

Doctor Don Musalem: 00:45:24

It's not like you see in the movies, but that's an awful feeling.

Doctor Don Musalem: 00:45:29

You know, I think nausea is potentially one of the worst feelings someone could ever experience.

Doctor Don Musalem: 00:45:36

And so ways to mitigate nausea are something that I really like to support patients with because it is such a quality of life reducing feature.

Doctor Don Musalem: 00:45:46

And there are some integrative modalities that I use and all.

Doctor Don Musalem: 00:45:49

If you don't mind, I would love to mention this, because this is a super cool thing.

Doctor Don Musalem: 00:45:53

The C band, you know, the little cheap things you can buy on Amazon, they're like $7.

Doctor Don Musalem: 00:45:57

Those sea bands you wear, if you go on a boat.

Rick Esselstyn: 00:46:00

Yeah, totally.

Doctor Don Musalem: 00:46:02

Yeah.

Doctor Don Musalem: 00:46:03

Little acupoints.

Doctor Don Musalem: 00:46:04

The p six acupressure point.

Doctor Don Musalem: 00:46:06

There was an amazing study that did show that it reduced the feeling of retching, nausea, and vomiting in cancer patients undergoing chemotherapy.

Doctor Don Musalem: 00:46:14

You were at the day of chemo and then four days after chemo, so five days total.

Doctor Don Musalem: 00:46:19

I have all my patients do that who are on chemotherapy that are known to cause higher levels of this nausea feeling, and it gives them a lot of relief.

Doctor Don Musalem: 00:46:26

So that's a fun fact for nausea.

Doctor Don Musalem: 00:46:29

And I usually pair it up with some acupuncture.

Doctor Don Musalem: 00:46:31

If that nausea continues to be a problem, a lot of folks will use ginger, but.

Doctor Don Musalem: 00:46:36

Oh, I do actually have them do ginger tea.

Doctor Don Musalem: 00:46:38

Like a nice little turmeric ginger tea or a chamomile ginger tea.

Doctor Don Musalem: 00:46:44

Plants plant strongs.

Doctor Don Musalem: 00:46:47

Chamomile ginger or chamomile turmeric tea is my favorite, actually.

Doctor Don Musalem: 00:46:50

That's yours.

Doctor Don Musalem: 00:46:51

That's good.

Rick Esselstyn: 00:46:51

Yeah, yeah, yeah, yeah.

Rick Esselstyn: 00:46:53

Well, thank you for that.

Rick Esselstyn: 00:46:56

So, anything more on lion's mane?

Rick Esselstyn: 00:46:58

Are we good?

Doctor Don Musalem: 00:46:59

Yeah, I mean, you know, Dean Ornish's study really promoted that, and I think that there is definitely a place in cancer patients.

Doctor Don Musalem: 00:47:05

I guess it's not something I like to entertain for chemo brain, but I see a lot of them are starting to take that.

Doctor Don Musalem: 00:47:10

I would worry about drug interactions, but in the survivorship phase, I give the green light.

Doctor Don Musalem: 00:47:14

With lion's mane, the only problem would be I feel financial toxicity.

Doctor Don Musalem: 00:47:18

It's pretty darn expensive, and you would just want to make sure that you're getting a brand that's high quality.

Doctor Don Musalem: 00:47:23

I want people to be very careful with that because it's a hot item right now.

Doctor Don Musalem: 00:47:26

So everyone's coming on the market promoting it.

Doctor Don Musalem: 00:47:28

So we need to be very careful to use high quality products.

Rick Esselstyn: 00:47:31

Right.

Rick Esselstyn: 00:47:32

So we just talked a little bit about chemo.

Rick Esselstyn: 00:47:35

I have a follow up question on kind of chemo and radiation, specifically if, you know, if it has an effect on the microbiome.

Rick Esselstyn: 00:47:43

And if so, do you have any recommendations for your breast cancer patients?

Doctor Don Musalem: 00:47:51

Yeah, thanks for asking that, rip.

Doctor Don Musalem: 00:47:52

And that's actually area of research that we're currently actively putting protocols together to continue to investigate this further to understand what is the chemo doing the gut microbiome.

Doctor Don Musalem: 00:48:01

But the space that we are actively looking at study design, and we have a current protocol we're working at getting funded, is actually looking at a whole food plant only diet that is a medically tailored meal to look at the impact of optimizing the gut microbiome and the impact of that optimization that we know helps to regulate the immune system for the chemo immunotherapy to actually be more effective at the level of the tumor.

Doctor Don Musalem: 00:48:26

So, extremely exciting study.

Doctor Don Musalem: 00:48:28

So I had a really exciting meeting earlier today about getting this study funded, and I'm hopeful.

Doctor Don Musalem: 00:48:34

We've been denied multiple times.

Doctor Don Musalem: 00:48:35

Actually hard to get these sort of studies off the ground because you're competing against, you know, some of these other novel drug therapies, immunotherapies.

Doctor Don Musalem: 00:48:42

But I think hopefully we will be getting it funded here soon.

Doctor Don Musalem: 00:48:45

To help to answer that question, I'm not.

Doctor Don Musalem: 00:48:48

I stick to the basics.

Doctor Don Musalem: 00:48:49

You know, I want my patients to get food diversity.

Doctor Don Musalem: 00:48:52

Sometimes it can be a little bit hard during cancer treatment, but I really work closely with them, with the various foods that they can tolerate to really enhance.

Doctor Don Musalem: 00:48:59

Trying to get at least 30 different plant foods a week, week to help to enhance that gut microbiome, you know, trying to make sure we don't overuse antibiotics unnecessarily.

Doctor Don Musalem: 00:49:08

Thinking about crazy things like mouthwash, like, you know, it starts in the mouth rip.

Doctor Don Musalem: 00:49:12

I think you've said that before, even.

Doctor Don Musalem: 00:49:13

Right?

Doctor Don Musalem: 00:49:14

So, you know, let's.

Doctor Don Musalem: 00:49:15

Let's just try to keep things as basic as possible.

Doctor Don Musalem: 00:49:18

I don't like to overuse probiotics.

Doctor Don Musalem: 00:49:20

I don't.

Doctor Don Musalem: 00:49:20

I don't think that we're really good at using precision probiotics currently at this time right now, anyways.

Doctor Don Musalem: 00:49:26

So I'm not a big promoter of probiotics, honestly.

Rick Esselstyn: 00:49:29

Yeah.

Rick Esselstyn: 00:49:30

Yeah.

Rick Esselstyn: 00:49:31

Uh, what about, like, I.

Rick Esselstyn: 00:49:33

So I love the fact that you said you just kind of go back to the basics, right?

Rick Esselstyn: 00:49:39

I mean, let's go back to the basic blocking and tackling, which is kind of whole food, plant based.

Rick Esselstyn: 00:49:43

You mentioned, you know, the 30 different varieties of whole plant based foods.

Rick Esselstyn: 00:49:49

I think going back to the american gut project, which is what they recommended.

Rick Esselstyn: 00:49:53

Um, but I know that you also are a fan of resistant starches and, uh, fermented plants.

Rick Esselstyn: 00:49:59

Can you talk a little bit about both those things?

Doctor Don Musalem: 00:50:02

Yeah, I mean, beans are great, you know, amazing.

Doctor Don Musalem: 00:50:05

And breast cancer research, there was really cool data that showed that melanoma, that was, like, the first place that they started using the immunotherapies really regularly, and they found that, wait a minute, these people with a more diverse gut microbiome are having improved effects.

Doctor Don Musalem: 00:50:20

So every doctor in the world started giving probiotics.

Doctor Don Musalem: 00:50:23

No one got better.

Doctor Don Musalem: 00:50:23

Right?

Doctor Don Musalem: 00:50:24

And then they kind of looked a little bit further and they found it was really the resistant starch and beans seemed to be, like, the magic.

Doctor Don Musalem: 00:50:29

So this was American Institute for Cancer Research.

Doctor Don Musalem: 00:50:32

By golly, this is.

Doctor Don Musalem: 00:50:33

What year would this have been?

Doctor Don Musalem: 00:50:34

This is probably like: 2015

Doctor Don Musalem: 00:50:39

Like, everyone's spending all this money on probiotics.

Doctor Don Musalem: 00:50:42

And when someone's immunocompromised, there was actually a question, like, could probiotics be harmful?

Doctor Don Musalem: 00:50:46

And there are some strains of probiotics that we kind of want to say, no time out.

Doctor Don Musalem: 00:50:51

There could be something called translocation where it could be in the GI tract and maybe absorbed and cause potential blood infections.

Doctor Don Musalem: 00:50:59

Again, first, do no harm.

Doctor Don Musalem: 00:51:01

Get out of the body's way.

Doctor Don Musalem: 00:51:02

Let it do what it needs to do.

Doctor Don Musalem: 00:51:03

Nourish the body with what it needs.

Doctor Don Musalem: 00:51:06

This is so simple.

Doctor Don Musalem: 00:51:09

It's just so nice to be in the space with the patient and just help to simplify this.

Doctor Don Musalem: 00:51:14

Still give them hope that they have an active role to participate in their care.

Doctor Don Musalem: 00:51:19

But it doesn't mean that they have to spend gobs of money on supplements to accomplish that particular goal.

Rick Esselstyn: 00:51:25

Totally.

Rick Esselstyn: 00:51:26

And, you know, with the thing with resistant starches, another great form of resistant starch comes in potatoes.

Rick Esselstyn: 00:51:32

Yes, potatoes.

Doctor Don Musalem: 00:51:36

They're so high in potassium, so my women are having a lot of diarrhea and some of the treatments, and everyone's like, oh, I eat my banana.

Doctor Don Musalem: 00:51:42

I'm like, just have a potato.

Rick Esselstyn: 00:51:45

Potato.

Rick Esselstyn: 00:51:46

A little medium potato has more potassium than banana.

Rick Esselstyn: 00:51:49

Really.

Rick Esselstyn: 00:51:49

I mean, it's incredible.

Doctor Don Musalem: 00:51:50

And what I have them do is heat the potatoes on the weekend, put them in the refrigerator.

Doctor Don Musalem: 00:51:55

Right?

Doctor Don Musalem: 00:51:56

So the glycemic load is a little bit lower.

Doctor Don Musalem: 00:51:59

So I think that's great.

Doctor Don Musalem: 00:51:59

The only thing I think that's funny is I hear some experts saying, toast bread, put in the refrigerator, then heat it up.

Doctor Don Musalem: 00:52:04

I'm like, okay, you're taking it too far.

Doctor Don Musalem: 00:52:06

Sounds gross.

Rick Esselstyn: 00:52:07

No?

Doctor Don Musalem: 00:52:08

Wow.

Rick Esselstyn: 00:52:10

I have heard it now, though.

Doctor Don Musalem: 00:52:12

Yes.

Doctor Don Musalem: 00:52:13

I don't do that.

Doctor Don Musalem: 00:52:14

I'm not that great.

Doctor Don Musalem: 00:52:15

I'm not that committed, I guess.

Doctor Don Musalem: 00:52:16

I'm like, nope, I'm going to toast my bread, my sprouted bread, and enjoy it on the spot.

Rick Esselstyn: 00:52:20

What I'm going to do.

Rick Esselstyn: 00:52:21

What about fermented plants?

Doctor Don Musalem: 00:52:24

Yeah, I love kimchi for, for folks.

Doctor Don Musalem: 00:52:27

I think it's great tempeh, you know, so I'm definitely a promoter of those various foods, too.

Doctor Don Musalem: 00:52:32

I have to be a little bit careful with some of that when they're undergoing chemotherapy, if their counts are dropping.

Doctor Don Musalem: 00:52:37

I don't like to be too pushy, but into the survivorship phase, total green light.

Doctor Don Musalem: 00:52:42

A lot of them will do some of the plant based yogurts, and not all the plant based yogurts even have fermented product in it, so they would want to be mindful of that.

Doctor Don Musalem: 00:52:51

And a lot of the plant based yogurts are just so processed.

Doctor Don Musalem: 00:52:53

I'm.

Doctor Don Musalem: 00:52:53

I'm not super.

Doctor Don Musalem: 00:52:55

I personally don't use them myself, and so we really kind of go through to make sure if they're using them, it's one that's going to be okay.

Doctor Don Musalem: 00:53:00

A lot of them are just doing it because they like the experience of that sort of a thing.

Doctor Don Musalem: 00:53:05

I usually recommend what's in be a plant based woman warrior in the xander tart, where you take the tofu with the raspberries and a little bit of maple syrup and lemon rind and some lemon juice.

Doctor Don Musalem: 00:53:20

And I haven't mixed that up.

Doctor Don Musalem: 00:53:21

It's kind of like a tofu derivative or, you know, a yogurt derivative.

Doctor Don Musalem: 00:53:24

Of course, there's no cultures in that either, but it's good.

Doctor Don Musalem: 00:53:26

And then I think that's also a shout out in terms of what other fermented foods do you do?

Doctor Don Musalem: 00:53:31

I like, you know, I'm okay with sourdough bread.

Doctor Don Musalem: 00:53:34

I would much rather my patients do sprouted bread.

Doctor Don Musalem: 00:53:38

But if they want to do a true sourdough bread, you know, if you go to your grocery store and it's, like, the soft bread and it says sourdough, you need to make sure that it truly is sourdough.

Doctor Don Musalem: 00:53:48

Most of the store not.

Doctor Don Musalem: 00:53:50

But if someone's getting real sourdough, I have a lot of patients that make it themselves.

Doctor Don Musalem: 00:53:53

They enjoy doing that.

Doctor Don Musalem: 00:53:54

So I give them the green light on that as well, for further.

Rick Esselstyn: 00:53:57

Evan?

Rick Esselstyn: 00:53:58

Well, you mentioned sprouted.

Rick Esselstyn: 00:54:02

What I've been doing lately is I've been getting the Ezekiel 49 sprouted wraps.

Rick Esselstyn: 00:54:07

Um, and I just throw them in the.

Rick Esselstyn: 00:54:09

Throw in the toaster for a minute and a half, and then I throw on oil free hummus, two big handfuls of arugula, uh, usually four slices of tofu, sriracha sauce, and then a little bit of avocado, and I'm in heaven.

Doctor Don Musalem: 00:54:27

Oh, yeah.

Doctor Don Musalem: 00:54:28

That sounds so good.

Doctor Don Musalem: 00:54:29

So, I.

Doctor Don Musalem: 00:54:30

Can I share a funny story?

Doctor Don Musalem: 00:54:31

I think I may talk maybe too much.

Doctor Don Musalem: 00:54:33

Sorry if I am.

Doctor Don Musalem: 00:54:34

So.

Doctor Don Musalem: 00:54:35

This is funny.

Doctor Don Musalem: 00:54:36

So, when I had my transplant, you know, I would obviously only do plant foods.

Doctor Don Musalem: 00:54:41

And so to get my protein, I would do edamame at lunchtime and a wrap.

Doctor Don Musalem: 00:54:45

And so I had my wrap, and there was edamame in it.

Doctor Don Musalem: 00:54:47

I had to make it for me, and I was eating it, and, you know, I really couldn't move.

Doctor Don Musalem: 00:54:51

I had all these tubes in me.

Doctor Don Musalem: 00:54:52

So I'm eating it, and the edamame are rolling on the floor.

Doctor Don Musalem: 00:54:55

So in the hospital, there was, like, edamame rolling out of my wrapped sandwich onto the floor, and I'm like, oh, don't mind me.

Doctor Don Musalem: 00:55:01

Don't step on the edamame.

Doctor Don Musalem: 00:55:04

Help me clean that up, and in a week, I'll be able to do this on my own.

Doctor Don Musalem: 00:55:07

But right now, I need some help.

Doctor Don Musalem: 00:55:08

And I know they're probably like, did she stop eating those darn sandwiches?

Doctor Don Musalem: 00:55:12

It was really cute.

Doctor Don Musalem: 00:55:14

It was a good memory.

Rick Esselstyn: 00:55:16

Wow.

Rick Esselstyn: 00:55:16

Wow.

Rick Esselstyn: 00:55:18

All right, so we're almost approaching an hour here, and I feel like we haven't even gotten started.

Doctor Don Musalem: 00:55:24

But.

Rick Esselstyn: 00:55:24

No, but we have.

Rick Esselstyn: 00:55:26

So let's talk about sleep.

Rick Esselstyn: 00:55:28

And I know you're not technically a sleep expert, but I think you've got some pretty good thoughts on sleep regarding maybe hygiene and alcohol and even people that are having sleep apnea.

Rick Esselstyn: 00:55:46

So if you could address some of those things, it's so important.

Doctor Don Musalem: 00:55:50

Sleep.

Doctor Don Musalem: 00:55:51

I joked about it when you and I chatted the last time, but, gosh, you know, you can eat perfect, you can exercise perfect, but if you're not sleeping, you're really just working against yourself.

Doctor Don Musalem: 00:56:01

So you have to prioritize.

Doctor Don Musalem: 00:56:02

Sleep seven to 9 hours a night.

Doctor Don Musalem: 00:56:05

You don't need more than that.

Doctor Don Musalem: 00:56:05

By the way, I had a woman the other day was getting, like, 12 hours.

Doctor Don Musalem: 00:56:07

I'm like, let's set your alarm at 9 hours and get your day.

Doctor Don Musalem: 00:56:10

Let's start enjoying the fact that we're alive.

Doctor Don Musalem: 00:56:14

Get up.

Doctor Don Musalem: 00:56:15

Call me.

Doctor Don Musalem: 00:56:16

I'll give you some energy.

Doctor Don Musalem: 00:56:17

We'll get the day going.

Doctor Don Musalem: 00:56:18

So up to 70% of cancer survivors have insomnia.

Doctor Don Musalem: 00:56:23

That's a huge number.

Doctor Don Musalem: 00:56:24

And the first thing that I really want to shout out again, as you mentioned, rip, is that sleep hygiene.

Doctor Don Musalem: 00:56:29

You know, the number one reason people, in my opinion, feel insomnia is because it's way too much blue light exposure during the day and not enough daylight.

Doctor Don Musalem: 00:56:38

So we talked earlier.

Doctor Don Musalem: 00:56:39

I tell my patients, as soon as you wake up, I want you to get up, look at that gorgeous sunshine, get that sunlight, and you start to actually increase your melatonin by doing that.

Doctor Don Musalem: 00:56:51

So that's good, right?

Doctor Don Musalem: 00:56:52

You want that melatonin by the time you go to bed at night.

Doctor Don Musalem: 00:56:55

But if you're on the screen being exposed to all that blue light during the day, that blue light starts to slowly drop the melatonin as we go.

Doctor Don Musalem: 00:57:04

So blue light.

Doctor Don Musalem: 00:57:05

I have my patients use blue light glasses or if they're on screens, get blue light protectors.

Doctor Don Musalem: 00:57:09

Very important.

Doctor Don Musalem: 00:57:10

Sleep apnea.

Doctor Don Musalem: 00:57:12

You know, about 26% of adults have sleep apnea, but about 20% of those are actually people that don't snore.

Doctor Don Musalem: 00:57:22

And we know that sleep apnea can increase blood pressure.

Doctor Don Musalem: 00:57:25

So if I have a patient who has high blood pressure and I notice that they've never had sleep apnea testing, and they're on two or three medications for blood pressure, I'm thinking, gosh, this is so crazy.

Doctor Don Musalem: 00:57:34

Like, no one's checked their sleep apnea or overnight oximetry.

Doctor Don Musalem: 00:57:38

I send probably 95% or more of my patients for an overnight oximetry because it is critical to make sure there's not sleep apnea.

Doctor Don Musalem: 00:57:49

If sleep apnea is present, you're not metabolically optimized.

Doctor Don Musalem: 00:57:53

It's more likely that your blood sugar is going to be less regulated.

Doctor Don Musalem: 00:57:56

It's also likely that your cholesterol is going to be higher.

Doctor Don Musalem: 00:57:59

I am a big believer in overnight oximetry testing for all of my patients.

Doctor Don Musalem: 00:58:03

I love it.

Doctor Don Musalem: 00:58:05

It's so cool, it.

Doctor Don Musalem: 00:58:06

Mayo.

Doctor Don Musalem: 00:58:06

I have experts in all the different specialties that love this stuff.

Doctor Don Musalem: 00:58:11

Doctor Joseph Chung.

Doctor Don Musalem: 00:58:13

He is currently researching the impact of a whole food plant only diet on inflammation in sleep apnea to show reduction in that sleep apnea score.

Doctor Don Musalem: 00:58:21

Just with the implementation of this diet, it's been fun working with him with some of the studies in that space.

Doctor Don Musalem: 00:58:26

Then it's important also to ask, why can't you sleep?

Doctor Don Musalem: 00:58:32

Is it stress of the diagnosis?

Doctor Don Musalem: 00:58:34

Is it hot flashes?

Doctor Don Musalem: 00:58:35

It's usually hot flashes for my patients, so I'm really aggressive at treating those hot flashes for the women I see, because a lot of the medicines that I'm giving are causing those hot flashes.

Doctor Don Musalem: 00:58:45

And, man, that's so disrupting from.

Doctor Don Musalem: 00:58:47

They wake up, they're shoving the sheets off, they're soaking wet, then they're cold.

Doctor Don Musalem: 00:58:52

It's just such a rough night.

Doctor Don Musalem: 00:58:54

I really.

Doctor Don Musalem: 00:58:54

My heart goes out to them.

Rick Esselstyn: 00:58:56

Is that.

Rick Esselstyn: 00:58:56

Is that something that you've experienced, the hot flashes?

Doctor Don Musalem: 00:58:59

Oh, yeah.

Doctor Don Musalem: 00:59:00

So I.

Doctor Don Musalem: 00:59:00

It's interesting.

Doctor Don Musalem: 00:59:01

So I kind of stumbled across something.

Doctor Don Musalem: 00:59:04

This is why I love being a patient.

Doctor Don Musalem: 00:59:06

Face all the sense of like, oh, good, figure this out.

Doctor Don Musalem: 00:59:08

This is great.

Doctor Don Musalem: 00:59:09

And then everyone's like, oh, she's so smart.

Doctor Don Musalem: 00:59:10

I'm like, oh, no, I just was a patient.

Doctor Don Musalem: 00:59:11

I figured it out for myself.

Doctor Don Musalem: 00:59:13

Not smart at all.

Doctor Don Musalem: 00:59:14

It just helps to be a patient.

Doctor Don Musalem: 00:59:15

So hot flashes.

Doctor Don Musalem: 00:59:17

So I was on.

Doctor Don Musalem: 00:59:18

They put me on magnesium years ago because of all my heart issues, and I took it for a while.

Doctor Don Musalem: 00:59:22

And I stopped taking.

Doctor Don Musalem: 00:59:23

I'm like, I hate taking supplements, right?

Doctor Don Musalem: 00:59:26

And I didn't think about it, right?

Doctor Don Musalem: 00:59:28

And I get hot, and then my daughter's like, you need to take your magnesium.

Doctor Don Musalem: 00:59:31

So I started taking it again, and it died.

Doctor Don Musalem: 00:59:34

I'm like, wait a minute.

Doctor Don Musalem: 00:59:34

When I'm on magnesium, I have no hot flashes.

Doctor Don Musalem: 00:59:36

When I'm not on it, I do.

Doctor Don Musalem: 00:59:39

So what's going on?

Doctor Don Musalem: 00:59:40

So I started introducing my patients.

Doctor Don Musalem: 00:59:41

Hey, take some magnesium glycinate at night when you go to bed, let me know what you feel from it.

Doctor Don Musalem: 00:59:45

They'd come back and, man, I'm sleeping better.

Doctor Don Musalem: 00:59:48

Why do you think you're sleeping better?

Doctor Don Musalem: 00:59:49

I think my hot flashes have reduced.

Doctor Don Musalem: 00:59:50

I said, interesting.

Doctor Don Musalem: 00:59:52

So I did a study a few years back, and sure enough, we see a reduction in hot flashes with the magnesium.

Doctor Don Musalem: 00:59:59

This is important.

Doctor Don Musalem: 01:00:01

Magnesium glycinate is nicely absorbed in the bloodstream, and it goes where it should go.

Doctor Don Musalem: 01:00:06

It also crosses the blood brain barrier, so it gives you this beautiful relaxation.

Doctor Don Musalem: 01:00:10

It's really nice.

Doctor Don Musalem: 01:00:11

It can help relax and sleep, and then it seems to help hot flashes a little bit.

Doctor Don Musalem: 01:00:16

Not dramatic, but there's a little bit of a benefit.

Doctor Don Musalem: 01:00:18

So I love it.

Doctor Don Musalem: 01:00:19

To help sleep, it's my first supplement that I lean in on is magnesium glucose.

Doctor Don Musalem: 01:00:23

Listening.

Rick Esselstyn: 01:00:24

Wow.

Rick Esselstyn: 01:00:27

Yeah.

Rick Esselstyn: 01:00:28

No, and that was, and so I know that this was a different kind of supplement specifically for the hot flashes, but it's something we didn't mention in the supplementation because I guess so it's because it's so specific.

Doctor Don Musalem: 01:00:41

Right.

Doctor Don Musalem: 01:00:41

Well, and I waited because I knew, I was hoping it was going to mention.

Doctor Don Musalem: 01:00:47

I was like, oh, we're going to bridge back.

Doctor Don Musalem: 01:00:49

Sneaky.

Rick Esselstyn: 01:00:50

Okay.

Doctor Don Musalem: 01:00:51

Yeah.

Doctor Don Musalem: 01:00:51

I talk too much.

Doctor Don Musalem: 01:00:52

I try to be really clever about where I'm going to put my words.

Rick Esselstyn: 01:00:55

Oh, well, you are, but so is my magnesium glycinate.

Rick Esselstyn: 01:01:02

Is it a liquid?

Rick Esselstyn: 01:01:03

Is it a pill?

Rick Esselstyn: 01:01:04

What is it?

Doctor Don Musalem: 01:01:05

So I usually use a capsule.

Doctor Don Musalem: 01:01:07

And you do want to look at the different brands, and I don't think I could probably recommend brands in here.

Doctor Don Musalem: 01:01:11

I would be careful doing that.

Doctor Don Musalem: 01:01:13

But it's important that you look at the label, because some magnesium glycinates, you have to take four pills to get 400 milligrams, and the dose I recommend for patients is 400 milligrams at night.

Doctor Don Musalem: 01:01:25

Some of my patients do between 400 to 500 milligrams at night.

Doctor Don Musalem: 01:01:29

So that's how much I want you taking.

Doctor Don Musalem: 01:01:31

So you need to look at that label.

Doctor Don Musalem: 01:01:32

There are a few brands that are out there.

Doctor Don Musalem: 01:01:34

That one pill equals 400 to 500 milligrams, and those are the ones I have my patients taking.

Doctor Don Musalem: 01:01:40

Okay.

Doctor Don Musalem: 01:01:41

There are some powders you can do.

Doctor Don Musalem: 01:01:43

You know, if someone is taking four pills before I go to bed at night, I'm not super thrilled about that.

Doctor Don Musalem: 01:01:47

That's a lot of pills just sitting on your.

Doctor Don Musalem: 01:01:49

In your GI tract.

Doctor Don Musalem: 01:01:50

So there's nice powders you can do as well with the magnesium.

Doctor Don Musalem: 01:01:54

Just take a look at the label and find out what they're sweetening it with, if there's any fillers.

Doctor Don Musalem: 01:01:58

When you get into that whole powder territory, you start to run the risk of other additives being added into it.

Doctor Don Musalem: 01:02:03

So just be mindful.

Rick Esselstyn: 01:02:04

Evan, is there any other reasons why somebody would want to be taking this supplementation?

Doctor Don Musalem: 01:02:09

Well, the majority of Americans are deficient in magnesium, so I get them on it to help them with their sleep, knowing that I'm closing this nutrient gap of magnesium that is very prominent in our country, also for bone optimization.

Doctor Don Musalem: 01:02:23

For bone optimization.

Doctor Don Musalem: 01:02:24

Calcium, magnesium, vitamin D.

Doctor Don Musalem: 01:02:27

Some folks advocate for k two.

Doctor Don Musalem: 01:02:30

We need a little research.

Doctor Don Musalem: 01:02:31

I think it is interesting, and I don't think it should cause harm.

Doctor Don Musalem: 01:02:34

The k two research with breast cancer is interesting, though, because dietary k two looks very harmful, but it comes from high fat animal products, so it would be harmful.

Doctor Don Musalem: 01:02:43

That makes sense, right?

Doctor Don Musalem: 01:02:45

That doesn't translate to k two as a supplement necessarily being harmful, but there's this little bit of noise in the research.

Doctor Don Musalem: 01:02:52

So, you know, I do like some of the studies on k two, to be quite honest.

Doctor Don Musalem: 01:02:58

So I'm not against my patient taking it if they want to be on it.

Doctor Don Musalem: 01:03:03

I think that there's enough data to show the safety, and I think there's certainly data that promotes that.

Doctor Don Musalem: 01:03:08

Maybe it's a reasonable consideration for bone optimization.

Rick Esselstyn: 01:03:12

Well, I mean, and I would imagine that most people that are eating a whole food, plant based diet are getting, I would imagine, ample magnesium from their nuts and seeds and other sources that magnesium comes from.

Doctor Don Musalem: 01:03:28

They should be.

Doctor Don Musalem: 01:03:29

And this isn't one we can really test easy in normal laboratories, because the normal magnesium level isn't one that looks at the red blood cell magnesium.

Doctor Don Musalem: 01:03:37

So if I check a magnesium, it's always going to be normal in my patient.

Doctor Don Musalem: 01:03:41

It's not the more sensitive tests that I have available to me at Mayo Clinic.

Doctor Don Musalem: 01:03:45

So you're right, and it's not a supplement that I really worry about the risk of overdosing a person.

Doctor Don Musalem: 01:03:52

You know, in women who are pregnant, who are pre eclamptic, they give them very high doses of magnesium to the point that their reflexes go down.

Doctor Don Musalem: 01:04:00

So we know when you start to get too high your reflexes are down and there's no way to get someone up that high because you're having to give iv doses at a really high rate.

Doctor Don Musalem: 01:04:08

So it's, it would be pretty impossible to cause harm with magnesium.

Doctor Don Musalem: 01:04:12

But keep in mind magnesium citrate, magnesium oxide, those will cause a lot of GI upset.

Doctor Don Musalem: 01:04:17

Magnesium citrate will cause diarrhea, you know, so.

Rick Esselstyn: 01:04:23

Okay.

Rick Esselstyn: 01:04:23

Okay.

Doctor Don Musalem: 01:04:25

Let me ask you this.

Rick Esselstyn: 01:04:29

Yeah.

Rick Esselstyn: 01:04:30

So you mentioned kind of the avoidance, especially as we're getting on in the day of the blue light.

Rick Esselstyn: 01:04:38

What are your thoughts on alcohol?

Rick Esselstyn: 01:04:40

Because I know so many people that tell me they, they have a glass or two of alcohol now or wine and it just, it's, it sends their sleep into a tailspin.

Doctor Don Musalem: 01:04:53

Absolutely.

Doctor Don Musalem: 01:04:54

And alcohol is a carcinogenous, you know, we have to step away from that.

Doctor Don Musalem: 01:04:58

If someone wants a glass of wine, you know, once, twice a week or at special occasions in connection with others, I think it's probably okay.

Doctor Don Musalem: 01:05:06

But they shouldn't go over that amount, particularly for women, you know, men, the us guidelines or men can have up to two drinks a day, but if you look at Canada's guidelines are currently at two drinks a week for both men and women.

Doctor Don Musalem: 01:05:17

So absolutely it can impede the sleep hygiene.

Doctor Don Musalem: 01:05:22

It also can trigger those hot flashes more for women.

Doctor Don Musalem: 01:05:24

So I really don't have, want my patients to over consume alcohol and I really do limit them, you know, no more than one, up to three drinks a week and never know, never more than one drink on any one occasion and never drink alone.

Doctor Don Musalem: 01:05:42

You know, if you're going to have it, have it because you're enjoying it in a social connection.

Doctor Don Musalem: 01:05:47

I don't think that we need to, you know, have alcohol to enjoy ourselves in a social connection, I certainly don't.

Doctor Don Musalem: 01:05:53

But you know, it's a normal way of life for a lot of people.

Doctor Don Musalem: 01:05:57

Ritually, culturally we look at blue zones.

Doctor Don Musalem: 01:05:59

It's a part of the power of nine and blue zones, you know, but in those areas of the world people are living very different lifestyles than we do.

Doctor Don Musalem: 01:06:07

So I think we need to really heed caution when it comes to alcohol consumption.

Doctor Don Musalem: 01:06:12

7th leading cause of death in our country and it's a direct link to increasing the risk of premenopausal breast cancer, breast cancer in young women as well as post menopausal.

Doctor Don Musalem: 01:06:21

There's not many things that trigger premenopausal breast cancer in terms of lifestyle and this is one of them.

Doctor Don Musalem: 01:06:26

So we have to be careful.

Rick Esselstyn: 01:06:28

Yeah, you, so you mentioned, you know, kind of like, never, never drive drunk.

Rick Esselstyn: 01:06:34

You mentioned never drink alone, which, which leads me to the next topic I'd love to discuss with you because I feel like it's been very prominent as of late.

Rick Esselstyn: 01:06:45

I know that.

Rick Esselstyn: 01:06:46

So I, you know, I had Doctor Amy Commander on the podcast last week.

Rick Esselstyn: 01:06:52

Love her.

Rick Esselstyn: 01:06:53

She is, you and her are, like, cut from the same cloth.

Rick Esselstyn: 01:06:56

You're just so wonderful.

Rick Esselstyn: 01:06:58

And, you know, one of the things that, with the work that she's doing is she's really, like, highlighting the social connections and how important it is for people to connect.

Rick Esselstyn: 01:07:10

And I'd love to hear from your vantage point what you think are the, how important it is.

Rick Esselstyn: 01:07:17

I think you refer to it as horizontal connections and then.

Rick Esselstyn: 01:07:21

Vertical connections.

Doctor Don Musalem: 01:07:23

Yeah.

Doctor Don Musalem: 01:07:24

And doctor commander is doing amazing work.

Doctor Don Musalem: 01:07:26

I just, she's such a dear friend.

Doctor Don Musalem: 01:07:29

So it's really exciting in this space of lifestyle medicine to have our connections as well.

Doctor Don Musalem: 01:07:33

Horizontal connections.

Doctor Don Musalem: 01:07:35

Are that right?

Doctor Don Musalem: 01:07:36

They're the loving connections we share with one another.

Doctor Don Musalem: 01:07:38

And, and I love that.

Doctor Don Musalem: 01:07:40

So important that patients get involved with those loving support groups and surround themselves by love and harmony and peace.

Doctor Don Musalem: 01:07:48

So I really want to encourage that horizontal connection.

Doctor Don Musalem: 01:07:51

You know, it was reported that about 60% of Americans feel lonely.

Doctor Don Musalem: 01:07:56

That's a significant number.

Doctor Don Musalem: 01:07:58

And Doctor Murthy, our us surgeon general, he wrote a report on loneliness.

Doctor Don Musalem: 01:08:02

And so this is a big area of discussion currently because we know that those weak social ties are just as harmful as being obese or being an alcoholic.

Doctor Don Musalem: 01:08:14

So it's very concerning.

Doctor Don Musalem: 01:08:15

There's actually been a study that connected it to the equivalent of having 15 cigarettes a day is the same impact on mortality as loneliness, which is crazy.

Doctor Don Musalem: 01:08:26

You know, there's increased risk of premature death from any cause when it comes to loneliness.

Doctor Don Musalem: 01:08:31

So we really need to pay attention to this.

Rick Esselstyn: 01:08:33

Yeah, no, that is, that is crazy pills.

Rick Esselstyn: 01:08:35

And I think in, in my life, especially as I've gotten older, Don, about some of my friends that I used to see all the time that, you know, for whatever reason, they're not married, they don't have families, and they're at an age now where they've, some of them have retired and they lead very lonely, monk like existences at home or in their apartments.

Rick Esselstyn: 01:09:04

And, and then when I do get together with them, I can see that they have gone downhill rather quickly.

Rick Esselstyn: 01:09:13

So it's.

Rick Esselstyn: 01:09:14

It is, I think it wreaks havoc on your body, on your brain, on your, your wellness, all those things.

Doctor Don Musalem: 01:09:24

Well, I think this is a, you know, big shout out to these events that you do.

Doctor Don Musalem: 01:09:28

You know, when you see that connection and that love and that engagement, it's like the energy the room just raises.

Doctor Don Musalem: 01:09:33

And I think that that's so special to be actively involved in community.

Doctor Don Musalem: 01:09:38

And that's also, you know, a big reason if someone doesn't have family.

Doctor Don Musalem: 01:09:43

You know, sometimes these things aren't avoidable.

Doctor Don Musalem: 01:09:46

It's just how it ends up being.

Doctor Don Musalem: 01:09:47

Consider volunteering the best things you can do.

Doctor Don Musalem: 01:09:50

You're giving back.

Doctor Don Musalem: 01:09:52

It's an act of service, and it really helps to define, you know, that.

Doctor Don Musalem: 01:09:56

And you shared that nice quote from Picasso.

Doctor Don Musalem: 01:09:58

Amy and I shared both of our favorite code is that the meaning of life is to find your gift, but the purpose is to share it with others.

Doctor Don Musalem: 01:10:05

You know, volunteering can help you to fulfill that need for that horizontal connection, which I love.

Rick Esselstyn: 01:10:12

Yeah.

Rick Esselstyn: 01:10:14

Well, and if it's one of the reasons, I mean, I look back at what happened with COVID and how many people hightailed it into their, you know, into their.

Rick Esselstyn: 01:10:25

Their homes, their apartments, and weren't going out, weren't seeing people.

Rick Esselstyn: 01:10:30

Uh, I especially.

Rick Esselstyn: 01:10:32

I know so many high school like adolescents that it really affected in a major way.

Rick Esselstyn: 01:10:40

And their only connection to the world was through their.

Rick Esselstyn: 01:10:43

I, you know, their cell phones and, you know, how unhealthy that is.

Rick Esselstyn: 01:10:48

And that just leads to, I think, even a heightened state of loneliness and isolation.

Doctor Don Musalem: 01:10:57

So you're right, and they shouldn't.

Doctor Don Musalem: 01:11:00

That doesn't close the gap, that they think they're getting a social connection by doing their various social media, Snapchat, Instagram, Facebook.

Doctor Don Musalem: 01:11:07

But that doesn't close the need.

Doctor Don Musalem: 01:11:10

That doesn't erase the need for true social connections.

Doctor Don Musalem: 01:11:13

So.

Rick Esselstyn: 01:11:13

Very good point, which is why I am such a fan of pickleball.

Rick Esselstyn: 01:11:22

I can't even tell you what Pickleball has done to save the lives and the social connections of so many people that I know.

Rick Esselstyn: 01:11:31

It's crazy.

Doctor Don Musalem: 01:11:33

Well, that's cute you mentioned that.

Doctor Don Musalem: 01:11:34

Because when they look at these sport that's linked to longevity.

Doctor Don Musalem: 01:11:38

You know what racket?

Doctor Don Musalem: 01:11:39

Sports.

Doctor Don Musalem: 01:11:40

So that's interesting.

Doctor Don Musalem: 01:11:41

So maybe it's this.

Doctor Don Musalem: 01:11:42

Maybe it's that connection.

Doctor Don Musalem: 01:11:44

I had a meeting earlier today with Rennie Moss.

Doctor Don Musalem: 01:11:46

She was my hospital administrator that came with me to Plantstock this year.

Doctor Don Musalem: 01:11:50

Got to play pickleball with you and John Mackey.

Doctor Don Musalem: 01:11:53

And she's so good in pickleball.

Doctor Don Musalem: 01:11:55

So we have a team, actually, that plays in our city, and she helps that team come to victory every year.

Doctor Don Musalem: 01:12:01

So Mayo Clinic took home the gold pickleball.

Rick Esselstyn: 01:12:06

I remember she was good.

Rick Esselstyn: 01:12:08

She was good, and she was.

Rick Esselstyn: 01:12:09

And she was very competitive.

Doctor Don Musalem: 01:12:12

So intense.

Doctor Don Musalem: 01:12:13

But yeah, go Rennie.

Doctor Don Musalem: 01:12:14

So we love that.

Doctor Don Musalem: 01:12:15

We love how intense she is.

Doctor Don Musalem: 01:12:17

So that's good.

Doctor Don Musalem: 01:12:18

But, you know, real quick, you mentioned also I love the ability to talk about connections with my patients because it's easy to talk horizontal connections.

Doctor Don Musalem: 01:12:26

Everyone knows what that is.

Doctor Don Musalem: 01:12:27

But when it comes to spirituality, that's kind of it.

Doctor Don Musalem: 01:12:30

Awkward thing to talk about to a patient, right?

Doctor Don Musalem: 01:12:32

Like, how do you, how do you break the ice on that one?

Doctor Don Musalem: 01:12:35

So I can easily use, you know, the American College of Lifestyle medicine's six pillars of connection and go into this horizontal as well as vertical.

Doctor Don Musalem: 01:12:45

And so vertical connections are belief in something bigger than yourself.

Doctor Don Musalem: 01:12:51

And gosh, if we think we're all that matters and we're that inward thinking, you're going to just succumb to your cancer in a pretty rough way.

Doctor Don Musalem: 01:12:59

That's all I'm going to say.

Doctor Don Musalem: 01:13:01

As soon as you get cancer, all of a sudden you find spirituality.

Doctor Don Musalem: 01:13:04

You find the fact that life is something bigger than what you're all about.

Doctor Don Musalem: 01:13:08

And that is like the saving grace, no pun intended, to the beauty that can unfold from that teachable moment or the teacher of life, of what cancer can really be.

Doctor Don Musalem: 01:13:18

And that's where people can really lean in to just the, the essence of the experience of going through what they're going through and learning from it, you know, stoic philosophy.

Doctor Don Musalem: 01:13:30

I love it because they really give so many deep lessons that can help to build our resilience.

Doctor Don Musalem: 01:13:36

And I think that this is one of them is just knowing that life is truly about something bigger than ourselves.

Doctor Don Musalem: 01:13:43

And so, yeah, I would say out of all the pillars of lifestyle, medicine is probably the most important part of it.

Rick Esselstyn: 01:13:52

More important than the food, I hate to say it.

Doctor Don Musalem: 01:13:55

Yeah.

Doctor Don Musalem: 01:13:56

Because if you don't have that belief in that meaning and desire, you're not going to as much interest in showing up for yourself.

Doctor Don Musalem: 01:14:05

Right?

Doctor Don Musalem: 01:14:06

Like, this is like the substance of what we're about.

Doctor Don Musalem: 01:14:08

So I don't know, like, I'm just like jubilanthe.

Doctor Don Musalem: 01:14:14

I'm so happy.

Doctor Don Musalem: 01:14:15

I wish I could share that with everyone, but I think that's like, what matters to me is it's just like that knowing, you know, I learned the hard way that I trust in that process with some of my experiences.

Rick Esselstyn: 01:14:27

Yeah.

Rick Esselstyn: 01:14:27

Let me ask you this.

Rick Esselstyn: 01:14:28

So what is your vertical spiritual connection?

Doctor Don Musalem: 01:14:35

You know, I am not formally, you know, formally religious, I would say.

Doctor Don Musalem: 01:14:42

I grew up going to church.

Doctor Don Musalem: 01:14:43

I still go to church occasionally.

Doctor Don Musalem: 01:14:46

I'm not, like, as good as I should be or one tells, but I just I pray.

Doctor Don Musalem: 01:14:51

I believe in God.

Doctor Don Musalem: 01:14:52

For me, it's God.

Doctor Don Musalem: 01:14:53

I know some people use source or universe, whatever it is to you, but for me, it's God.

Doctor Don Musalem: 01:14:58

And I pray, and I give gratitude.

Doctor Don Musalem: 01:14:59

So that's how I use my gratitude.

Doctor Don Musalem: 01:15:02

Practice is I thank God all the time.

Doctor Don Musalem: 01:15:05

I'm constantly thanking God, you know, for whatever it may be.

Doctor Don Musalem: 01:15:09

For the October super moon.

Doctor Don Musalem: 01:15:11

Like, holy cow, is that magical?

Doctor Don Musalem: 01:15:13

And it was so amazing, the power of that.

Doctor Don Musalem: 01:15:16

Or after the hurricane, I saw so many amazing pictures.

Doctor Don Musalem: 01:15:20

It's like, oh, my gosh, how could someone deny the fact that there's a God, you know, it's just, like, magnificent how the sky lights up.

Doctor Don Musalem: 01:15:28

So I guess what I would say is, I do hear a lot of people relate to nature is their God, and I can see that because I see that deep reflection.

Doctor Don Musalem: 01:15:35

Reflection and in some of the miracles that just seem to appear.

Doctor Don Musalem: 01:15:39

So.

Doctor Don Musalem: 01:15:39

So for me, that that's how it unfolds in my life.

Doctor Don Musalem: 01:15:44

that near death experience in: 2016

Doctor Don Musalem: 01:15:50

I feel like, as if I met, in a way, the spirit of.

Doctor Don Musalem: 01:15:56

Of a larger force than me.

Rick Esselstyn: 01:15:58

Yeah.

Doctor Don Musalem: 01:15:59

So I was very blessed to experience the power of that existence, kind of one within me in that four minutes that I was in that space.

Doctor Don Musalem: 01:16:10

So I would never deny it.

Doctor Don Musalem: 01:16:12

For me, that's what works for me.

Doctor Don Musalem: 01:16:14

You know, we should never compare our stories to other people, and nor should we judge other people.

Doctor Don Musalem: 01:16:19

You know, I've had.

Doctor Don Musalem: 01:16:20

We all.

Doctor Don Musalem: 01:16:21

I think it's only natural to probably go towards judgment.

Doctor Don Musalem: 01:16:24

We really want to try to not do that.

Doctor Don Musalem: 01:16:25

We want to just try to have acceptance and kind thoughts for others and to know that every one of us come from different experiences, maybe different sorts of traumas, different backgrounds.

Doctor Don Musalem: 01:16:36

And so these thoughts that we have are things that we just have to work on and have to process and understand more deeply.

Rick Esselstyn: 01:16:46

Doctor Don Musalem for president.

Doctor Don Musalem: 01:16:51

No, no, I mean, the favorite.

Doctor Don Musalem: 01:16:54

I mean, gosh, you know, I mean, it's just so exciting for me.

Doctor Don Musalem: 01:16:57

And I just think when it comes to the whole food plant based nutrition, I've said this before, it's just such an opportunity to just nourish and love yourself.

Doctor Don Musalem: 01:17:04

Right?

Doctor Don Musalem: 01:17:05

Love others, love self, be self compassionate, be gentle with self, show up for you.

Doctor Don Musalem: 01:17:10

That's so important whether you have cancer or not.

Doctor Don Musalem: 01:17:14

That would be my message.

Rick Esselstyn: 01:17:15

Yeah.

Rick Esselstyn: 01:17:18

So let's.

Rick Esselstyn: 01:17:20

Wow, you know, don, this is.

Rick Esselstyn: 01:17:22

I just love talking to you.

Rick Esselstyn: 01:17:25

Can we finish with some fun spices and herbs that you recommend to your patients?

Doctor Don Musalem: 01:17:32

Yeah.

Doctor Don Musalem: 01:17:32

So you know, when it comes to herbs, I love omelet fruit, and I know Christy funk loves this one too.

Doctor Don Musalem: 01:17:39

She's just so amazing for the messages that she spreads to such a wide audience.

Doctor Don Musalem: 01:17:44

So omelet fruit is indian gooseberry.

Doctor Don Musalem: 01:17:46

You can get it in a powder or a supplement.

Doctor Don Musalem: 01:17:49

I have the majority of my patients on this.

Doctor Don Musalem: 01:17:51

A lot of my patients come in wanting to take collagen, and I actually don't encourage collagen for my patients because there is some cancer research that I find disconcerting.

Doctor Don Musalem: 01:17:59

So I like collagen.

Doctor Don Musalem: 01:18:00

It's good for skin, it's good for hair, but bigger than that, it's a powerful antioxidant.

Doctor Don Musalem: 01:18:05

It's a powerful anti inflammatory.

Doctor Don Musalem: 01:18:08

And there's some crazy cool research with what it can do with cholesterol.

Doctor Don Musalem: 01:18:12

There is research showing that it can lower ldl and triglycerides by 20%.

Doctor Don Musalem: 01:18:17

And I see exactly that in my patient population.

Doctor Don Musalem: 01:18:19

It's fascinating.

Rick Esselstyn: 01:18:21

Wow.

Doctor Don Musalem: 01:18:21

I love Amla.

Doctor Don Musalem: 01:18:23

And you guys have a green tea, indian gooseberry tea, which is yummy.

Rick Esselstyn: 01:18:30

Yeah.

Rick Esselstyn: 01:18:31

Thank you.

Rick Esselstyn: 01:18:31

With an Amla base.

Doctor Don Musalem: 01:18:33

Yeah, yeah, yeah, yeah.

Doctor Don Musalem: 01:18:34

The indian gooseberry, right?

Doctor Don Musalem: 01:18:35

So I love omelet.

Doctor Don Musalem: 01:18:36

You know, I love ginger.

Doctor Don Musalem: 01:18:38

Cook with tons of ginger.

Doctor Don Musalem: 01:18:40

You know, use the fresh ginger root.

Doctor Don Musalem: 01:18:42

Like if you're using a smoothie, I'll just pull off a big piece and wash it.

Doctor Don Musalem: 01:18:45

I don't even peel it.

Doctor Don Musalem: 01:18:46

Throw it in your blender, make your smoothie or use ginger spice.

Doctor Don Musalem: 01:18:49

So that's great.

Doctor Don Musalem: 01:18:50

Ginger tea is great.

Doctor Don Musalem: 01:18:52

Turmeric E.

Doctor Don Musalem: 01:18:54

Turmeric is a supplement I don't recommend very much.

Doctor Don Musalem: 01:18:57

Lots of drug interactions, interacts with chemotherapy, women, breast cancer, tamoxifen.

Doctor Don Musalem: 01:19:02

Do not do it.

Doctor Don Musalem: 01:19:04

Turmeric as a supplement with tamoxifen will deactivate the ability to make tamoxifen into its active form that will treat your breast cancer.

Doctor Don Musalem: 01:19:11

So no to the supplement of turmeric unless your doctor says it's safe.

Doctor Don Musalem: 01:19:17

Now, it's totally safe as a food, so cook with it as much as you want.

Doctor Don Musalem: 01:19:22

Just don't take it as a supplement.

Doctor Don Musalem: 01:19:24

So I use a lot of turmeric as a food for my patients under don.

Rick Esselstyn: 01:19:29

What's the difference is the pill form, not just ground up turmeric.

Doctor Don Musalem: 01:19:34

The dosing is so much higher in the pill form.

Rick Esselstyn: 01:19:37

Okay.

Doctor Don Musalem: 01:19:38

You're getting much higher doses when you're taking it.

Doctor Don Musalem: 01:19:40

So I give them the green light as a food, as a spice, and their curry, whatever they're doing, but I just don't want them doing it as a supplement.

Doctor Don Musalem: 01:19:47

That's my big.

Doctor Don Musalem: 01:19:48

It's so hard to absorb turmeric anyways.

Doctor Don Musalem: 01:19:51

You know, it really is hard to absorb it.

Doctor Don Musalem: 01:19:54

So the likelihood of a toxicity interacting with some of these various chemos and with tamoxifen may not be as substantial as I'm kind of, you know, describing.

Doctor Don Musalem: 01:20:06

But let's not take a chance because that would be detrimental.

Doctor Don Musalem: 01:20:09

And again, it's first do no harm and gosh, it's so delicious in our food, you know, so use it in your food.

Doctor Don Musalem: 01:20:16

That's my recommendation in regards to that.

Doctor Don Musalem: 01:20:18

Ceylon cinnamon is amazing for blood sugar.

Doctor Don Musalem: 01:20:22

So I recommend, you know, a half a teaspoon, up to one teaspoon a day.

Doctor Don Musalem: 01:20:26

I have them add it to their overnight oats.

Doctor Don Musalem: 01:20:28

I recommend the Ceylon cinnamon because it doesn't have the kumarin is what's reported in it.

Doctor Don Musalem: 01:20:33

So it's maybe a little bit safer.

Doctor Don Musalem: 01:20:35

So I love the cinnamon.

Doctor Don Musalem: 01:20:37

Oh, I know.

Doctor Don Musalem: 01:20:38

Another really cool seasoning is cardamom.

Doctor Don Musalem: 01:20:42

And this is thought to be like the queen of spices.

Doctor Don Musalem: 01:20:45

This is kind of corny.

Doctor Don Musalem: 01:20:46

Like this goes back to my naturopathic years.

Doctor Don Musalem: 01:20:48

But it's a very feminizing herb.

Doctor Don Musalem: 01:20:50

So I think for women undergoing breast cancer treatment, I give my patients like a yemenite, very healthy granola recipe where they don't use oil.

Doctor Don Musalem: 01:20:58

There's like just a tidbit of maple syrup in it, some other nice things, and cardamom and cinnamon.

Doctor Don Musalem: 01:21:03

And they love it.

Doctor Don Musalem: 01:21:04

It smells delicious.

Doctor Don Musalem: 01:21:05

So I love cardamom.

Doctor Don Musalem: 01:21:07

Some cool fatty liver studies that showed that it can improve the liver function, the liver enzymes, as well as reduce some inflammation and oxidative stress with that cardamom.

Doctor Don Musalem: 01:21:17

So it's a powerful antioxidant.

Doctor Don Musalem: 01:21:19

I love cardamom.

Doctor Don Musalem: 01:21:20

So consider it.

Rick Esselstyn: 01:21:23

Thats interesting about the fatty liver.

Rick Esselstyn: 01:21:25

I mean, I know that it seems like non alcoholic fatty liver disease is like skyrocketed.

Doctor Don Musalem: 01:21:33

No kidding.

Doctor Don Musalem: 01:21:34

It sure is.

Doctor Don Musalem: 01:21:35

And thats my next plan of attack.

Doctor Don Musalem: 01:21:37

Next study.

Doctor Don Musalem: 01:21:37

Im going to take that breast cancer study and put it over in our liver transplant team because that makes me pretty sick to know that were actually doing liver transplants for people that have fatty liver when we can reverse it with a whole food plant based diet.

Doctor Don Musalem: 01:21:51

Right?

Rick Esselstyn: 01:21:52

Yeah.

Rick Esselstyn: 01:21:53

Let me ask you this, don.

Rick Esselstyn: 01:21:54

Um, and first let me make a statement and then tell me if you think this is correct.

Rick Esselstyn: 01:22:00

And that is it.

Rick Esselstyn: 01:22:02

See, it seems to me that the number one cancer in women is breast cancer.

Rick Esselstyn: 01:22:08

The number one cancer in, in men is prostate cancer.

Rick Esselstyn: 01:22:12

Maybe in, in both.

Rick Esselstyn: 01:22:14

You know, a common denominator is colorectal cancer.

Rick Esselstyn: 01:22:17

What is it about the is that an accurate statement or not?

Doctor Don Musalem: 01:22:23

I'd have to look at the most recent reports and that.

Doctor Don Musalem: 01:22:26

But you're bringing a very good point up when we think of these lifestyle cancers.

Doctor Don Musalem: 01:22:29

Absolutely.

Doctor Don Musalem: 01:22:29

And we know lung cancer is still the cancer that people tend to die from, but that's not one that's always, you know, a lot of those lung cancers aren't necessarily from smoking all the time.

Doctor Don Musalem: 01:22:38

It can be combined.

Doctor Don Musalem: 01:22:39

So when we look at the, the ones you're talking about, I think I know where you're getting at from a lifestyle perspective.

Rick Esselstyn: 01:22:44

Well, my question is, what is it about the breast tissues, what is it about the prostate that somehow is attracting these cancer, I guess you call it these mutations to occur and for the cancer to take place there, do we.

Doctor Don Musalem: 01:23:04

Know there's more than just those cancers that are increasing?

Doctor Don Musalem: 01:23:09

We see a lot of endometrial cancer, ovarian cancer, as you said, the colon cancer, and I feel so much of this is lifestyle mediated.

Doctor Don Musalem: 01:23:17

We know that alcohol drives the risk of cancer.

Doctor Don Musalem: 01:23:19

We know obesity, overweight drives the risk of cancer.

Doctor Don Musalem: 01:23:21

That adipose tissue carries along so many deleterious side effects pathways that it interrupts.

Doctor Don Musalem: 01:23:30

We know the nutrition.

Doctor Don Musalem: 01:23:33

erican Medical association in: 2022

Doctor Don Musalem: 01:23:40

You know, we know it's so harmful.

Doctor Don Musalem: 01:23:43

And when we look at a recent report on the incidents, the rise in cancers among young people, we see this very concerning rise among breast and colon cancer in young people.

Doctor Don Musalem: 01:23:56

And, you know, I'm out of that arena of prostate cancer, so I can't speak to is if they're seeing an increased rise in younger prostate cancer patients as well.

Doctor Don Musalem: 01:24:03

But I would expect they probably are.

Doctor Don Musalem: 01:24:05

I should be careful with that, though.

Doctor Don Musalem: 01:24:07

But with the breast and colon cancer, you know, this report is because of lifestyle in colon cancer.

Doctor Don Musalem: 01:24:12

People aren't getting enough fiber.

Doctor Don Musalem: 01:24:13

And breast cancer is for a myriad of reasons, you know, and we look at the various toxic exposures that individuals pollution.

Doctor Don Musalem: 01:24:21

We look at the preservatives that are in food.

Doctor Don Musalem: 01:24:24

There was a really interesting report that was published this year that, and this is concerning mono and diglycerides.

Doctor Don Musalem: 01:24:32

It's in everything.

Doctor Don Musalem: 01:24:33

It's in baby formula, you know, it's in plant based yogurts, it's in plant based ice creams.

Rick Esselstyn: 01:24:39

It's in almost every plant based milk.

Doctor Don Musalem: 01:24:41

Yeah, exactly.

Doctor Don Musalem: 01:24:42

Mono and diglycerides increase the risk in this study, this is a french study they followed for seven years.

Doctor Don Musalem: 01:24:47

Increase the risk of breast cancer 24%.

Doctor Don Musalem: 01:24:50

Are you ready?

Doctor Don Musalem: 01:24:50

This for prostate cancer.

Doctor Don Musalem: 01:24:51

It gives me.

Doctor Don Musalem: 01:24:52

I have chills right now.

Doctor Don Musalem: 01:24:53

Ready to say this?

Doctor Don Musalem: 01:24:54

46%.

Doctor Don Musalem: 01:24:55

These are associations, guys.

Doctor Don Musalem: 01:24:57

So it's not like it's good, but it's still.

Doctor Don Musalem: 01:24:59

That's a big number.

Doctor Don Musalem: 01:25:00

That's.

Doctor Don Musalem: 01:25:01

You don't need mono diglycerides.

Doctor Don Musalem: 01:25:02

The wraps rip.

Doctor Don Musalem: 01:25:03

You brought up that you like the Ezekiel wrap.

Doctor Don Musalem: 01:25:05

I have a picture.

Doctor Don Musalem: 01:25:05

I show my patient.

Doctor Don Musalem: 01:25:06

Hey, this is a safe wrap.

Doctor Don Musalem: 01:25:08

Let's look at the ingredients.

Doctor Don Musalem: 01:25:09

When you go to the grocery store, find something similar.

Doctor Don Musalem: 01:25:11

You know, it doesn't have to be this, but that's the one I personally use as well.

Doctor Don Musalem: 01:25:14

The majority of wraps out there all have monoandiglycerides.

Doctor Don Musalem: 01:25:17

The vegan butters, all mono and diglycerides.

Doctor Don Musalem: 01:25:19

So it makes the stuff kind of soften and then caring.

Doctor Don Musalem: 01:25:22

Ian, another thing, in plant based milks, there was 32% increased risk in breast cancer.

Doctor Don Musalem: 01:25:26

The association.

Doctor Don Musalem: 01:25:27

So, you know, there's so much out there.

Doctor Don Musalem: 01:25:30

If we could just back up and make life more simple, like, do what our grandparents did, you know, move around, love a lot more, worry a lot less.

Doctor Don Musalem: 01:25:40

Get some sleep and eat your plants.

Doctor Don Musalem: 01:25:43

Lots of vegetables, fruits, whole grains, fibers, you know, beans.

Doctor Don Musalem: 01:25:46

Get your resistant starches and spices.

Doctor Don Musalem: 01:25:48

Spices, such powerful medicinal value.

Doctor Don Musalem: 01:25:51

Get lots of variety.

Rick Esselstyn: 01:25:52

Yeah.

Rick Esselstyn: 01:25:53

My sister Jane loves to say, plants, plants, plants, and dance, dance, dance.

Doctor Don Musalem: 01:26:01

I have a picture of Jane dancing.

Doctor Don Musalem: 01:26:03

Yeah.

Doctor Don Musalem: 01:26:03

I love that.

Doctor Don Musalem: 01:26:04

That's so cute.

Doctor Don Musalem: 01:26:05

That's so cute.

Doctor Don Musalem: 01:26:06

Love it.

Rick Esselstyn: 01:26:06

Yeah.

Rick Esselstyn: 01:26:07

So, Dawn, I don't want to.

Rick Esselstyn: 01:26:10

I don't want to be too greedy with my time with you.

Rick Esselstyn: 01:26:13

So I want you to end.

Rick Esselstyn: 01:26:16

Let's end my, my time with you today.

Rick Esselstyn: 01:26:19

If you could share just one.

Rick Esselstyn: 01:26:21

And I know, I know you've got dozens and dozens and dozens, but just one of your patient success stories.

Rick Esselstyn: 01:26:26

So we can kind of leave on a super high note today.

Doctor Don Musalem: 01:26:32

Yeah.

Doctor Don Musalem: 01:26:32

I'm going to share the one that I think is the most powerful.

Doctor Don Musalem: 01:26:35

And, you know, I.

Doctor Don Musalem: 01:26:36

When I talked to plants, doc, I talked about how I don't even like to use that word, hope, because I think there's a dichotomy.

Doctor Don Musalem: 01:26:42

Like, hope is like, you're still kind of wondering if I like knowing.

Doctor Don Musalem: 01:26:45

Like, I like to meet people from this, knowing there's still this, you know, part of breast cancer when women are stage four, that they tell women, you know, there's no cure.

Doctor Don Musalem: 01:26:54

I kind of don't like that because I was in that space once where they said, oh, you have so long to live.

Doctor Don Musalem: 01:26:58

I hate that.

Doctor Don Musalem: 01:26:59

Like, we are not God.

Doctor Don Musalem: 01:27:01

No one can predict I'm here 23 years later, I had, you know, of course I had the non Hodgkins lymphoma, but same thing I given x amount of time.

Doctor Don Musalem: 01:27:08

Michelle Mecca, she knows I talk about her story widely, she was a fitness competitor, well known, beautiful, amazing woman, really exercising, right, but diet, you know, in that, in that space of fitness, she was doing a lot of animal protein, not saying that was the trigger, but it was present, she gets breast cancer, very aggressive, her two positive estrogen receptor negative, a few years later it recurred to her brain, so she went through radiation, she went through various treatments, she went through surgery as well, because after the radiation they wanted to make sure that what they were still seeing on imaging didn't have cancer in it.

Doctor Don Musalem: 01:27:51

And in fact she is now cancer free.

Doctor Don Musalem: 01:27:54

Here is a woman with metastatic cancer to her brain, she's whole food plant based, I was climbing a mountain in Canada, this is true story, like dying, right?

Doctor Don Musalem: 01:28:03

I get a message of like God, Michelle just saved my life, literally it says, hey doctor Musalem, you're not going to believe this, but I can't stop thinking about broccoli, she's like, it's like a true addiction, she's like, I just constantly want it so, it's so cute.

Doctor Don Musalem: 01:28:17

So she's whole food plant based now doing amazing travels around the world, talking about her journey and her story.

Doctor Don Musalem: 01:28:23

She remains on medicines every single day.

Doctor Don Musalem: 01:28:25

These medicines are tough, her life isn't easy, it's like constantly resistance.

Doctor Don Musalem: 01:28:32

She's on this one medicine that causes alterations of her hands and feet, God bless her, she was a fitness competitor, she still spends a lot of time in the gym, you should see her muscles still.

Doctor Don Musalem: 01:28:40

And she wears like special gloves and special socks, so she can still do her exercise because she knows how important it is.

Doctor Don Musalem: 01:28:47

But yeah, I mean I have chills talking about just an incredible woman, so resilient and just nailed it, won that competition on metastatic breast cancer.

Doctor Don Musalem: 01:28:58

So just applause to her is a good story of knowing that it is possible, and with metastatic breast cancer you can get rid of this disease, you're going to be on treatment possibly for maybe even most of her life, but the good news is she's flourishing.

Doctor Don Musalem: 01:29:14

So really awesome.

Rick Esselstyn: 01:29:16

Well I think that's a great segue, because you know, in my book, you will always be one of the most incredible, fascinating success stories you are, you epitomize resiliency as we talked about, I think last time, toxic happiness in the best way, right?

Rick Esselstyn: 01:29:42

And just a force, a force of life that radiates, I'm alive and I love my life, and you've, you know, you're living true to that Picasso quote, so way to.

Rick Esselstyn: 01:30:00

Way to be.

Rick Esselstyn: 01:30:00

Don, I.

Rick Esselstyn: 01:30:01

Listen, I just.

Rick Esselstyn: 01:30:02

I can't tell you how grateful I am for you coming on the podcast not once, but twice this month to share all of your knowledge and expertise.

Rick Esselstyn: 01:30:13

Everybody's going to be so much better off for it.

Rick Esselstyn: 01:30:15

And, you know, I just.

Rick Esselstyn: 01:30:17

I can't wait till the next time we get to either be on the podcast together or be together in person at one of the plants strong retreats.

Doctor Don Musalem: 01:30:27

I can't wait either.

Doctor Don Musalem: 01:30:28

Rif, thanks for the amazing work you do, for inspiring everyone, and you bring such good energy to this.

Doctor Don Musalem: 01:30:33

You know, it's so exciting in your family, too.

Doctor Don Musalem: 01:30:35

So it's really a beautiful example of what.

Doctor Don Musalem: 01:30:38

What life can look like when you.

Doctor Don Musalem: 01:30:40

When you put the effort in.

Doctor Don Musalem: 01:30:41

So thanks for everything.

Doctor Don Musalem: 01:30:42

Thanks for having me here.

Doctor Don Musalem: 01:30:43

I appreciate it.

Rick Esselstyn: 01:30:44

Yeah.

Rick Esselstyn: 01:30:44

Hey, we got to do the virtual fist bump, Betty.

Rick Esselstyn: 01:30:49

Come on.

Rick Esselstyn: 01:30:53

Boom.

Doctor Don Musalem: 01:30:54

All right.

Rick Esselstyn: 01:30:55

Playing strong.

Doctor Don Musalem: 01:30:57

Bye.

Rick Esselstyn: 01:30:59

Boy, howdy.

Rick Esselstyn: 01:31:01

I took away so many wonderful ideas and advice from this episode, and I hope that you did as well.

Rick Esselstyn: 01:31:08

We are so lucky to have someone like Doctor Don Musalem on our team rooting for each and every one of us.

Rick Esselstyn: 01:31:16

Now, once again, if you're listening to this episode, the day that it comes out, which is October 24, as a reminder, you can register and attend this free webinar.

Rick Esselstyn: 01:31:28

It's called and healing navigating the breast cancer journey.

Rick Esselstyn: 01:31:33

It'll be tonight, and I'll be sure to drop that link in today's show notes.

Rick Esselstyn: 01:31:37

I would encourage you, please share this episode with anyone who you think might benefit.

Rick Esselstyn: 01:31:42

We know that navigating a difficult diagnosis is confusing.

Rick Esselstyn: 01:31:48

It's paralyzing.

Rick Esselstyn: 01:31:49

But we also want to empower you to make the healthiest decisions that you can for you.

Rick Esselstyn: 01:31:56

Thank goodness that we have doctors like Doctor Don Musalem who also feel the same way.

Rick Esselstyn: 01:32:02

Until next time, always, always keep it plant strong.

Rick Esselstyn: 01:32:09

The Plant Strong podcast team includes Carrie Barrett, Lori Cordowicz, and Amy Mackey.

Rick Esselstyn: 01:32:16

If you like what you hear, do us a favor and share the show with your friends.

Rick Esselstyn: 01:32:20

Friends and loved ones.

Rick Esselstyn: 01:32:22

You can always leave a five star rating and review on Apple Podcasts or Spotify.

Rick Esselstyn: 01:32:27

And while you're there, make sure to hit that follow button so that you never miss an episode.

Rick Esselstyn: 01:32:34

As always, this and every episode is dedicated to my parents, Doctor Caldwell B.

Rick Esselstyn: 01:32:40

Esselstyn Junior and Ann Kryo Esselstyn.

Rick Esselstyn: 01:32:44

Thanks so much for listening.

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