S1 Ep 2: 'Understanding Breast Cancer' featuring Jo Gamble BA (Hons) DIP CNM AFMCP

Are you a nutritional therapist or nutrition professional - you'll love the new IHCAN magazine Podcast.

Presented by the wonderful nutritional therapist Kirsten Chick, we'll bring you IHCAN content you know and love in easily digestible 45 minute episodes, perfect to listen to on a commute, a dog walk, while cooking or in-between clients 🎧.

In this episode we speak to Jo Gamble.

Jo Gamble was the first Functional Medicine Practitioner in the UK, and she specialises in working with people with cancer. 

We explore different types of breast cancer, including oestrogen and progesterone receptor positive, Her2 positive, and triple negative. Along the way Jo talks genetics and plastics, Tamoxifen and Metformin, mushrooms and melatonin and a whole lot more. Most importantly, how to change the terrain:

"So just like soil grows beautiful flowers, it also grows weeds. And in our
body, if our terrain is not optimal, that weed-growing is the pathogenesis of cancer. [...] If you don't change that soil, you're just gonna grow more weeds."


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The IHCAN magazine Podcast is provided for professional education and debate and is not intended to be used by non-medically qualified individuals as a substitute for, or basis of, medical treatment.

Transcript

Hello, I'm Kirsten, Chick nutritional therapist and author, and I'd like to welcome you to the first series of the ICAN Magazine podcast and today I have with me Functional medicine practitioner Joe Gamble and we're going to be talking on the theme of. Understanding breast cancer. So welcome, Joe.

Thanks, Kirsten. Lovely to speak to you.

So you were the first functional medicine practitioner in the UK, is that correct?

Yeah, that's correct. So I graduated from I FM. 10 maybe 11. I think it might be 11 years this year in the first like world cohort of functional medicine practitioners.

Fantastic. How did that?

Come about. So I trained initially in nutrition like many people did. Who's listening to the podcast. And I'm gonna be honest, I got to the end of that and was like. This hasn't given me a deep enough dive. There's gotta be something else out there. And then I got the opportunity to do a web-based course with Doctor Christy Hughes on functional medicine. I was like, great, this is this is it. But I still that wasn't a certified course. It was just like a. Interest only. She bought an amazing speakers doctor Jeffrey Brand. Carol Fitzgerald, Bob Brown tree and I'm like, these are the people I wanna be surrounded by. And then the first I FMCP came to London. So I joined on that one, but then it meant going over to America and I was like in. For a penny, in for a pound. I'm gonna do it.

Yay, well done.

And if I'm gonna do it, I'm going to be the first. I'm a. Taipei. Brilliant.

Good on you. And I came across here. Yeah, because we're you're. Well, we're both medical supporters of the yes to life cancer charity. So I'm aware you specialise in integrative oncology. So. So what's drawn you towards that area?

Yeah. OK. So my story very, very quickly is my now 20 year old when she was two, was diagnosed with JRA juvenile idiopathic arthritis, which is autoimmune origin. But she was treated with methotrexate initially and then other disease modifying drugs. And I very quickly realised the impact of methotrexate is a chemotherapy drug. It's still used in leukaemia but not really used very much in cancer anymore. Truthfully, was gonna kill her. She ended up in in intensive care within about 8 weeks of starting methotrexate. And I remember sitting there and it was New Year's Eve. And and I was looking at her and I was looking at the machines. And I sat outside, turned midnight and there was fireworks going off all over the place. And I was like, if I don't take this into my own. Once I'm not gonna see her for another new year. That sounds very dramatic. But when you've got bilateral pneumonia and you've got, like, a she just turned 3 at this point she was pretty sick. Yeah. So that night was my night of going. I've already asked the doctors what I can do, and they've said nothing. It was my night to go. I've gotta find out more. And I'm gonna sound like my. Mother, in my day in the day. You know, Google wasn't. As good as Google is now. There isn't, you know, great resources, but I did find a naturopath in London and and he was like, you know, you've got to take matters into your own hands because you're right. Her liver's already. And liver enzymes are really high. She's sick. You've gotta do it. So that was my real exposure, not to cancer, but to the impact of the drugs. And that's always been like a big sort of driving force to me. And I'm not saying I'm anti drugs. I'm I'm not at all. But I'm like the impact of some of these farmers are so catastrophic. And yet the medical world aren't dealing with the aftermath. Of what they've created. So that was that was. My entry in.

Well, yeah. And she's OK now.

Yep, she's 20. She's at Bristol University studying biochemistry, and she's going to take over the world.

Fantastic. Oh, good for her. So today I. Thought it would be interesting for listeners to get a low down on the different kinds of breast cancer that are out there. So we're kind of swerving topic a little bit. So this seems like you know oestrogen receptive, hurty positive, triple negative, all all the different kinds that. Are out there. So you know, there's going to be a lot more going on for each individual. And their diagnosis. But could you just talk us through what those kinds of labels are referring to?

OK. So breast cancer obviously is originating from the tissue of the breast, but the different types of breast cancer certainly influence the way that the medical profession go. So like you said, the most common type of breast cancer that we are seeing today. Is oestrogen receptor positive breast cancer and where we often get surges of that is perimenopausal as women's oestrogen goes up sadly but. Truthfully, we're seeing big Insurgences post pregnancy again, postprandial big changes in hormone balance. And that's a really tough one where, you know, women are getting diagnosed with we small babies. Yes, you do get some older women presenting with it, but generally it is that kind of 35 to 55 is our most common bracket and that is the number one breast cancer and actually the number one cancer being diagnosed in the UK. It's not the number one. Killer. But it is the number one cancer and that may be partnered quite often with the PR as well. So progesterone receptor? I would say to my clients in those circumstances. Give me the. Breakdown of your your tissue typing. So what's come back after they've had either the biopsy? With surgery and they'll get a score out of eight, eight out of eight being the most strong oestrogen receptor. That now away from that you can have her two positive breast cancer. So her two is something that's undergone a gain. A great deal of research cause it. Was one of the first cancers to receive a. Targeted therapy Herceptin, although nowadays we're using other abbreviations cause the septin isn't. Licenced not painted anymore, but that was one of the very first and. Billions of pounds of research to look at how we've got a receptor and a targeted therapy working perfectly. And then the belief of that's gone out and rolled out over lots of other types of cancer. You can have triple positive cancer. So it's then ER positive PR positive and her two positive. And then you can also have triple negative cancer. I mean in the opposite of that, which is there is no target tissue. Triple negative, which used to be thought of as a either older person's cancer. That's not true that that's so not true. Triple negative is actually one of the hardest to treat conventionally because they're not that anything to target. So what they've done is they've stolen. The treatment from sort of your positive the the chemotherapy they use for EO positive, they also use triple negative in the private sector. They've had it in immunotherapy, but that's not yet funded for NHS. And honestly, it has. One of the highest relapse rates. However, if you can get your patients to five years post diagnosis, their risk of relapse comes down significantly. So some people say to me, oh, that's that's an easy cancer to. Work with. I'm like, not so convinced about that.

So they're they're.

The different types of cancer or relating to the breast, of course. However, I think what's important, even before you get to that is to take a step back, because as a whatever you call yourself an integrative oncologist, like a nutritional therapist with an interest in in oncology, whatever the different sort of labels that people are using in this integrative. You've always gotta. Start by looking at the terrain. And that terrain I was described to people as the soil that's allowed this cancer to grow in the first instance. So just like soil grows beautiful flowers, it also grows weeds. And in our body, if our terrain is not optimal that weed growing. Is the. Pathogenesis of cancer. So yes, there's some great books out there, particularly from an integrative point of view that you go. I'll open that up and I'll follow that protocol. And actually that's not right. That's not how we should be working as as practitioners. What we should first of all be doing, whether it's a whether it's a cancer of the breast or the brain or the colon or the big toe, is dealing with the terrain because that's not how the medical profession work. And that's really why people relapse it. Frequently because however much aggressive the treatment has been, if you don't change that soil. You're just gonna grow more. You're gonna grow more weeds. So I think you know. I know you weren't after protocols off me. Today, but I always. Say that there are protocols, there's. Certain things that we should be thinking about and there certainly should certain characteristics that we need to be thinking about for different cancers. But take a. Step back and really look into that terrain.

And that's the perfect answer, isn't it? So when you've got somebody coming to you for support, who is saying, you know, I've, I've read this book and it's telling me to eat more. And I've read this book and it's telling me to eat Paleo or keto, and I've read this book and it's telling me to be vegan. And I'm so confused. Used, there's your answer is math.

Yeah, yeah, yeah. You've got to you've absolutely got to and when maybe let me go a bit more to brain centred and and sort of share with you where my brain's going here. If your body is pro inflammation. Then that will create an imbalance in the soil. So understanding what's going on in our body is so paramount. Thinking about immune system and immune activation. So I'm I'm gonna try to not go there. But I'm gonna. Skirt around the outside of viruses and vaccination. That's why I'm trying not to go there, but just go. We know that chronic viruses impact. Our immune activation, our immune regulation, so we've certainly seen when looking at labs I and this is not new, this is not COVID linked. Like, look at the impact of Epstein Barr virus on immune regulation, but we can't help but look at the last couple. Of years and go. But now there's been significant changes to many people's immune activation, whether that's been caused by the virus or the vaccine.

Or both and.

All I would say to that point is watch this space in another five years. Time and I can't help but think we're going to see an even bigger. Surgeons of cancer post. Viral implication, but that falls within that terrain situation, as does our toxic load. So many people have heard me lecture and toxicity. I do a lot of lecturing for Nutri advanced on toxicity and I. Talk about like.

A bucket.

And that bucket gets full. That's gonna make the soil not very nourishing. It's not gonna, it's. Not gonna allow things to grow. And of course. Genomically some of us are much more predisposed to the build up. Of that of that bucket.

So yes, what you're bringing in here is that we are living in a in a very different environment now to one that we were living in even 50 years ago, and that's all going to have an impact. But also we're all going to respond to that differently depending on what's going on in our terrain to begin with and other factors that are involved. There. So yes, there's a lot. There's a lot to unpack there and it really kind of helps us to understand why we can't just write a protocol in a book and give it. OK. Absolutely, absolutely. So coming back to hormonal breast cancers, so these are the ones that have receptors for oestrogen and or progesterone that's that. So that suggests that these hormones are driving the tremor. The tumour growth, yeah. So the medical approach.

Yeah, this is 1.

With that, so apart from kind of like surgery, chemotherapy and things like that, there's then medication like tamoxifen for example, which is trying to address that aspect. From an integrative medicine and functional medicine approach. Is this a good time to talk about Dutch testing?

Yeah. Perfect. Absolutely perfect. Let's go there. Let's.

In the table lights. Let's go and.

Have some fun in this area. So first of all, we did actually sort of miss a driving force behind this type of cancer and that is the BRC A1 stroke 2G. That actually affects a very small percentage of breast cancers. Now we only used to think B RCA12 was a driving factor behind, ER, positive breast cancer. We now know it can also impact upon negative cancer as well. So if we just put the Bracha gene to one side. Because we could have an hours long conversation about. That but that. Isn't what's affecting most people, and even with those people, interestingly, I'll just just show a caveat in there about the RCA one. So on my caseload I have a. 22 year. Old with, ER, positive BCA one breast cancer 22. I also have a 71 year old on my caseload who was found out to have a BRC A1 gene. When both of her daughters got breast cancer because they've both got it, they were tested so she was tested and bless her at 71, had to make the decision whether she had a. A double mastectomy, but she's never had cancer. So you've got to throw it in there. And this is where, why? I'm throwing this out there cause that's where I want to go is. Why did hers turn on at 22 and she got to 71? And they've, they've done mammograms have done a breast MRI, they can't find anything. So how was she got 71 and it hasn't turned on.

So if we.

Just hold that. In our heads, we've gotta think about, first of all, our unique genomic stability and instability. And then the terrain that we bathe those genes in. So for me, your positive breast cancer from a genomic point of view actually more what I'm interested in. Is what's your sick one? Be one doing sip. One be one will push more oestrogen down the four hydroxy. The much more dangerous pathway and then what's going on with your GSTM one and your Co Mt. Now those 3 pathways. So typically what you will see is upregulation of. That one be one down regulation of GSTM one and C OMT in that situation. That's the perfect genomics. Form for breast cancer, meaning you you're more likely to push your oestrogen estradiol down the four hydroxy pathway and you're not able to. Deactivate that oestrogen, add a methyl group to it and make form of foxy, which is safe. So if you're looking at Snips, that's your perfect snip for the starting point of breast cancer. Answer. However, you've then gotta go. Well, what did I bathe those in? So if we think about estradiol? Or oestrogen in general. Yes, we're producing it. And yes, at certain times in our life, we have a higher load of it. Those two, particularly that I mentioned having a baby and perimenopause. But you've also got. To think about environmental exposure to those oestrogens.

And I think.

In the world that we live in and you said 50 years, I'm going to say it's. Not even 50 years. I reckon you could say 30 years, 25 years, the amount of plastic in the environment has exponentially gone up and I had an amazing chance in close encounter with with a lady. A few weeks ago, who specialised in plastic and she originally specialised in plastic linked to, she was a marine biologist from South Africa and now she's gone into human impacts of plastic. Look, and she was telling me that nobody regulates plastic because it's non food and they did an experiment where nothing to do with organic cause. That's not what they were looking at. They cooked a a meal that was locally produced, like not wrapped in plastic versus the same meal bought from the supermarket. And the thousands of percent greater amount of microplastics in that meal, which makes. Sense to us, doesn't it? And then you've only got to open. Up your own fridge and go home. Even when you try quite hard. Still, a lot of plastics out there, there's plastics. Everywhere there's oestrogen in the water supply, so there's obviously lots of people using exogenous estrogens linked to OCP HRT. So is it a surprise that the number of breast cancers is going up when you look at those environmental exposures, couple those environmental exposures? With the perfect genomics storm boom. No wonder we've got breast cancer, so. You mentioned Dutch test. Dutch is one of my favourite tests in this circumstances. But I would always partner that with. A genomic test to look at detoxification and also hormone balance. So I love life code. That's that's always my go to it where that's concerned. And I generally run those panels to go. This is your genomic susceptibility and then the Dutch test to go and this is where you. Are right now. And I'm even gonna add one more just pulling out something else that you said about tamoxifen and tamoxifen is? Processed down the sip 2D6 pathway and maybe about 20% of the population are a speed clearer of sip 2D6. But yet no medical doctor looks at that pathway to go. Are you going to be somebody that's going to speak? Clear this to moxen. Through your system. And instead just whack. All of these, ER, positive like. Perimenopausal women onto tamoxifen and then wonder why some of. Them relapse. So again, checking your zip 2D6 which is part of that detox pathway, is essential if somebody's going on that drug.

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So yes, we have these two tests, then we have the the, the genetic tests that look at what's going on genetically, what the potential to happen is and where the body is struggling or what. Has the potential to struggle in metabolising all of these things, and then we have the Dutch test to go. OK, well, these are the metabolites that are present right now. So from there that can give us clear indications of what pathways you're doing. Well, what pathways you're not doing so well. And like you say, what's going on at the moment? So is it interesting that that can then help make a decision about whether or not tamoxifen is is effective to follow? Are there any so any any kind of foods and nutrients that that might point you towards as well? So there's there's a lot of nuances that come out of these tests. Obviously this isn't specific for an individual, but any general tendencies that. You would expect.

OK, so so not for most tests, but I. Don't wanna forget vitamin D vitamin D deficiency? It's highly associated with the pathogenesis of most cancers. Breast cancer is huge up on that list, so optimising somebody's vitamin D is essential. But looking at the 2416 ratio, indoor 3 carbonyls, dim your broccoli supplement.

It's a huge.

Part of that work, because we've got to be able to work on if somebody's upregulated in their sick one, be one, we want to be thinking about how we can support the metabolism of those hormones. Also. Again, it depends on whether it's standard of care where they are. In chemotherapy, radiotherapy, mushrooms, and mycotoxins, mycotoxins, mycotoxins, microtherapy don't give them mycotoxins. Want to avoid that? Microtherapy is a really important part, particularly mushrooms like Coriolis and Mitaki, and again. Cookers ganoderma their mushrooms that are really beneficial. Especially if they're on standard of care like chemotherapy trying. To offset the side. Effects of that treatment really good use of that. What I would like to just mention is not something I do use, but something I don't use and that's. Whilst Ashwagandha is 1. Of my favourite. Herbs. I love it. You've got to be really careful of using ashwagandha in breast cancer. It can raise our DHA levels, leading to more oestrogen metabolism. So yes, you do want to support somebody's adrenal response, but ashwagandha. Shouldn't be your go to it in those circumstances? And then also depending on what the genomics tell you around the methylation capacity, giving them some methyl support is really important.

So that things like methylfolate. Yeah, malamine, yeah. And and and and and looking.

At like their pimps, polymorphism and thinking about choline synthesis and what we can do to support very gently those methods.

So there's some real nuanced information that can come through from those tests and and potentially you can then retest with the Dutch test. So oh look it that's doing its job, it's doing exactly what we're doing.

And that's that's.

Often what I do say say I've got somebody I've worked through with them, their standard of care, as in they've come, they've come to see me really early. Maybe I've supported them through their chemotherapy radiotherapy surgery. And then we get. To the end of radiotherapy and. Because usually you do chemo first, then surgery, then. Radio and then they then go on to tamoxifen and often what I'll do, particularly the ER cancers is go. Let's do a Dutch test now. Then let's get you on to we've already checked your detox plaster. You're not a speed clear of two D6. Let's start moxen and then let's. Retest you and see whether that's moxen is doing what it. Should do I. Just hate to say this at this point. There is no follow up testing on the NHS whatsoever. Not for even serum. Estradiol levels don't get tested once they're on to moxen, not at all.

Yeah. And I'd say that's kind of where it's, it's useful and it's handy that we have some really great tests at our fingertips that on privately, yeah, but really unfortunate that they're not more accessible.

Yeah. And my other favourite testing must just say in this would be and I almost always pan unless I can get these markers done on the NHS or if they're through private. I can. I can get the big ones. Is adding in a FDX because the other markers part of the terrain markers that you want to look at is of course vitamin D. Magnesium is also quite beneficial, less about the pathogenesis of cancer and more about sort of adrenal response and what's going on with the adrenals. But top of my list is CRP and ESR and ideally HSCP for the inflammatory burden lactate dehydrogenase because that gives us an idea about what's going on with their. Metabolic function. So think about their Kreb cycle. And and also homocysteine levels and it's amazing how many clients present with high homocysteine, well, what's high homocysteine, a sign of lack of methylation which we know drives breast cancer. So understanding those markers and actually if you're going I'm working in the cancer arena. This pub Med stood is on each of these markers to say why they should be tested as part of standard of care, but I hate to say this, none of those are tested as as part of standard of care. So I do sometimes write to the medical doctor and, you know, put nice reference to pub Med and go, can you? Please do this but. I would say you never if if anybody can get home assisting, please tell me what you've said cause I can't get home assisting on the NHS, but I I can often get they're not HSC RP but I can generally get CRP, ESR and LDH and then a full blood count to look at their neutrophil to lymphocyte ratio and their immune regulation through their white blood cells. If all yeah, vitamin D absolutely. You can usually get it once a year, but sadly you know, with cuts even vitamin D is getting harder to get through the NHS.

Yeah. Yeah. So there's a lot. There's a lot of testing there. There's a lot of deep diving that you can do and and that we've focused mostly on the hormone receptive. And says what about triple negative? Is there anything that you would particularly highlight for those?

Yeah, actually one of the things is melatonin synthesis. So there's quite a lot of good research out there about low levels of melatonin and driving of, well, a cancer in general. But there's a. Lot of decent research out there about triple negative breast cancer and low levels of melatonin. I know as NT's we can't prescribe melatonin, I have lots of clients that prescribe their own melatonin and that's. Echo but again. In the Dutch test. Looking at their melatonin levels, melatonin is a tumour surveillance agent. Melatonin is a really powerful antioxidant. Melatonin helps to protect our healthy tissue through radiotherapy. So there's so many. Benefits beyond supporting my circadian rhythm. That melatonin can give us also thinking about things like toxic burden and glyphosphate levels and triple negative breast cancer. And again, you know, sadly, you've only got to look at. The food that. We're putting in our mouths and glyphosphate levels and other toxicant levels. And you go. It's it's, it's. It's coming in our food supply. It's it's there all the time and and actually grains are one of the highest levels of of that coming into our body.

And then her two positive is there anything specific that you'd look at there?

So again. Toxic burden is going to be across all of the different types of of of cancers, and again looking at genomic stability, particularly in her too and seeing what they're doing with their sort of like sod 2 levels, which is a need for. Antioxidants thinking about their blood sugar balance and this is where many people are familiar with using like off licenced drugs. Again, not something we can prescribe, but thinking about like the use of metformin, cause it's very sugar loving, as are most cancers. But that one particularly. Is thinking about what's going on with again immune regulation is, is, is vitally important in these circumstances. But even thinking about things like what's going on with that iron levels, their copper levels, they're ceroplastes. Levels. Again, all of those can be achieved through the FDX reports. You might have. To add in the ceroplastes because it's not standard in all but but but you can get all of those and really looking at those patterns within them thinking about stress, thinking about circadian rhythm. Thinking about their. Alcohol consumption and actually the types of alcohol. The toxins like you know, sadly a. Lot of wine has. Got a lot of quite nasty toxins coming in so. And so they're all things that I I do think about her two is a very, very fast too metastasized. Cancer quite often goes to the brain. Certainly bones lung, liver metastases is something to think about there so. There's lots of sort of underlying that we need to look at. Insulin levels, fasting glucose, fasting insulin, IGF 1 levels. That's all part of your kind of terrain testing, and the sooner that you get in there with being able to assess the terrain, the better. So whether that is through, you know. Like the sooner people are diagnosed, the sooner that you can get in. That's that's when you wanna be seeing these clients. Not even when they're finished. Standard of care.

Yeah, because often you'll get people saying, OK, I've. I'm coming now because I've been through my treatments and actually.

Oh, do you know what's even worse than that? And I'm sure you've seen this working in the field and come when I've when.

Thank you.

I've relapsed. Yeah, yeah, yeah. So yes, relapses, metastases again, it's it's all terrain dependent, isn't it? We really want to get in there and support that. So we've we've kind of, we've talked about a lot of different. We've used a lot of an acronyms and we talked about a lot of detail there, but just kind of stepping back a little bit now, say you're working with somebody who can't afford all of this testing. They've got the basics of their diagnosis or they're still waiting for the basics of their diagnosis. They've come. To you the. Seconds. They've had an inkling that anything's gone. Well, how are you going to assess that individual?

So obviously our questioning is a huge part of their assessment like their previous life, getting all of that information from their, their stress levels, their sleep hygiene, getting like thinking about what they're, they're where they get their food from. You know, you can get a lot of information from all of this, what their hormonal. Industry is like. I'd certainly like you said, if budget doesn't allow it, I'd write to the doctors and get the very basics. And in this instance, and maybe they're just going through the oncology work up, I'll write to their GP because.

You've got to.

Know how to work the system and often the GP's like oh, I don't know what to do to help you but. Yes, I can do that. I can. I can run these bloods, whereas oncologists like no, I don't need that information. So I'm not gonna do it. So you kind of one minute. You wanna go to the GP, the next minute you want there on just depends what you're trying to achieve from that. So yeah, OG right to their GP. Full blood count, liver function, gamma GT. LDH, ESR, CRP. Let's get some basics done. HBA 1C. No, you won't get fasting glucose and fasting insulin. But let's have a. Look at their HBA 1C. That information can give you a lot to work with. I guess if you then pushed me and. Said look, Joe. I've only got the budget to pay for. One thing what would that one thing be? It would be genomics every time. Why cause they're with you always whereas the Dutch test is going to change and you know what? Somebody's gotta sit one be 1A sip 3A4. You were guaranteed that they're gonna have a higher level of four hydroxy in 16A, so. If I couldn't do anything else. If I could only do the the detox pathway test through life code cause that will give you all. Of that. That will come in at 200 pounds. And I would say that. Would be the best £200 I. Could ask anybody to spend.

Yeah. And then something that so we that we could talk to you about this all day, but something something we haven't kind of touched on massively. So we've got kind of geeked out, a little bit on the sides behind this, but what would be your main tip to? People coming to see you with a diagnosis. Who were freaked out? And, you know, quite terrified about the whole prospect and freaked out about diet. What would be your top tip?

OK, so first. Of all, let's control the controllable. That's what I would say to people. And as practitioners, we can empower our clients to control as much as they can in that journey versus the oncologist. That kind of disempowers them you. Will go for chemotherapy every three weeks. You will turn up to your radiotherapy. 15 sessions you will. And and I think even just that makes a huge difference. You can go away and do XY&Z. OK, so basics. Now I don't like again. It's. It is about the individual, but getting their diet as low GI is absolutely paramount. I'm not. I know there's a lot of great books out there. Like vegan diets and breast cancer, the issue is with vegan diets that they can be quite carb heavy because obviously if you get in proteins from beans, also getting carbs. It's quite hard to do low GI fully plant based diet, so my absolute #1 is really get as close to ketosis as possible to lower those sugar levels because you're then straight away reducing a huge source of fuel to this cancer. Look around your kitchen and see what you can get rid of from an estrogenic point of view. You know, I would say to people just pick one thing and start with so even personally I'm like I, you know, I've been on this bandwagon like I said, for nearly eighteen years, but this year I again went probably cause I was speaking to this lady. About microplastics and when we already do able and coals, we'll have veggies come in boxes and but I looked and I went. What are our biggest offenders in our? Fridge and you know what, hummus. Because both my kids love, huh? My baby will sit there with a spoon and eat the hummus. It's always organic. I only pick one made with olive oil rather than plant oils, but it's always served in plastic. So this year I went no. More hummus. I'm making it, and it's being served in the glass jar and that's the only hummus that comes into our fridge. And that's what I say to people. Don't go. I I can't have any plastic go. OK, I can lower my veggie plastic, right? I've done that. Take the box. Go me. OK, next I can philtre my water if I can afford it. A burkie. I also like whole House water philtres alongside that cause. Think about what you're showering and brushing your teeth in, but you know might. Not be able to afford both. OK. Next and actually I'm sure you'd agree with me years into it, you probably still go. There's still next on your. List cause there. Certainly on mine.

There's always gonna be next. Yeah, yeah. Definitely slice chicken. Load it there every.

Now and again isn't absolutely. Absolutely. And that's what I did and. I went, you know, we've stopped. Drink, I mean. We we we're a dairy free, gluten free, pretty much grain free house. But again, I've stopped bringing plant based milks in in Tetra packs part environmental as well as you know what's in these Tetra packs. And and get all of our milk in glass bottles from Abel and Cole, who now dutifully drop it off it. Almond milk and coconut milk in. Glass bottles and it's like, wow, that's. The you know the next level of I can. Do one more thing. Whereas I think. We as practitioners can feel a bit overwhelmed with this. So how do you think our clients feel when you're talking a whole new language? So even if you go right today, you are going to do this with your increase your brassica vegetables and then I would also say a huge. Emphasis on lifestyle. Medicine. Remember some of the basics, cancer loves and aerobic environments. Well, when we're not breathing particularly deeply, we've not got much oxygen. Buy some indoor plants and put them in the spaces where you spend most of your time. And try and get outside with nature.

Try and.

Move your body and actually they don't. I know plants cost a little bit, but they don't cost much money and actually again go, go. Right. Here's your two nutrition goals. Here's your two lifestyle goals. And actually they can leave your office. And be like, yes, I can do.

Brilliant. Yeah, love it. So is there anyone or anything out there at the moment, Joe, who is particularly rocking your nutrition world?

Yeah. Doctor Nasha winters? Yeah. She's just about to open up the first integrative hospital in Mexico. OK, that's not on our doorstep. Though I know she's very keen to get one in Europe. Next, watch her. She is a force to be reckoned with.

Fabulous. And that to you, what do you love most? About what you do.

Making a difference. So people often say to me, how do you how do you handle working in the cancer arena? And I I spend probably 75% of my time in cancer and and actually you say that to me having just lost a client of seven years worth. Of work that that. I've worked really closely with. Secondary breast cancer I picked up at secondary breast cancer. And she just died this week, seven years later. Now you know as well as I do that the prognosis for secondary breast cancer is not seven years. It's more like 18 months, two years Max. So to get seven years out of her than normal, that doesn't mean it. Didn't hurt to. Go. But she's gone and she's left two. It's behind. So what I say is it's not always the easiest specialism, but it is about making a difference. And if every day I can show up for work and make a difference to people's lives, then I'm doing a job that I will continue to do. If I feel that. I can no longer make a difference. Or change jobs or change specialisms. But until then, I will keep going because we have skills, we have tools in our tool kit that no medical doctor has, and I'm not saying they've got tools that they, they have their own tools, albeit limited chemotherapy radio. Hormone treatment surgery, targeted therapy, immunotherapy. It's still quite limited so. I know that my toolkit is pretty. And well, so I. Can still use it. I'm still going to. Keep going and still going to make a difference.

Fabulous. Keep going, Jay. Thank you so much. That's been brilliant. It's been really, really fascinating, really interesting to talk. With you.

Awesome, I really enjoyed it.

Brilliant. Good. Good to see you say that was functional medicine practitioner Joe Gamble. First functional medicine practitioner in the UK chatting with me. Kirsten chick. I hope you enjoyed listening and have gained a deeper understanding of breast cancer from an integrative medicine perspective.

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