Welcome. My name is Jann Balmer. I'm the Director for Continuing Medical Education at the University of Virginia School of Medicine. I'm also on the board of LessCancer.org and I am pleased and proud to have John Whyte join us today. John, can you just introduce yourself so that we get your titles all right. Sure. First of all, the biggest title is friend of Jann Balmer. I'm delighted to be able to speak with you today. I'm currently the Chief Medical Officer at WebMD, which many people know is really the world's largest platform of online health information. I'm a practicing internist here in Washington, DC, Virginia area, and part of my time at WebMD, I run an Office of Engagement at the Food and Drug Administration. Before that I headed up Health and Medical programming at Discovery Channel where I met Jann. Terrific, John, thank you so much and I really appreciate you being with us today. We're going to talk about cancer risks, and I know that you have done a lot of research on this and compiled a lot of information. Can you talk to us a little bit about what motivated you to think about this topic, and I know that you wrote a book about it. Can you just talk a little bit about what motivated you to start this whole process. Other than screening, which really is very limited for cancer, for breast cancer, for colon cancer, a few others, we really don't focus as a society on cancer prevention. I wrote this book to help change that. Part of it is during the pandemic, a lot of people were missing screenings, and then I point out, I wrote the book during the pandemic. But more importantly, I thought about in terms of we talk to patients all the time about how to prevent diabetes. What do you need to do in order to not get diabetes? We even created a new term, pre-diabetes, to try to prevent you from progressing. In heart disease, we talk about cardio, what you need to do, the type of exercises you need to do, what you shouldn't eat. But when it comes to cancer, we don't have those discussions with patients, we don't talk about what you need to eat and not to eat, we don't talk about the quality of your sleep, the role of stress that it plays in cancer, the importance of physical activity. So I really wanted to provide some foundation, some background material, and really give people some tips and tools that they can take control of their personal cancer risk. Well, thank you. I think you're absolutely right. Cancer really doesn't focus on cancer prevention very much, which is why the LessCancer organization has really devoted itself to cancer prevention and looking at environmental toxins and other things that people take for granted, but that really can precipitate or predispose someone to cancer. In doing all of your work and in all of the work that you do at WebMD, can you identify for us three or four things that you think are critically important for people to think about in terms of assessing their own risk and preventing cancer? The other thing I want to point out, Jann, to listeners is there's this belief by many people that cancer is due to genetics, if my family had cancer, I'm going to get cancer, or it's simply due to bad luck, so there's nothing that I can do. It's fate. I hear that a lot of times from people, and this goes to the point that the reality is only about 30 percent of cancer is due to inherited mutations, genetics. The rest, 70 percent is caused by lifestyle, is caused by environmental toxins. That's the whole reason that people can be empowered to take control of their cancer risk, but they need to know what to do. When you think about it, it really is about changing people's minds to think about that food really is medicine. It's as powerful as prescription drugs. Are you going to eat an orange or a bunch of potato chips? When you think about it that way, you'll start to make different decisions because we do know, there is a wealth of data that talks about the relationship between several types of cancers, particularly colon cancer and the consumption of red meat. There's lots of data there in terms of what we need to be eating and what we shouldn't be eating. It's about the role of physical activity. Physical activity is probably as close to a magic pill as we have in terms of reducing risk. But we don't talk to people about what you need to be doing. In terms of cancer prevention, it's not about 10,000 steps a day, it's about some exertion. You need to sweat three days a week for 30 minutes or so. Then it's also about the role of stress. We've learned over time that cancer is in some ways a disease of inflammation and chronic stress. Those palpitations, that's upset stomach, that's the feeling of dread that many people are experiencing does impact the ability of your cells to fight infection. It makes your cells make mistakes when dividing. That basically is what cancer is about. Your cells divide in an abnormal way and create a cancer cell. It's really about controlling those things that you can control. You can't control your age, but you can't control your weight, what you eat, how often you exercise, the amount of quality sleep that you get every day, the amount of stress in your life, as well as some of the environmental toxins as well, and educating yourself about the environment in which you live. Your zip code, Jan as you know, this matters as much as your genetic code when it comes to cancer and many other health conditions. Well, that's that's so very true and I think it gets so overwhelming for a lot of people to try to figure out what am I supposed to do? How am I supposed to live healthy? All of those things. The reality is, with all of the pandemic and all of the things that have happened in the last two years, it only makes the whole situation worse. As I listen to people talk and they're overwhelmed and trying to figure out what they need to do, the thought of trying to add one more thing in to make themselves healthy makes it really difficult. But there's a lot of things that we don't know what's in them. There's food that we don't know what's in it. We don't know what chemicals were used to make them look pretty. There's a whole lot of things about water. One of our board members, Rob [inaudible] did a lot of work on water and PFAS. I just think that, if we can help people figure out what things they can control and some really concrete ways that they can think about risk. The chronic inflammation from overwhelming stress, you're right, is absolutely a huge factor. We do not think about risks, Jan. We really don't. We think about the risk of a car crash, the risk of dying from heart disease. Cancer is still a leading cause of death, 600,000 people are still diagnosed with cancer every year. Your lifetime risk of being diagnosed with cancer is about one in three. That includes many skin cancer. It's still very real in terms of cancer diagnoses. You haven't won the war on cancer. That's part of the challenge that people don't really think about risk in terms of the way that they need to. I'm hopeful that the pandemic has also taught us, at the end of the day, all we have is our health. Our jobs, in comparison, we've learned a lot about the long commutes that we had before. In terms of the focus on wealth, that doesn't matter if you don't have your health. I'm hopeful that in some ways one of the silver linings of the pandemic is that there's a greater focus on self-care, and people are really starting to turn and think about their own health and is what you said. Look at ingredients list, do some research, educate themselves, develop a healthy lifestyle, so it's not this idea that I often hear from people I want to lose 10 or 20 pounds before an important event. Well, I want you not to gain 10-20 pounds a year, which is often what happens once we get past 30 or 40 years old. It really is very difficult and I think you're right. I think lifestyle is fundamentally changed as a result of this pandemic, and people are re-evaluating family and themselves and the risk benefit ratios of this go lifestyle. But in terms of really making this concrete for people, can you help us identify three or four things. You've talked about decreasing our red meat and sweating, exercising 30 minutes at least three times a week. Are there other things that, from your research and from your perspective are critically important for people to think about that don't sound overwhelming, that can be woven into their lifestyle? The biggest tip and advice that listeners could utilize today that would likely reduce their cancer risk, is to start eating more fish and to substitute fish for typically processed meats. Some people may be thinking, I don't like fish, I've had from patients it smells fishy. he reality is that fish is chock-full of nutrients, it's chock-full of vitamins, minerals, Omega-3 fatty acids that reduce clots that occur in our brain and our hearts. It's also low in calories. Substituting processed meats for fish twice a week is going to be a step in the right direction. Jan, less than 20 percent of Americans eat fish. You are kidding. Once a week, just once a week. Just think about China's start with once a week, every week or twice a week. The other thing that I tell people is, you know what, replace all your beverages with water. Another way that it's going to reduce total calories and is also going to reduce a lot of sugar that most of us consume in beverages. We know that alcohol is a toxin to the liver. Well, alcohol also can impair your cells from reproducing correctly and increase cancerous, particularly in breast cancer. If you started eat to fish and you substitute fish for process meats and drag more water, and substitute that for other beverages, that's a step in the right direction. Now the other big thing that you could start doing today is going to take time is get that quality sleep. We've all got these sleep trackers on and everything, utilize them. 7-8 hours of quality sleep every day, and maybe there's times that you don't get those quality sleep hours but you need to focus on that every day, and people dismissively, I'll do it when I'm dead. It's not that important. We actually have seen a lot of data that talks about shift workers, people that work these unusual hours and then often have challenges sleeping during the day, increased incidence of breast cancer, increased incidence of prostate cancer, typically hormonal based cancers, because that's what's happening in sleep. It's messing up our circadian rhythm, which basically is driven by two important hormones, melatonin and cortisol. That's the reason why trying to work on getting quality sleep is important, and some tips for that is, colder is better. I know a lot of people don't want to hear that about rooms, but I know you keep your thermostat at Jan, but it should be around 68 degrees. What do you keep yours at? Ours is that 67 year-round. You are doing good. Hopefully you're sleeping well. Yeah. Coder is better, and then a trick that I've talked about is, sometimes wearing socks to bed helps you fall asleep, and the reason why that is, believe it or not, is that it actually makes your blood vessels vasodilate in your feet and that actually cools your internal body temperature. That could be a trick, but you need to make sleep a priority. That's what's going to help you over time as well. Then in terms of physical activity, we've all been sitting around too much or on Zoom calls all day. How do we start getting moving? You might have heard the line, "sitting is the new smoking." It really is true. Physical inactivity leads to premature deaths. How do you find activities that you enjoy? It's not about necessarily going to the gym. It's about walking more, trying to get it doesn't have to be 10,000 steps a day, but maybe you could get new 6,000 or 7,000. Most people are below 4,000. That would be progress. But those are going to be some of the ways that you can make changes today in terms of what you eat, what you drink, the amount of sleep that you get, and how active you are that are going to decrease your overall cancer risk. It's not any one thing Jan, it's really these constellation, these daily choices that you make every day over time. It doesn't mean you can never have a great steak and a glass of wine and ice cream, but to many of us are having that several days a week. That's where we're really making poor choices when it comes to taking control of our cancer risk. Yeah, John I think that's so helpful. I think the more we talk about it, the more you realize that even taking very small steps, to trying to make your life healthier, to just take it a little bit of time and reflect on what you're eating, how you're spending your time, really giving yourself some time to unwind. It's about stress as well the same unwind. We're in a mental health pandemic, as well as an infectious disease pandemic. I talked about the role of chronic stress that it has on your body. When you think about it, when you're stressed, you make mistakes in terms of at work, you don't feel great. You feel like your memory is start to forget things. It definitely impacts your body. When you're stressed, what do you do? You say I need to go to sleep earlier, or you try to rest, you instinctively know, you have to address stress and there are strategies and tools. One of them that I've talked about that I've tried, is this gratitude journal, where you literally write down every day, something that you're grateful for. You can be like, really that's going to impact my cancer risk? But studies have shown through MRI, imaging and PET scans, it actually can help to rewire your brain. To lower those areas of the brain that in terms of activities that are increased with anxiety and depression. This is about trying to make things a priority, and knowing when to ask for help as well. Yeah, I think those are really important points and things that people have a tendency to take for granted. When you can't really take the good things in your life for granted and let the bad things take over because it increases stress. You don't eat as healthy, you get inertia. All of these things have very negative impacts. I like your idea of the grateful journal, even on a piece of paper and put it in a jar and then have you and your family look at it at the end of the week and see what kinds of things make a difference? I know that there were work with teachers in elementary school children where they took the time to reflect and write something positive about their classmates. Some of those comments and things taking the time to be kind is something that we don't talk about. But that actually reduces stress, gives you the opportunity to reflect and gives you the energy to think about trying to make small changes, drinking more water, getting up and walking around. I'm on Zoom way too much, everybody is, I need to get up and move around done. People aren't in offices, so you don't have the same social interaction and that can be isolating as well and it can create a whole cascade of bad behaviors that are less than ideal. They're not bad, nasty, they're just not in your best interests in terms of your health. Nothing is 100 percent preventable. We have to acknowledge that. But what we do know is that science can give us guidance in terms of how do we reduce that risk? Because it is about, I heard this phrase the other day, our health span, as well as our lifespan. We will want that quality life. When we come back to food, those are acquired taste. We're not predestined to like ice cream. I have young children, you have to keep at it and you can develop different tastes and you have to introduce new things to the diet. Physical activity is about finding things that you enjoy that you're going to continue with over time. You don't want to make these things chores, you want to make them something that you enjoy as part of a new attitude towards your lifestyle where you want to take control of your health. As I said before, I think COVID really has taught us the importance of self-care. I agree with you completely. I think self-care as we look at ourselves and our families, I think what's happened is the predominance of work being the most important thing in our lives has shifted a little. It's actually, if people take a little time to reflect, there's an opportunity for you to really think about what you want out of your life and what the healthy issues are, and how your family and the people that are important around you can actually enhance that life because I think good health and happiness have to go together, which feels crazy. People take all of that for granted, but you really have to take time to think about being happy with and the blessings that you have in your life and the good things that happen in your life. But to also take the time to love yourself and to take good care of yourself because the people around you need you to do that. Absolutely. I think that's a really hard thing for a lot of people, is to realize that they themselves are valuable enough to the people that they love to take good care of themselves. Let's do just a little recap so that we make sure that we've hit all the high points. One is to exercise three times a week at least 30 minutes to make yourself sweat, to eat less red meat, to replace a lot of beverages with water, to find ways to be grateful for the good things in your life, and to be thoughtful about your food choices, and to eat fish twice a week. We don't want to forget about screenings. We want people to continue to get their colorectal screenings, the breast cancer screenings, all of these things have fallen to the wayside during the pandemic. But to recognize that most cancers can't be screened for. That's why reducing our risk is so important. I think the last thing is to pay attention to your environment, and where you choose your foods and how you choose your foods and the kinds of ingredients that are there and to help each other in your community, make your community healthy. Absolutely. Because I think that also empowers all of us to be engaged in the communities around us, which also then fosters a sense of belonging, which I think is a very positive thing. Well, John, you have just been so helpful today. Thank you so very much. Really appreciate it. I hope we get to talk again soon. Thank you so much. Already.
