240: The Power of Plant-Based Nutrition in Cancer Prevention and Treatment with Dr. Zahra Kassam

[00:00:00] Dr. Zahra Kassam: From the World Cancer Research Fund and the American Institute of Cancer Research, they’ve combined a group of nine guidelines that I tell all my patients. So they say, maintain a good weight, keep physically active, have a diet that is rich in fruits, vegetables, whole grains, and beans. If that's not a plant-based diet, I don’t know what that is.

[00:00:19] Maya Acosta: You have more power over your health than what you've been told. This is the Healthy Lifestyle Solutions Podcast. I'm Maya Acosta and I'm passionate about finding healthy lifestyle solutions to support optimal human health. If you're willing to go with me together, we can discover how simple lifestyle choices can help improve our quality of life.

[00:00:40] Maya Acosta: And increase longevity in a big way. Let's get started. Today, Dr. Zahra Kassam, a radiation oncologist, joins us to discuss how she's working to change how we think about cancer treatment. Dr. Kassam will share her insights on how plant-based nutrition can support cancer patients. Cancer is a devastating diagnosis for anyone, and it can be overwhelming for patients who feel that they have no control over their treatment.

[00:01:07] Maya Acosta: Dr. Kassam is working to change that by educating our patients on their lifestyle choices role in their cancer journey. So far, the response has been overwhelmingly positive with patients feeling empowered by the knowledge related to lifestyle modifications. Dr. Kassam is hopeful that more patients will begin to educate themselves on the role of lifestyle medicine in cancer treatment, and that we can shift the way that we think about cancer care.

[00:01:32] Maya Acosta: Stick around for this amazing conversation of hope as we help empower patients. As always, the full bio and the link for each of my guests are found on the website healthylifestylesolutions.org. Let's meet Dr. Kassam. Welcome back to another episode of the Healthy Lifestyle Solutions podcast. I'm your host, Maya Acosta.

[00:01:51] Maya Acosta: Very excited about today's topic. We are going to address cancer, and we just completed the month of October. We were talking. You know, all the things that we can do from our perspective in terms of lifestyle modifications to reduce our risk for breast cancer. And now we have Dr. Zara Kassam, who is here to talk to us about her specialty.

[00:02:12] Maya Acosta: She's a radiation oncologist. I actually know about her because of her podcast in Canada called Plant-Based Canada. And so welcome Dr. Kassam.

[00:02:23] Dr. Zahra Kassam: Thank you so much, Maya. Thank you for inviting me and, uh, the honor of being on your show with your amazing guests.

[00:02:30] Maya Acosta: Well, thank you. And you know, it's rare that I speak with other podcasters, so it's always fun to, you know, have the phase to speak with someone whose voice I hear on the podcast. And when you've done other interviews as well, it's always cool because it's like, yeah, I'm familiar with the voice. So.

[00:02:48] Dr. Zahra Kassam: I have an amazing podcast team. People who help and make that all happen.

[00:02:53] Maya Acosta: Mm-hmm. . Yeah. That's wonderful. They do a great job. As a matter of fact, they recently had Michelle Tree, who I'm friends with, and uh.

[00:03:01] Dr. Zahra Kassam: Yeah, an inspiring episode. My goodness. 

[00:03:03] Maya Acosta: I think she's an amazing person. I love chatting with her. I thought we could start by learning a little bit about you, un familiar also with your sister Shireen and she's in the UK, and if you could kind of tell my listeners a little bit about how both of you got started. It's like you both are doing profound things. One in the UK and one in Canada. You're both doctors. And tell us more about how you got started and then the immediate family members that joined you on this way of living.

[00:03:31] Dr. Zahra Kassam: As you said, I'm a radiation oncologist and uh, I had been a vegetarian for many years and my story really mirrors my sister Shireen in the UK and then in 2013 myself, my sister Shireen and my sister Leila all became vegan and we'd somewhat independently, but also supporting each other decided that we would become vegan that year.

[00:03:56] Dr. Zahra Kassam: And as part of all that journey, that learning, you know, Shireen and I realized all the evidence on plant-based nutrition for individual health, for planetary health, even though we'd started off by doing it from an ethical perspective. And that really opened everything up for us. And Shireen actually started on the journey of spreading the word in 2018 when she formed Plant-Based Health Professionals UK.

[00:04:20] Dr. Zahra Kassam: And as part of her work, she undertook the first Plant-based Nutrition Conference in the UK in 2018. And I flew across to UK for that and I was just so blown away by all the energy in the room, the evidence. And I said to Shireen, you know, will you help me put on a similar conference in Canada? And that's what we did in 2019.

[00:04:42] Dr. Zahra Kassam: And there's part of that interest that just, you know, we were sold out and so much interest and we found so many other people in Canada doing the same amazing work. So my dear friend Michele Fedeli, who is a dietician at the cancer center, I work in, we co-founded Plant-Based Canada in 2019, to carry on that work in education for educating health professionals and also the public.

[00:05:07] Dr. Zahra Kassam: You know, we just felt that there was a big gap in education in Canada, in the plant-based space, we see, you know, we, there's amazing people in the US showing us doing the amazing work in the UK, but there was a gap at that time and that's been great. We've done the podcast, we do our conferences, we do our educational events.

[00:05:25] Dr. Zahra Kassam: And my family, as you mentioned, you know, Leila, my sister in the UK. My other sister is doing amazing work in the ethical space. Uh, she is the co-founder of Animal Think Tank, which is an organization to build a social movement for animal justice and animal freedom. My parents, have followed us as well. So at the age of 73, they both became vegan.

[00:05:48] Dr. Zahra Kassam: After, you know, the three of us chatted incessantly to them about the necessity of doing so. We have moved forward as a family and that support is amazing. It's wonderful. I, I'm so blessed.

[00:06:01] Maya Acosta: We are definitely blessed by what your family is doing, and you really are change-makers. You're creating this movement in across the world, like throughout the world. I was aware of when around the time you started Plant-Based Canada because I was following, I think I probably started following your newsletter early on. I was aware of the podcast and so everything is on that website, right? Like all the work that you do, the conference, the podcast, it's all under Plant-Based Canada.

[00:06:28] Dr. Zahra Kassam: That's right. Plant-BasedCanada.org

[00:06:30] Maya Acosta: Dot org. Okay. That's important. . So I'm interested, Dr. Kassam, your perspective, you know, as a physician who's trained in this field of treating cancer, to suddenly wake up to the reality that. Perhaps we can reduce our risk for cancer and perhaps even with, you know, the treatments that are offered for cancer patients, but also other things like maybe intermit fasting or plant-based foods can support a cancer patient. So I'm wondering if we could start a little bit with your training.

[00:07:04] Dr. Zahra Kassam: I actually wanted to be an infectious diseases specialist, and I wanted to do that for a little while. And while I was waiting for the job to come up, one of my friends said, Why don't you look at oncology? I think your personality would suit it.

[00:07:17] Dr. Zahra Kassam: And I remember thinking, No, but why would I want to do oncology? I'll just be sad all the time. But this amazing job came up at a teaching hospital in London. It was a, a temporary job for six months and I thought, Well, I'll, I'll just take it while I'm waiting for my other dream job to come along. And I literally, I was on the wards for one week and I realized that was, for me, it was just gut feeling that this was the specialty for me where I could develop relationships with my patients.

[00:07:46] Dr. Zahra Kassam: And I could help them. And I found that my personality fit. And so that's when I went into the training program in the UK. I trained in clinical oncology, which is both chemotherapies and systemic treatments and radiation. And then I went to Canada to do specialty fellowship training and I did three years of clinical and research fellowship at the Princess Margaret Hospital in gastrointestinal malignancies.

[00:08:10] Dr. Zahra Kassam: And then thankfully I got a job in, in Canada where we had decided to stay. My husband and I, and I've been a radiation oncologist for 12 years now, and I work in Ontario, Canada. And then when I became vegan, you know, as I said, I found all this amazing evidence of how plant-based nutrition could actually help my patients.

[00:08:30] Dr. Zahra Kassam: That it reduces the incidence of cancer, it can reduce the mortality from cancer. And now with the amazing research that's being done, and we can talk about. Actually finding that with changes to the microbiome, you can actually improve your response to certain treatments by having a plant-based diet. So when I realized all this, I thought, oh my goodness, I didn't have any of this training during my medical school, my residency training, my fellowship, I did the course and plant-based nutrition.

[00:08:58] Dr. Zahra Kassam: Um, I did my sister, Shireen’s university-based course in the UK, which is a fabulous course for anybody who's interested. It's a eight to 10 week course in at the University of Winchester on plant-based nutrition, and it's very in-depth. It's for health professionals for the public. She and I then decided we wanted to become certified in lifestyle medicine because again, that further progression of our knowledge, that it wasn't just plant-based nutrition, it was all the lifestyle factors that can play into how we manifest disease and how we do. So.

[00:09:29] Dr. Zahra Kassam: We became certified in 2019 with the American Board of Lifestyle Medicine, which of course, I don't need to tell you or your listeners that the American College of Lifestyle Medicine is the flagship organization for lifestyle medicine globally, and what an amazing organization that is. And I, I encourage all my colleagues to look into that and think about being certified so that we can have knowledge in that side by side with our specialty, whichever specialty you're doing but bring that with all other treatments that are available. Bring that to the table as well to benefit directly our patients.

[00:10:01] Maya Acosta: Absolutely. And you know, I feel that every time we hear of a physician that when they buy into the evidence of what plant-based nutrition and lifestyle medicine can do for a patient, every time a physician signs up, you know, for this way of living, I feel like a star lights up in the sky. I really do. It's so difficult for the rest of us who are longing for our physicians to come on board. It's so hard to sit back and just feel like this small when we're trying to share with them what we believe is the right thing for us.

[00:10:34] Maya Acosta: And I kind of wanna share with you actually that we recently, my husband and I gathered with his former roommate undergrad when he was a student at Johns Hopkins University. And it was six guys that lived together. My husband was one of 'em. And they, you know, I used to hear stories. Riz told me these stories, how they lived together.

[00:10:54] Maya Acosta: They took turns during groceries, they took turns cooking the meals, and they always dying together. And these were guys in college, but they were all very dedicated and focused about what they wanted in their lives. And then we recently met up with them and they were shocked to learn that risk is now plant-based.

[00:11:09] Maya Acosta: We used the word vegan because I think they understood that a little bit better. And they told me, you know, he was a big meat eater back in college. How is this possible? Like what? And two of the people at the table at the reunion are also MDs. And I started to share a little bit about what I know, and I felt like it was.

[00:11:27] Maya Acosta: Just being debunked. And the reason I'm sharing this with you is because for a lot of us who want to be gentle in how we approach physicians, it's very tricky when a person who's not qualified, like myself is saying, Look, people are reversing their hypertension, their diabetes, and perhaps even are able to prevent cancer.

[00:11:47] Maya Acosta: So yeah, that's why I say a star lights up in the sky. A new star is bored. I guess you can say it that way too. When a physician signs up to support us, this.

[00:11:57] Dr. Zahra Kassam: I hear you. Sorry to interrupt. I totally hear you. Where we find the same things, but I do feel things are changing. I'm, you know, the people I work with, they're very much more open to what I have to say.

[00:12:08] Dr. Zahra Kassam: And you know, having like yourself, you've educated yourself so deeply on this. And now that I have as well, I feel that I'm coming from a strong position. That's why we formed Plant-Based Canada because education is so key to be able to advocate. So, and then this week, you know, something amazing happened.

[00:12:24] Dr. Zahra Kassam: The Ontario Medical Association Education Series had invited me to speak, uh, two physicians and um Oh wow. It was amazing. The opportunity for me was amazing. I was so grateful. And there were nearly a hundred doctors from Ontario that had joined and I got. Wonderful feedback from people who can see this now and who want to move forward with changing themselves individually as well.

[00:12:50] Dr. Zahra Kassam: So that made me so happy this week. That just happened, you know, a few days ago.

[00:12:55] Maya Acosta: Congratulations. Are you saying that you actually talked about like lifestyle medicine and nutrition? Did this group physic.

[00:13:04] Dr. Zahra Kassam: Have a talk with nutrition and lifestyle medicine

[00:13:04] Maya Acosta: Oh my God, it's, That's huge. That is huge, Wonderful.

[00:13:11] Maya Acosta: Maybe things are changing. Yes, I think so. I'm very hopeful. So as we, you know, go on to talk about what you specialize in when it comes to cancer, I'm wondering if you sort of can paint a picture for my listeners of your role as a radiation oncologist, because I always wanna know like, For example, you know, when we speak with specialists that work with breast cancer patients, they always say that the individual receives a team of people that support her through everything, her treatments and supporting her.

[00:13:40] Maya Acosta: What role do you play? Are you the individual that sits down with the patient and tells 'em that there's something to be concerned about?

[00:13:47] Dr. Zahra Kassam: So you are absolutely right. It's a completely team based, uh, specialty and usually. There's usually a surgical oncologist, a medical oncologist, and a radiation oncologist. And I would say that just generally, most people don't know what radiation oncologists do. So usually when a patient comes to me, they already have a diagnosis of cancer and I specialize in breast cancers and gastrointestinal malignancies. So, Whoever's made the diagnosis, whether that's a gastroenterologist or a surgeon, they will refer the patient to our, our cancer center, and they'll be referred to a medical oncologist who will do the systemic treatments like the chemotherapies and the immunotherapies.

[00:14:30] Dr. Zahra Kassam: And of course, that whole area has really just moved forward so exponentially with the new treatments. And they'll also refer to radiation if that's what's required. And significant portion of patients who have been diagnosed with cancer will require radiation as part of their treatment. Um, and that's the security of treatments and it's for palliative treatments as well.

[00:14:50] Dr. Zahra Kassam: About 50% of our work is actually for palliation. For symptom management, my day will be seeing people in clinics. So I will see people in new consult where I will go into detail about what their cancer is and what my role is with the medical oncologist, with the surgeon, um, and will form a team-based management plan for them.

[00:15:10] Dr. Zahra Kassam: And sometimes I am the first person to talk to them about what their diagnosis means. Sometimes people come to the cancer center and they don't understand what it's, they have, but most of the time they're already aware and I'm the one with the medical oncologist that goes into more detail about the treatment.

[00:15:28] Dr. Zahra Kassam: I also see follow-up patients once they've gone through treatment and I'm following them up to make sure that the cancer's not coming back. I'm surveilling them with CT scans and blood work and clinical exam, and then I also will recommend radiation if that's appropriate. I will work with my multidisciplinary team within radiation, which is radiation therapists, physicists, nursing to formulate a radiation plan.

[00:15:53] Dr. Zahra Kassam: So I do a lot of work behind the scenes to formulate the plan, the dose, the actual distribution. With all this tech modern technology we have, I spend a lot of hours in front of the computer making radiation plans. I will review my patients regularly during the treatment as well. Yes, it's a very multidisciplinary, You definitely can't be an oncologist on your own sitting in an office like some specialties are.

[00:16:18] Maya Acosta: You said early on that you were a little hesitant about going into oncology, thinking that perhaps it might be a little sad. How do you feel now that you're working with patients?

[00:16:29] Dr. Zahra Kassam: So I feel it's such a honor and a blessing for me to be able to be part of that journey. I. It is really important that I am present with my patients.

[00:16:39] Dr. Zahra Kassam: Every time I'm with them. I do everything I can to smooth their journey. I go that extra mile to smooth their, their journey in whatever way we can. Kindness is so important. Unfortunately, life is busy, Work is busy, people are burnt out. Kindness can sometimes not be there in interactions between patients and their doctors.

[00:16:59] Dr. Zahra Kassam: And I understand. So it's important for me to be kind and to make my patients feel that they're seen, and I feel I can do that. I feel my personality fits with that, and that to me is what I can bring because there are other doctors that can do the same thing, make treatment plans, carry things forward.

[00:17:17] Dr. Zahra Kassam: But what you bring with your personality to help smooth that journey is really important to me. And I always get emotional talking about it, but that's important to me. Yeah. Um, to be able to do that. So I think of my job, I feel blessed every day to do this. I work with amazing people who feel the same.

[00:17:35] Dr. Zahra Kassam: You know, my department, my other radiation oncologist, medical oncologist, and other staff I work with, I'm in a place. Everybody feels that way and I regularly get that feedback that my team has made. My patients feel very warm and supported through that time. And the other thing that you know, I feel I can now bring to them is I can bring that lifestyle discussion because our patients want something to take power over.

[00:18:02] Dr. Zahra Kassam: Everything is about what is happening to me. What is my radiation oncologist? Doing to me, prescribing me what chemotherapy. Everything's, I have no control, but, But they want some control. And I can feel that when I speak to my patients about the lifestyle aspect, that their anxiety, I can see it come down in the discussions I have.

[00:18:21] Dr. Zahra Kassam: I've started talking about all the bad things that are gonna have to go through the radiation, the side effects, everything. And then I talk about the lifestyle. So every new patient I see, I talk to them. Plant-based nutrition. I talk to them about the international cancer guidelines, which support plant-based nutrition.

[00:18:36] Dr. Zahra Kassam: I talk to them about physical activity, stress management, sleep. I talk to them about alcohol and smoking. Um, so all the things that we know of, and most of my patients are very, very receptive to that. And then as we go through the treatment journey and in follow-up, we can follow up and build on. But I hope that I can bring that extra piece to it, that extra control, that they can actually, you know, not only do we know that we can reduce the instance of cancer with this, but now that they have a diagnosis of cancer, can they change their outcome?

[00:19:08] Dr. Zahra Kassam: And yes. You can improve your outcome by implementing these lifestyle meta, measures. We have evidence for that and I feel that's important for us to educate our patients on. And there's not always a space to do that cause there are no resources that we are just trying to get through the day to see that the great number of patients that unfortunately are needing our service.

[00:19:28] Maya Acosta: First of all, thank you for bringing back humanity, the humanity back into medicine. You know, I often say that I believe physicians chose the field because they have a heart for helping people, and somehow along the way, just the frustrations of everyday life, I guess you just kind of disconnect. You know, maybe it's a, a way to protect oneself, you know, from what other patients are going through.

[00:19:50] Maya Acosta: But taking the time to acknowledge what they're going through and being human with them and showing kindness, I'm sure goes a long way. I once had a d friend of mine, I don't speak the, uh, once had a friend of mine a while back, who's also a physician. I remember one time speaking with a couple of his patients and they told me, They love him because he takes that extra time just to ask questions to check-in.

[00:20:16] Maya Acosta: Dr. You might know Dr. Leanna Leonov, who specializes in positive psychology. I, she talked about, Yeah, I love her message. She talked about wanting to educate her peers, you know, changing the conversation, how they approach patience rather than, you know, what is wrong with the patient? Just kind of, you know, just checking in and talking with the individual, having a different perspective rather than looking at me like, I'm, I'm sick.

[00:20:42] Maya Acosta: There's something wrong with me. Just I wouldn't e if I were sick, I wouldn't mind if you just asked me what you have for lunch today, or, you know, just something doesn't put me in a place. I'm the one that there's something wrong with. So I really appreciate what you just said. 

[00:20:57] Dr. Zahra Kassam: Yeah, I totally agree with you. And that conversation on lifestyle that allows you to do just that Absolutely. Mm-hmm. . Cause your patients will feed back to you. Yes. But yes, I'm doing that, or No, I'm not doing that. And then you get this picture of, of their life that absolutely allows that to happen.

[00:21:13] Maya Acosta: Exactly. So you say that you specialize in breast cancer and in GI-related, uh, cancers? That's right. Yes. Can you tell us a little bit more? Whatever you can. I know that I've heard that there are various types of breast cancers and then also what about GI? And so we spend the month of October talking about those things that we can do to reduce our risk for breast cancer. But I'm also very interested about the GI tract, like what can contribute to our risk increasing. 

[00:21:43] Dr. Zahra Kassam: So, um, GI cancers actually. But some of the ones that are increasing in incidents in our younger population. So if we look at the data, we find there's about 13 different types of cancer that is increasing in under 50-year-olds.

[00:22:00] Dr. Zahra Kassam: And I'm seeing this in my day-to-day practice that, you know, so many of my patients are younger than me now that they're under the age of 50. About half or more from the gastrointestinal tract, and these increases have happened in a space of time that it cannot be genetic. It has to be lifestyle and environmental.

[00:22:21] Dr. Zahra Kassam: We know generally that only about five to 10% of all our cancers are due to the genes that we are born with. The rest is environmental and lifestyle, and it's estimated. That, uh, you know, by our international cancer organizations, by the World Health Organization, that about 40 to 50% of all cancers are due to modifiable lifestyle factors.

[00:22:41] Dr. Zahra Kassam: So, and in GI that's the case as well. So each individual cancer will have a different contribution. So, for example, for breast cancer, it's estimated about 26% of all breast cancers are due to lifestyle factors such as Drinking alcohol. People don't know that 12% of all breast cancers are caused by alcohol.

[00:22:59] Dr. Zahra Kassam: Your listeners will now because of what you've, uh, discussed previously. But, um, and being overweight and having a poor diet, um, not being physically active for bowel cancer, which is now getting a more common, 50% of all bowel cancers are now thought to be due to modifiable lifestyle factors. It's so important.

[00:23:20] Dr. Zahra Kassam: To talk about that, and that's why I talk to all my patients about that. Specifically for GI, there's lots of evidence. So for example, that this year there was this incredible meta-analysis with over 3 million people at looking at gastrointestinal cancers, showing that a plant-based diet can reduce the incidents of several different types of gastrointestinal cancers.

[00:23:42] Dr. Zahra Kassam: We know from the World Health Organization in 2015, that process. Causes bowel cancer. It's a group one carcinogen. They have the same strength of evidence that process meat causes bowel cancer. As they do that, smoking causes lung cancer. They also categorize red meat as a probable carcinogen, a group two, a carcinogen in causing bowel cancer.

[00:24:04] Dr. Zahra Kassam: And since then, red meat and process meat has been linked to so many different types of, uh, cancers as well. So I feel that I can say to my, Really you need to minimize and avoid red meat and process meat, but the strong strongest evidence came from the GI cancers. Definitely carrying excess weight, not being physically active.

[00:24:22] Dr. Zahra Kassam: This also increases our risks of the GI malignancies as well as breast cancer. And this is all in our international guidelines. So for people who are interested, the American Cancer Society guideline is excellent. The guideline from the World Cancer Research Fund, American Institute of Cancer Research, they've combined.

[00:24:40] Dr. Zahra Kassam: To provide diet and physical activity guidelines. And I love those guidelines. They have a group of nine guidelines that I tell all my patients. So they say, you know, maintain a good weight, keep physically active, have a diet that is rich in fruits, vegetables, our whole grains and beans. If that's not a plant based diet, I dunno what it is.

[00:25:00] Dr. Zahra Kassam: Uh, they say minimize or avoid. Red meat and process meat. The American Cancer Society actually says there is no place in a healthy diet for red meat and processed meat limit processed food. This is so big. Now, you know, in Canada in 2019, the survey showed that more than 50% of our food is ultra processed in the US last year in adolescents, 80 to 90% of their food is ultra process.

[00:25:29] Dr. Zahra Kassam: So worrisome for heart disease, for diabetes, for obesity, and now for cancer. There's some emerging evidence showing from the Nenet SAN study, for example, from other studies in the US that processed food may increase your risk of cancer. Sugary beverages may increase your risk of colorectal cancer. So this is all now coming out and that's in the guidelines.

[00:25:50] Dr. Zahra Kassam: Don't have processed food. Minimize your don't have sugary beverages either. So this is all. They also say, If you have a diagnosis of cancer, follow these guidelines as well. So it's very clear, and these cancer guidelines are supported by the cardiovascular guidelines, the endocrine guidelines, the Canada Food Guide, the World Health Organization Guide, Organization, food recommendations as well.

[00:26:15] Dr. Zahra Kassam: So we now. In a place that we've got good national and international consensus, that plant-based nutrition is important and plant-based doesn't have to be a hundred percent of course, but at least 85% of diet should be plant-based. And it is, It's supported by our

[00:26:30] Maya Acosta: guidelines. This is incredible, and at the same time, I'm just so thankful that these.

[00:26:35] Maya Acosta: Studies, this research is available and more available to us, you know, um, not just in the doctor's office, but it's available by sharing like this through podcasts and other ways to get the information out to people that need to hear it. It's interesting that when we have our meals three times a day, we may only focus on, you know, how we feel, maybe, or, and whether you.

[00:26:59] Maya Acosta: Possibly can gain weight. I don't think a lot of us sit here and think, Well, this is going to mess up, you know, my endocrine system, or it's going to put me at risk for heart disease, or I don't think anybody's really sitting there thinking about it. But you know, the more that I become aware, the more that I'm just, gosh.

[00:27:16] Maya Acosta: It's just we do have a lot more control than what we knew or what we've known. So the other thing was also as I learned through lifestyle medicine about even the risk of drinking alcohol, I only drank wine, but I made a decision that it's just not going to come into my body anymore. And I started to bring on the show sobriety coaches that have this new way, a new approach of supporting people by helping them work with.

[00:27:44] Maya Acosta: You know, the emotions that perhaps were trying to suppress by, you know, using certain foods or alcohol. And I had one coach on that said that when she gives this lecture to her group, she uses an image of a woman drinking wine and really focuses on all the areas of the body. That wine or the alcohol is affecting everything.

[00:28:04] Maya Acosta: Sometimes we just think it's just the liver, but then you're at risk for all sorts of cancers throughout the body. Do you see that at all? And could you talk about it? I don't know. Yeah. But she said all the way from the throat, all the way down the mouth, the esophagus, all the way down to the stomach and in the liver.

[00:28:20] Maya Acosta: And now it's just like, Yeah, we need to talk about this a little bit more.

[00:28:25] Dr. Zahra Kassam: Absolutely. I just love what you said and then what you're doing. Absolutely. And we need to change the narrative on alcohol, which is so socially accepted, and also this myth that is somehow heart-healthy to drink wine. So all of that is not true.

[00:28:39] Dr. Zahra Kassam: It's actually there's no benefit from a health perspective for alcohol. For the cancer guidelines, it specifically states it is best not to drink, and we know that it increases the risk of seven different types of cancers, including the GI cancers that you've just mentioned and worldwide it's thought to account for about 5% of all cancers.

[00:28:59] Dr. Zahra Kassam: Which perhaps doesn't sound very much, but that's a huge number of people. And if you break it down per site, you know, it increases the risk of, for example, oral, you know, the head and neck cancers very significantly. Liver cancer, significantly. Breast cancer, the GI malignancies, very significantly so definitely I'm with you.

[00:29:18] Dr. Zahra Kassam: We need to educate our patients not to drink alcohol. My patients who have breast cancer, most of them are completely unaware about the link between alcohol and breast cancer, and that's 10 of all patients who have breast cancer. It's due to alcohol. And if we look at the, you know, this year, actually the World Heart Federation put out their policy statement on alcohol.

[00:29:41] Dr. Zahra Kassam: There is no health benefit to alcohol. They've stated that very clearly. It has detrimental. On your heart, on cancer, and on your brain, on your cognitive function. So I'm so happy to hear that you are, uh, advising people as well not to drink

[00:29:55] Maya Acosta: alcohol. Mm-hmm. , it's like this new movement that's happening, they call it sober Curious, just this movement of more and more people questioning it because it's so normalized.

[00:30:05] Maya Acosta: It's like, do I really need to drink anymore? Like maybe I don't need to, to have a good time. And there are younger people that have never consumed any alcohol, so it's just an amazing thing. And I only started learning about it as I started researching it and you know, like I just attract. The people that are in that field.

[00:30:22] Maya Acosta: So it's a beautiful conversation that we're having Now, you said earlier that a large portion of your patients cancer patients that you're seeing are under 50 years old. That is impressive. And my husband has been in practice for 25 years and he said, You know, when he treats Athero sclerosis, he's a vascular surgeon, as you probably know, but he started to see conditions.

[00:30:45] Maya Acosta: Once he treated patients that were in their fifties, sixties, maybe seventies. He's seeing patients as young as in their thirties or late twenties. It's amazing to me that this is happening at such a young age. You talked about nutrition playing a huge role in probably contributing to these cancers. Is that, do you think that the younger people maybe, I know that here in the States, a lot of, you know, younger generations have been raced on a lot of fast foods as parents are busy working and you know, just multitasking.

[00:31:17] Maya Acosta: There's so much going on. It's just people default to fast food.

[00:31:21] Dr. Zahra Kassam: Absolutely, and so many things that came up for me there. So we know that people are eating more fast food. We have studies showing that, and we don't even need studies. We can just go to a supermarket and see what people are buying. Our obesity rates are going up.

[00:31:36] Dr. Zahra Kassam: Our diabetes and our young people are going up. We know that chronic disease starts in youth. We know even that you can see changes of atherosclerosis in babies in the wombs for mothers who have high cholesterol. Mm-hmm. , we can see that all those things start. Very young. So the best thing we can do for our children is to teach them early about lifestyle, benefits of lifestyle.

[00:31:59] Dr. Zahra Kassam: So, you know, I think that all this increase in cancers that we are seeing in the under fifties, it is a pandemic issue now. Is because of our lifestyle and perhaps also the environmental toxins, um, that are in play as well. That is true. Another point to say about, you know, all these comorbidities, these, the diabetes, heart disease, comorbidities, put you at increased risk of getting cancer.

[00:32:24] Dr. Zahra Kassam: That's the fact that's coming out more now. So if we are going to be doing all these things that are increasing our risks of diabetes and et cetera, and obesity, we are adding to the burden and the risk factors. It's

[00:32:37] Maya Acosta: interesting that you say that about comorbidity because I, I'm trying to, I always wanna figure out how like.

[00:32:44] Maya Acosta: But what's the mechanism? Why is it the hormonal issue that's going on? Is it the fat itself that's affecting the organs or, That's

[00:32:53] Dr. Zahra Kassam: a great question. In fact, that's what I was gonna say, but thank you for triggering me for that. So, you know, if we think about the pathophysiological mechanisms at play, you know, if you look at the lifestyle literature, you see that they talk about.

[00:33:08] Dr. Zahra Kassam: How lifestyle can impact these pathophysiological mechanisms such as microbiome changes, such as epigenetic changes, such as cellular injury, and that all of those cause inflammation and then that inflammation can then feedback into. Promoting more microbiome changes, more cellular injury, more epigenetic changes.

[00:33:30] Dr. Zahra Kassam: So you get this chronic cycle of inflammation and it's increasingly recognized that inflammation is the core feature of chronic diseases. So if you think about chronic diseases having. The common mechanisms that we've just discussed, then it's not a far stretch to think that cancer would be then associated with it too.

[00:33:49] Dr. Zahra Kassam: That cancer, you know, Dean Ornish says maybe it now time to think about chronic diseases as just different manifestations of the same underlying dysregulation. Mm-hmm. , and then that makes total

[00:33:59] Maya Acosta: sense. Yeah. Okay. That makes sense. I'm so glad that you bring it up. I know that we're living in a culture now where we don't wanna body shame and we're, we wanna focus on the positive of having people feel good about who they are.

[00:34:14] Maya Acosta: And at the same time, it's a personal choice when an individual decides that perhaps the weight is not really just about image and how they look, but it's probably, you know, a certain way can affect their health and. I'm glad that you bring it out because you as a physician are seeing this, You see the association between core morbidity and the development of all sorts of conditions as well as cancer.

[00:34:38] Maya Acosta: So I have a question about your patients and when you advise nutrition and lifestyle changes. Is it easier when they are at an early stage of cancer to make these modifiable changes so that they have a better experience during treatment and perhaps even prevent recurrence? And is there a time when it's probably too late?

[00:35:00] Maya Acosta: And I ask that because my husband works with very advanced cases of atherosclerosis and just some things cannot be reversed.

[00:35:07] Dr. Zahra Kassam: When you're seeing people in the curative phases, when you're able to undertake a curative path, there's definitely evidence that you can reduce the risk of recurrence and you can improve their survival by instituting lifestyle measures.

[00:35:22] Dr. Zahra Kassam: So that, I think that's very clear from the litera. So even though we can, we are in that situation, we have a cancer diagnosis, you can change your outcome. That's really important to tell people when you do these lifestyle measures during treatments, for example, nutrition, counseling, physical activity, during treatment, you find studies that are showing you an improved quality of life, better weight profile and metabolic features.

[00:35:47] Dr. Zahra Kassam: And we know, unfortunately, When people have a diagnosis of cancer and they go through their treatments, they are at increased risk of getting a comorbidity after. So you know, the increased risk of cardiovascular disease, increased risk of, for example, with tamoxifen treatment, there's an increased risk of non-alcoholic fatty liver disease.

[00:36:04] Dr. Zahra Kassam: So we talked about the fact that having comorbidities increased your risk of getting a cancer, but also if you have a cancer, you'll also then increase your risk of getting comorbidities, either because you're still undertaking the same lifestyle factors. That were at play initially, but also because of the side effects of some of the treatments that we're doing.

[00:36:20] Dr. Zahra Kassam: So it's doubly important to talk about lifestyle measures because there's so many different aspects to that. And then the third piece of it is that unfortunately, if you have one diagnosis of cancer, you increased risk of having a second cancer. Unrelated second cancer compared to the general population.

[00:36:36] Dr. Zahra Kassam: Again, because the same underlying mechanisms are at play. So, so many different reasons to have that conversation.

[00:36:41] Maya Acosta: Absolutely. Thank you for covering

[00:36:43] Dr. Zahra Kassam: that. Then we have people who perhaps are in a phase where the cur of treatment is not a possibility and that you are talking about palliative treatments and we see that people can benefit from healthy lifestyle during that.

[00:36:59] Dr. Zahra Kassam: To improve their quality of life, um, improve their responses to treatments. You know, we mentioned earlier in the podcast that there are now some studies in the microbiome showing that if you have a microbiome that is putting out these short chain fatty acids, which is a sign of a healthy microbiome, you may improve your response to.

[00:37:21] Dr. Zahra Kassam: Treatments, chemotherapies and immunotherapies, and you may improve your survival. So that's early data that's coming out now, which is fabulous because they're linking this microbiome profile to plant-based eating. Mm-hmm. . And so if you can eat plant-based, you can change your microbiome and you can change your microbiome composition in a very short space of time.

[00:37:41] Dr. Zahra Kassam: We've got studies sharing that as well. So, There's benefits, whichever stage you are at, whether you can ultimately reverse the trajectory of your disease if you are in a phase which is not curative. There's not good data in that. Not like we have in the other aspects of prevention and the benefits in the curative phase, but we do have.

[00:38:02] Dr. Zahra Kassam: Anecdotal evidence and case reports in the literature of people who have very advanced disease, who, uh, either choose not to have conventional treatments or don't have the option of any more conventional treatments. There's about a thousand case reports in the literature of people who've managed to have a radical remission to have a cure without the option of the standard treat.

[00:38:23] Dr. Zahra Kassam: And if you look at what they do, you know Kelly Turner wrote this amazing book called Radical Remission, which I do recommend to my patients where she did her PhD project on this subject. She noted all these case reports in the medical literature, saw that these cases didn't tell you what these people were doing.

[00:38:39] Dr. Zahra Kassam: And so she decided she would do her PhD project going all around the world to interview people in that position to ask them what were they doing? And they had all completely changed their life and she found they were doing many different things and they were doing nine same. So she wrote her book, Radical Remission with each chapter describing each of the nine factors that people did, and one of them is nutrition.

[00:39:01] Dr. Zahra Kassam: One of them is using your intuition to make treatment decisions. It's a fascinating book. I really recommend it. I'm you probably aware of it and have read

[00:39:08] Maya Acosta: it. I haven't, I wanna say I know the title, but I've never read it. So now I will. . Thank you, . It's so encouraging the way that you're speaking about this, that it's, um, I just think that sometimes people might give up at some point and just say, Well, I'm at the mercy of this diagnosis, so.

[00:39:27] Maya Acosta: There's nothing left to do, but you're right. I mean, all the pillars of lifestyle medicine, especially working on building, you know, healthy relationships and stress management, which I think would probably be huge in palliative care, in helping patients to practice mindfulness, to alleviate probably some of the physical pain and some of the stress could be significant.

[00:39:47] Maya Acosta: And as you're saying, As just sharing all of this, I'm thinking of a friend that my husband approached who was diagnosed at the time. We met him in our sailing community. He's in Florida. He already had stage four prostate cancer. Was um, it had ma, I never say this right, but metastasized and. He was pretty much given nine months left to live and was sent home.

[00:40:11] Maya Acosta: And so we met him around that time and you know, we would see him often. And one day my husband said, I think I wanna share this with him. What do you think? And I said, If you can save his life, , please tell him the conversation happened. And that was almost four years ago. Yeah. Our friend was able to go back to work.

[00:40:27] Maya Acosta: Of course he has a lot of pain because it's now in his bones, but he was able to increase his energy enough to go back to work. And he's still. It doesn't mean the cancer went away, but the quality of life improved as a result of going plant based.

[00:40:41] Dr. Zahra Kassam: Amazing. Thank you for sharing

[00:40:43] Maya Acosta: that. Yeah. Yeah. I love these stories because I believe in the ability of recovery through by healing the heart, the spirit.

[00:40:50] Dr. Zahra Kassam: Totally. And actually you've reminded me of the amazing studies by Dean Ornish in prostate cancer. He did a series of studies on people who had early stage prostate cancer. Um, so it's really proof of principle studies, but these people had early stage prostate cancer so that they were in a stage that they could undergo active surveillance without doing the active radiation or surgical treatments.

[00:41:15] Dr. Zahra Kassam: And he did a randomized control study on 93. People where he did standard of care and in the intervention group he did lifestyle interventions. So he did the low fat vegan diet, he did physical exercise and stress management, and one year on average, the psa, which is the marker that we monitor the activity of prostate cancer on average in the intervention group, those who were doing the lifestyle intense lifestyle changes, their PSA on average had gone down a bit compared to the other group where the PSA had gone up a bit.

[00:41:47] Dr. Zahra Kassam: And then at two, In the same group of people, they found that the people who were just standard of care, 27% of them had required radiational surgery or an active treatment compared to only 5% in the group with the intensive lifestyle changes. And then he did other incredible studies. He looked at activity and the length of their telomeres, the genetic analysis on their prostate cancer.

[00:42:13] Dr. Zahra Kassam: Biopsies and he found that you could increase Lamase activity and that their telomere length was longer. At five years in the intensive lifestyle group, they also looked at the serum of patients in the intensive lifestyle group, and they found that that serum inhibited the growth of prostate cancer cells eight times more than in the standard group.

[00:42:36] Dr. Zahra Kassam: And then even more mind blowing to me, they did that genetic analysis showing that. At three months after this lifestyle change, you could up-regulate or down-regulate gene expression. And there were 500 transcripts that this happened in, and some of them were the known, you know, cancer, cancer changes, uh, cancer genes.

[00:42:58] Dr. Zahra Kassam: So, To think that you can change the expression of your genes after three months of an intensive lifestyle intervention is huge. There were small studies, but I mean mind blowing and hypothesis generating and more work should be done on

[00:43:12] Maya Acosta: this. This is fascinating. Thank you for sharing that as well. My goodness.

[00:43:16] Maya Acosta: So much. Great information. For the listeners, I wanna also mention two of the books that I had the opportunity to check. You contributed to two, and if you'd like to talk about them, one is to support clinicians. I believe it's called plant-based nutrition and clinical practice. And then the other book, which I love and I've heard you speak about why you put it together is eating plant-based.

[00:43:38] Maya Acosta: And this one specifically, I would love my listeners to go out and grab a copy of it because many times people wanna know how to get started. There's so much information out there, Dr. Kassam. So if you'd like to share a little bit about, uh, the books and, um, how people can grab a copy.

[00:43:55] Dr. Zahra Kassam: Thank you so much for that opportunity to do that.

[00:43:57] Dr. Zahra Kassam: So the first book, Eating Plant Based Scientific Answers to Your Nutrition Questions. That was our first book. It came out earlier this year that's co-written by my amazing sister, Shireen Kassam, whose idea it was. And what we wanted was to have a book that we would've wanted to read when we first. Became vegan, you know, nearly 10 years ago.

[00:44:18] Dr. Zahra Kassam: And you know, when you become vegan, when you go plant based, you have a number of questions that you have. You have people asking you this continuously. They're suddenly very interested in your life in a way they weren't before and we weren't educated at the beginning in all the health benefit, all these.

[00:44:34] Dr. Zahra Kassam: Questions like, you know, but look, this magazine said being vegan is bad for you and this and that. We wrote the book that we really wanted for the public health professionals can read it as well. And we've referenced it really well because we wanted it to be for everybody. So, you know, 60 pages of that 280 page book is references.

[00:44:53] Dr. Zahra Kassam: So if you can go as deep as you want with this book, or you can just read, uh, the book itself. And we made it in a question and answer format, which is the format that we. Find that our learning is helped by, and it's the common questions that we get on a day-to-day basis from our patients, from my colleagues, and we've divided it into, you know, a chapter on eating meat and eating fish and eating dairy and eating eggs.

[00:45:16] Dr. Zahra Kassam: So it's not a recipe book or a necessarily how to book, but it's all the background and evidence and we hope we've included any question that you might be asked on plant-based eating.

[00:45:27] Maya Acosta: Well, if I can say that it's a perfect book. You don't need recipes in the book, because that's the one mistake that I make, and I say this often to my listeners, is when I first got on board, I went and just started printing a lot of recipes.

[00:45:41] Maya Acosta: I have a huge folder to this day, like this full of recipes, and then I didn't know. Where to start, but I also didn't know the importance of eating. You know, why I wanna eat more greens, why I wanna have mushrooms in my diet. Because I wasn't doing the research about the nutrition itself. I just was looking at the recipes and the way that your book is written, as you've explained it, helps answer those concerns that we have, like, Where do I get my protein?

[00:46:07] Maya Acosta: What about calcium? And also it gives us the information to share with other people who are interested as well. So if people question us, Where do you get your protein? I'm often asked, What is your favorite? What is it pro? Uh, how do they say it? What is your favorite? Protein or something like that, , which is really awkward to me, so I'll just answer it with beans.

[00:46:27] Maya Acosta: But I know that a lot of plant-based foods have protein, and so it gives us sort of that information to know how to then speak with new people about this way of living. And then you give us a lot of science as well. Like you said, you talk about meat and. What the World Health Organization says about process meets, and so there's science in it.

[00:46:47] Maya Acosta: I just think everyone meets this book. It's probably the one book that everyone should have when you first start off, I did the e Cornell training, the course as well, and I felt like it was so much information because it covers. The nutrition aspect, but also the planet and the animals. And I recommend it as well, but a lot of information for someone new.

[00:47:08] Maya Acosta: Uh, whereas for example, this book is just perfect. It's easy to read and it gives you the foundation for this way of living.

[00:47:16] Dr. Zahra Kassam: I really appreciate your kind words. Thank you, Maya. Thank

[00:47:19] Maya Acosta: you. Yes. And the other book that you also wrote, this one, the Plan-Based Eating came out this year. So is it available on Amazon or where can people grab a copy?

[00:47:30] Dr. Zahra Kassam: Yeah, so it's available on Amazon or Book Depository. Usually anywhere you get your books it's available. And the other one as well, the other one, Plant-based Nutrition and clinical practices just come out in, uh, I'll just pop it up here. I dunno. I just love the cover of this so much. It's so beautiful and green.

[00:47:50] Dr. Zahra Kassam: It came out on amazon.com, amazon dot c, Amazon UK. It's in book depository. Hammersmith Health Books, which is our publisher, have it uh, on their website. You can order directly from them as well. If you do it through them, you get a free e copy. As well. That's a nice bonus, and if you want the e copy it, it's half the price of the physical book as well.

[00:48:13] Dr. Zahra Kassam: Mm-hmm. and that second book is really meant for health professionals. It can be read by anybody because I think the way the authors have done it, the authors have done such an amazing job. People who are not health professionals can also read it and benefit if they want a deeper knowledge. And this book was actually conceived, um, to go as in accompanying book to my sister's plant-based nutrition at the University of Winchester in the UK.

[00:48:37] Dr. Zahra Kassam: And it has chapters on cardiac health. Diabetes, obesity, uh, liver disease, cancer, um, brain health. Um, and we have amazing, amazing authors and, and lots more chapters. We have also the end, the two final chapters are one on lifestyle medicine by the amazing Dr. Laura Freeman from the UK and also, Because planetary health is so important in all of, there's no individual health without planetary health and the links of our food system to our individual health, but the links to our climate crisis and our ecological crisis, we wanted a chapter to bring everything together at the end.

[00:49:17] Dr. Zahra Kassam: And that's written by my, uh, amazing sister Lela Kassam, my amazing father, Dr. Amir Kassam, who's an expert in conservation agriculture, uh, globally and in poverty alleviation. So we finished the book with that chapter and a call to action, a Call to action to all health professionals because as Dr. Katz, the past president of the American College of Lifestyle Medicine and all around amazing person said, You cannot now rightly call yourself a health professional if you do not fervently and frequently advocate for the health of the planet as well.

[00:49:49] Dr. Zahra Kassam: That we thought that was an a perfect way to leave.

[00:49:52] Maya Acosta: Yes, it's wonderful and I'm thinking this would be a great Christmas gift for our physician

[00:50:00] Maya Acosta: Like you just never know who would be open to content like this. I know that my husband gave a book to the CEO of his hospital. and he went plant based. He's like, This individual is like 90% plant based. So then my husband comes to me and he's like, What, What other book should I give him? . So I read, Yeah, I read so much that I say Give him the Longevity Diet, you know, by Dr.

[00:50:23] Maya Acosta: Walter Longo, because that's another book that this individual who cares about his health would really be interested in. But this book, it's probably the. Type of book like this that I've seen that I think would be nicely to kind of just give to our physician. I said, thank you at the end of the year.

[00:50:40] Maya Acosta: Have a great Christmas. Here's a gift for you

[00:50:45] Maya Acosta: I mean, you just never know, like who will be receptive or to this information. So is there anything else that you'd like to share with our listeners or any kind of like a final message, Words of encouragement?

[00:50:56] Dr. Zahra Kassam: I also want to say thank you to Maya for all that you are doing. I mean, this is amazing. And educating ourselves, spreading the message is so, so amazing.

[00:51:05] Dr. Zahra Kassam: So key to everything. I would just like to end with saying that eating. In a plant based way is so amazing, beneficial for our own individual health. For planetary health and for all the life forms that we live on this planet with. When you look into the evidence, there is no other way of moving forward.

[00:51:28] Dr. Zahra Kassam: It is the most compassionate choice for ourselves, for our family, and for all the beings on this planet.

[00:51:35] Maya Acosta: Thank you so much for all that you do and for spending time with us and sharing all of this information that is just so valuable for us. Thank.

[00:51:43] Dr. Zahra Kassam: Thank you, Maya, for inviting me and allowing me to share this time with you.

[00:51:47] Dr. Zahra Kassam: It's been really fun. Thank

[00:51:48] Maya Acosta: you. Thanks. Here's a recap of our conversation. Dr. Zara Kassam is a radiation oncologist and co-founder of Plant-Based Canada. The non-profit organization aims to educate the public and health professionals on the evidence-based benefits of plant-based whole food nutrition for individual and planetary health.

[00:52:08] Maya Acosta: Dr. Kassam has dedicated her career to helping people with cancer. She's now using her platform to educate others about the benefits of plant-based nutrition for cancer prevention. Hers is a team based specialty working with a surgical oncologist and medical oncologist, as well as other specialists to support her cancer patients.

[00:52:28] Maya Acosta: Dr. Kassam specializes in treating breast cancer and gastrointestinal malignancies. I was surprised to learn that GI cancers are increasing in younger populations. According to the World Health Organization, modifiable risk factors can significantly reduce the risk of cancers in chronic disease. Dr. Kassam says that lifestyle changes in a whole food plant-based diet can help in the curative face during and after treatments.

[00:52:55] Maya Acosta: In other words, there is always time to make healthier lifestyle choices. She references a recent 2022 meta-analysis with 3 million people, which looked at gastro intestinal. Cancers. The meta-analysis showed that a plant-based diet could reduce the incidence of cancers as part of her mission to support individuals and health professionals.

[00:53:15] Maya Acosta: Dr. Kassam has recently co-authored two books. She co-wrote, Eating Plant-Based with her sister, Shireen Kassam. This is the book that they would've wanted to have at the start of their journey. She also contributed to the plant-based nutrition and clinical practice written for clinicians. This book was co-edited by her sister Shereen and their dear.

[00:53:37] Maya Acosta: Registered dietician Lisa Simon, who I also invited on the podcast. The world is changing and more and more physicians are beginning to embrace the power of nutrition to prevent Hals and in some cases, reverse disease. The Ontario Medical Association Education Series invited Dr. Cassam to speak on plan-based nutrition.

[00:53:57] Maya Acosta: 100 of her colleagues attended her lecture. This is a fantastic win for all of us who wish to have more doctors well-informed on Nutri. I wanna thank you once again, Dr. Kassam, for joining us today. And as always, to all of my listeners, thank you for tuning in and I hope that you found this conversation to be beneficial.

[00:54:17] Maya Acosta: You've been listening to the Healthy Lifestyle Solutions podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave us an honest review on Apple Podcast. That helps us to spread our message. Thanks for listening.