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Transcript

Zahra: Very welcome, everybody, to this amazing podcast, Nutrition for Noobs, hosted by Kevin and Michelle. And I'm so happy to be invited today. My name is Dr. Zahra Kassam.

Kevin: Wow, you're hired. That was amazing.

Zahra: Wow.

Kevin: I can quit now. You're going to put us out of a job. Thanks, Zahra.

Michelle: Thank you so much, Zahra. I cannot tell you how excited I have been to record today. You're just such an incredible inspiration, and I have to say, such a very lovely and humble and compassionate, welcoming human being. I'm just honored to know you. Thank you so much for joining us. Yes, thank you.

Zahra: Thank you so much for those lovely words, and I'm really happy to be here. Thank you for the invitation.

Michelle: So Kevin, I'm so excited that you get to meet Dr. Zahra Kassam. And do you know what? Just a really fun story, just to introduce her. When I first met Zahra, I was a little bit confused, because as a project management professional at the hospital, I had previously worked with a Dr. Zahra Kassam. It was very confusing. Still, that's confusing, yeah. And I kept getting them mixed up. Just lovely from the moment that I met her. And wait till you hear that everything Zahra is involved in. Dr. Zahra Kassam is a radiation oncologist at the Stronach Regional Cancer Center and assistant professor at the University of Toronto. She's certified in lifestyle medicine, co-chairs the Canadian Lifestyle Medicine Group of the American College of Lifestyle Medicine. She is co-founder of Plant-Based Canada, a non-profit advancing evidence-based plant-based nutrition for human and planetary health. Dr. Kassam is also co-author of Eating Plant-Based and co-editor of Plant-Based Nutrition in Clinical Practice and promotes sustainable food systems through her roles in national health care organizations. I have to tell you that bio does not do justice at all.

Kevin: Seems pretty comprehensive.

Michelle: I think too. She's not only co-chair of the conference, you founded this conference, right? Like, I believe that, did the, is the UK conference come first? Yes. And you went over to support that and said, hey, why can't we do this here? And I was like so entrenched in and learning as much as I could. I had, you know, I had been practicing holistic nutrition for a number of years. And then I had done T Colin Campbell's program at Cornell and I was just scrounging to find anything. And I was going to conferences in the States, which is very expensive actually to travel there and get hotel, everything. So I was just on alert. And when I saw that there was going to be a Canadian conference, I was like, oh my gosh, this is amazing. And I think I was one of your first ticket buyers.

Kevin: That's great.

Zahra: Yeah. And I've been going every year since. Oh, amazing. We so value your support and you're right. That was exactly why we did the conference in Canada. You're right. I flew over to my sister Shireen's conference in March, 2018, and I really went there to support her and got there and was just so blown away by the energy and the fact that people were so interested to learn more about nutrition. And, you know, Shireen and I had been on the journey pretty much together and we'd been learning and doing university courses on nutrition. And then the following year, we both certified in lifestyle medicine. So I said to her, please help me do this in Canada. And she said, of course, as she always does. And that year we were sold out very quickly. And so based on that energy and based on the amazing people that just offered their help to me and wanted to join us, we formed Plant Based Canada to promote Canadians and to also have a networking platform and a conference here in Canada that was accessible, not just to health professionals, but to the public as well at accessible prices. And you are right, going over to America and especially now in this political climate, it's nice not to have to go and do that.

Kevin: Absolutely. A hundred percent.

Michelle: Absolutely. And I have to tell you, too, Kevin, like I had been to only one similar enough, like the Plantrition had a big conference that I went to in Anaheim. And you've heard me mention that one several times. But that was the first nutrition conference I'd ever been to that actually had really good food.

Kevin: Which is important.

Michelle: And I would say that the conference that Zara and her team put on here in Canada also has really delicious food. And it's just it's just a no-brainer, right? Like you're at a nutrition conference.

Kevin: You don't want to be eating garbage. Absolutely. It's important. Right. It's literally putting your money where your mouth is. Sorry.

Michelle: It's walking the walk, talking the talk. Yeah, exactly. You're just such an icon in leading this in Canada, I would say. I wouldn't even just say Ontario. I would say you're leading the charge in Canada. You're setting such a wonderful example. And I also love the inclusiveness that you have around that to include folks like me who are not, you know, regulated health professionals, but still very entrenched in this mission. So thank you for all that you do.

Zahra: Thank you for your kind words. And the really amazing thing about starting on this journey was finding all the incredible people who are already doing this work, like yourselves and the amazing, amazing people. And you see every year at the conference, we're now on our seventh one, but every year we have a completely new set of Canadian speakers. And each year I think, gosh, how are we going to do better next year? And each year is just amazing. So thankfully, I'm not leading the charge. I'm just with all you amazing people doing the same thing. And that's really, really lovely to see.

Michelle: Wonderful. Well, I guess we've kept the secret long enough to tell the audience what we're talking about today.

Kevin: Yeah, let's get to that.

Michelle: Obviously, with Zara's incredible expertise, we're here. I asked her to come and just kind of help unpack for us about the relationship between nutrition and cancer, like cancer prevention, cancer treatment, because this is what she does. And I think it's such a deep topic that touches all of us in one way or another. I know when I used to do a little bit of teaching on this at the Canadian School of Natural Nutrition, and I always opened it up by letting my students know at the time that I remember being a little girl going to brownies and we were, it's ironic, we were selling the are terrible, but we were trying to find a cause that we could donate our cookie money to for our local brownie troop. And a lady that I loved dearly that lived across the street, I knew she had cancer. That was the first person in my experience that I had ever heard of having cancer. And then I remember looking into it because I wanted to do something to help. Gertie was her name. And so I brought that to the brownie troop and I said, can we raise money to help people with cancer? I want to help my neighbor Gertie. She's so nice to me. And at that time, you had a one in four chance in Canada of developing cancer was the statistic. And in my lifetime, it's doubled. It used to be a rare thing or not quite so common to have somebody in your experience cancer. Now we all have, sadly, too many of these experiences. So I'm looking forward to you guiding us through this. First, can we just let you talk a little bit about your journey, Zara? And I know that your whole family seems to me to just be an incredible group of people, brilliant professionals and advocates for health, for animals, for environment. I'd love for you to share just a little bit about your family and how that shaped who you are today.

Zahra: Thank you so much. My family is amazing and I feel so blessed to be on this journey with them all. And it, of course, all starts with our parents. And my parents are amazing people who really understand that we should use our privilege in service to others. And they modeled that their entire lives quietly, consistently, and they valued hard work. And my sisters and I grew up in that environment, my brother as well. And Shireen, Leila, my two sisters, and I around 2013 started talking more about animal justice issues. We'd already been really interested in it. We were all vegetarian at that stage for animal justice. But we started reading more at that time and became vegan because we understood then that the egg and dairy industry were equally awful and cruel. And so as part of that, myself and Shireen, who Shireen is a haematologist in the UK, we started reading about the health information, the impact on the planet. And that's where the impetus came to learn more about that, get educated, doing the university courses and becoming certified in lifestyle medicine and then forming our respective organization, Shireen in the UK, Plant Based Health Professionals UK and myself, Plant Based Canada. My sister Leila, she does work in animal justice and her organization is Project Phoenix, which is to build a mass movement for social change for animal freedom in the UK. And it's lovely to be doing this all together. We know that all of these social justice issues are all connected. At their core, they're all connected. And my father is a world leader in conservation, agriculture, sustainable food systems. So it all is interlinked. And we were all very close and we speak most days of the week with somebody in the family and we try and keep in touch with what we're all doing.

Michelle: That's so lovely. So what led you to your profession, to radiology oncologist?

Zahra: So I actually wanted to be an infectious disease specialist. And I had this romantic idea of traveling the world and working for international organizations and treating infectious diseases. And I did a diploma infectious diseases from the London School of Tropical Medicine and Hygiene. And then while I was waiting for that job, I was filling in my time, waiting for the ideal job to come up for me in infectious diseases and my idea of traveling around the world. And the job that I took was a six month stopgap in oncology at St. Bart's Hospital in London, UK. And after three days on the ward and being with patients going through their cancer diagnosis with such dignity, and I suddenly had a crisis of what I was going to do. And so in the end, just couldn't decide. And I said, well, whatever comes up first is what was meant to be for me. And then came up oncology. And by the time I'd finished my six months doing that job, I'd already decided that that was the path for me. And I've been doing that now for 26 years, just specifically treating patients with cancer. This year, I will have been a physician for 31 years.

Michelle: Wow. Congratulations. Amazing.

Zahra: Thank you. So yeah, and I love my job. I love my job. I love getting to know people through the journey and trying to smooth their path. And I'm so blessed that I work in an amazing cancer center with a team who feel the same and who treat patients like their family. So I'm very blessed in that too, because I know that many people work in areas that they are very committed to, but don't always have the support that they need to provide to their patients.

Michelle: Yeah, that's incredible. So was nutrition a big part of your values when you went into this profession? You mentioned being vegetarian, but plant-based eating came into your experience at some point. Where did that transition occur?

Zahra: So that came in in 2013 when I became vegan, and I'd been practicing then for 18 years without any idea about the impact, the power of nutrition for preventing chronic disease, including benefiting my patients with cancer. And then, of course, all the studies that we are seeing in how nutrition and other lifestyle factors improve quality of life during treatment, improve how we do after a cancer diagnosis in reducing risk of recurrence and improving survival. So it then became absolutely imperative for me to start sharing that information with my patients. And we are not trained in that. I had no nutrition training in my medical school, in my specialist training, nor did my colleagues. And even if we do, there is very little time in the clinical encounter to start talking about these lifestyle factors. And yet it's one of the commonest questions that our patients ask us. So we have to be knowledgeable about it. Unfortunately, that's still very slow. The great thing is that our cancer guidelines, our international cancer guidelines, including the Canadian Cancer Society, the World Cancer Research Fund, the American Institute of Cancer Research, the American Cancer Society, they all acknowledge the power of lifestyle. And we have great dietary and lifestyle recommendations. I'll quote some of the wording of the international guidelines. They say, have a diet rich in fruits and vegetables and whole grains and beans and legumes and limit your processed meat and limit your red meat and limit your sugary beverages and your ultra-processed food. So this is absolutely what we promote for all chronic diseases. So I'm able to, together with the Canada Food Guide, speak to my patients knowing that there is the backing of the international and national guidelines for them. So I used to do one-on-one talking to my patients about lifestyle. And I would always go over time in my appointments. But people were so open to talking about this. So we've actually, with the help of some really passionate radiation therapists and other health professionals, we've now instituted a small education session. It's a health promotion, planting the seeds session that comes in at the end of the radiation treatment for people going through treatment. And we just highlight the six pillars of lifestyle medicine. And we point them in the direction of resources that we have either at the Cancer Centre or outside so that they can then take the next step. And we also have amazing programmes at my Cancer Centre, mindfulness-based stress reduction courses, an insomnia course, a fear of recurrence course. So I'm blessed where I am. And I think my patients have access to really great services, both in my hospital and also in these amazing organisations that work, such as Gilders Club Toronto, Wellspring. These are all programmes that my patients can access.

Michelle: That's absolutely incredible. And so when it comes to the advice that you may be able to impart on a patient, is there ever any friction between the oncologist's guidance and the guidance that you might be offer with all of your wealth of knowledge and experience in terms of nutrition?

Zahra: Not really, actually. It's very, I feel very happy with the guidelines we have. The Canada Food Guide, as you know, is very plant-based. And when we talk about plant-based for health, we understand that our patients don't have to be 100% plant-based to get the benefits of nutrition. And I talk to my patients about the Canada Food Guide being mostly plants. And I talk about a plate that is half fruits and vegetables, a quarter whole grains, and a quarter of the plate being protein. And I very specifically say the Canada Food Guide says choose plant proteins every day and more often. And so that makes that, in my mind, like an 87.5% plant plate and less than 12%, 13% from animal foods, which is very consistent with the Planetary Health Diet from the Eat Lancet Commission. They updated that in October this year, as you know.

Michelle: Right.

Zahra: So that's all very consistent. The cancer guidelines, if you go on their website and you see the 20 top tips for eating plant-based, that's very in line with the advice that I want to give our patients as well. So there's not really any friction in that sense. For myself, obviously, I am vegan for the animals and for the environment. And so I personally am 100%, as is my family. And we know that if our patients do choose to be 100%, they can not only survive on that, but they can thrive because you've got all those benefits that we've discussed, but also possibly even more benefits in terms of health. Because some of the studies that we're seeing, those small recent studies looking at 100%, compared to, say, the Mediterranean diet, you are seeing some incremental benefits there for being 100%. But you don't need to be 100%.

Michelle: Right, right. And I think that's very, very comforting for people.

Kevin: Yeah. So, Zara, I was wondering, so your patients, I think, are exceedingly lucky to have you to help guide them. I was just wondering if you see more broadly if nutrition generally and nutrition elements are front and center in training new oncologists and training new doctors. Because I do have cancer in my family, as most people do. So I'm at a slightly elevated risk for certain types of cancer. And of course, I've spoken to this with my family doctor. And nutrition and my eating has never come up. Not once. And he's never even asked, like, you know, what do you eat or anything like that. And so I'm just wondering, like, from a medical profession standpoint, have you seen any substantial shifts in more accepting of nutrition and teaching doctors to talk a little bit more about nutrition as a foundation? Because, you know, prevention, I think, is much more important for treating cancer than once you've already got it, if we can, you know, stop a little bit of it early.

Zahra: Absolutely. There was so much in what you just said. So prevention absolutely is key, not just for cancer, but for all the chronic diseases. And we can just note as well that chronic diseases do increase risk of cancer as well. So there is that interaction. There is a lot of work to do. I'm not seeing major shifts, I have to say, in getting nutrition into medical schools and into training. And there is a growing body of lifestyle medicine physicians. And that is very exciting because the American College of Lifestyle Medicine is the flagship organization for the medical specialty lifestyle medicine, which is an evidence-based specialty using the six pillars of lifestyle medicine for prevention, for management, and even reversal of some of the chronic diseases. So we know that those lifestyle behaviors include a predominantly whole food plant-based plate. They include exercise, social connection, stress management, optimal sleep, and avoidance of toxic substances. And if you look in the literature, it is the fastest growing medical specialty globally. So that's very exciting. In Canada, we are also increasing in our numbers. And Michelle will know that in our group, we've got nearly 500 people who are registered with the American College of Lifestyle Medicine in our specific Canadian lifestyle medicine group. So that's very exciting. We are seeing that growing, but that's a tiny drop in the number of physicians and healthcare professionals we have in Canada.

Kevin: Right.

Zahra: So yes, when Michelle and I are looking inside our group, we're getting really excited and we're happy. And then when you look out the other way, you understand that there's a long way to go. Now, there are pockets where things are changing, and that's the whole idea of our group. So in, for example, Laval University, Dr. Raoum, Carolyn Raoum, has introduced lifestyle medicine into their residency program.

Kevin: Okay.

Zahra: We're seeing two weeks of lifestyle medicine in education at the University of Toronto Medical School through Dr. John Steven Piper.

Kevin: Two whole weeks? I don't know. Sorry. Sorry, we should be thankful. But it seems, how long is a medical degree? Seven years and you get two weeks? But anyways, continue. Gotta start somewhere. Yeah, you have to start somewhere.

Zahra: Yes, exactly. But don't be sorry, because that's sort of how I think as well. So we have a long way, long, long way to go. And so, you know, the question is how to do that? How do you do that quickly in a system that is very rigid and hard to get anything done? And one of the ways we're seeing an avenue to get the discussion on food in is climate and planetary health. And that aspect has, in the last few years, that's become a real thing. You know, hospitals have got their sustainability leads and their working groups. And the Royal College of Physicians has now got their National Advisory Committee on Planetary Health. And we've got organizations like the Canadian Coalition of Green Healthcare and Cascades. And they're now, you know, they've brought in food into this sustainability piece. So that's where I'm trying to get into to promote the plant-based eating, because, of course, it's all the same. The benefits are for the environment and for individual health.

Kevin: Makes sense. Right.

Zahra: The other interesting but sad part of planetary health is with all this climate impact, we are going to see an increase in our chronic diseases, increase in cancer rates due to air pollution and, you know, UV light changes and disruptions of our fruits and vegetable supplies. And so that is projected to increase our cancer risk. And not only that, but the extreme weather events are going to disrupt the really complex systems that we have in place that are needed to treat patients with cancer. We're already seeing disruptions in radiation treatments in various areas. We've seen it in the U.S. And, you know, what a surprise if you interrupt your radiation treatment, you reduce your survival from cancer. So there are so many interlinking aspects that we have to consider.

Michelle: Right. Wow. Well, you're certainly well-positioned with the work that your father's involved in and that your sisters are involved in to actually link these things together. I think everybody that becomes aware, I believe, of the power of plant-based nutrition as a tool for health and longevity, if they didn't start out knowing that, you discover it along the way. And then, of course, these connections become completely obvious, but it's but it's amazing how I don't know if it's just the the messaging that we get from society or the just really eating without thinking about it too much, that, you know, it isn't immediately apparent. Can we dive a bit into the prevention and then I want to get to how the nutrition can impact a treatment. But when you say nutrition for cancer prevention and what does that actually really mean to you or how would you explain that to a patient?

Zahra: So I would say that we have some fantastic studies showing that those people who are vegetarian and vegan or plant-based and different studies use different measures of food. And so we can talk a little bit about that. But these studies do suggest that there is a reduced risk for people who eat less meat. There's a reduced risk for cancer, a number of different cancers. And in fact, just this just last week, there was a large overview of nine studies which had one point eight million people in them. And they looked at meat eaters and poultry eaters and pescatarians and vegetarians and vegans. They hardly had any vegans, actually, out of one point eight million, they had eight thousand vegans. And that's been very difficult to draw really good conclusions from that. But they did find that vegetarians had lower risks of several cancers, including breast cancer and prostate cancer. And these are two of our most common cancers. Also kidney cancer, pancreatic cancer, multiple myeloma. So this overview was very consistent with what we've known already from those the big studies that were included in this overview. So, for example, the Adventist Health Study and the EPIC Oxford studies, these two are very interesting because a third of their population are vegetarian or vegan. And that makes them ideally suited to be able to study the impact of nutrition on cancer outcomes. And both of those studies were very consistent. They showed reduction in overall cancer risk by about eight to 10 percent if you're vegetarian and then about 16 percent if you are vegan. And then we have other studies, the UK Biobank study, the NutriNet Santee study, the Health Professionals Follow-Up Study and Nurses Health Study through Harvard. They're all pretty consistent, showing that plant-based dietary patterns are associated with reduced risk of getting cancer in the first place. And actually there are some smaller studies showing that plant-based dietary patterns might actually also help slow certain cancers such as prostate cancer. And now we're seeing amazing research coming out of Memorial Sloan Kettering in the haematological malignancies through Dr. Irvi Shah, you know, in a very neglected area. We don't haven't done much nutrition research in the haematological malignancies. So there's more coming out in that sense. We have we have studies showing that it improves quality of life during treatment, that it improves quality of life maybe afterwards, a few years after after treatment as well. And then there are studies showing that there is associated reduced mortality when you are following plant-based dietary patterns, reduced mortality from cancer. So it really does feel like it's across the board. Obviously, we have more more data in in the prevention area, though.

Michelle: Zara, I know I was super excited when I learned about epigenetics. Can you just talk about that a little bit for our listeners and and actually what that means in this context?

Zahra: So, yes, epigenetics is a key, really one of the key pathological processes in disease development, not just for cancer. But when we think about the the main processes, I think about the lifestyle literature that talks about epigenetic changes, microbiome changes, cellular stress and injury as the three central pathophysiological processes that can cause inflammation that then feeds back and causes more of the same in this this loop. And then that manifests as different diseases, including cancer, but also the other chronic diseases. So epigenetics is when you have some external impact that causes changes in the expression of your genes. So your DNA stays the same, but our lifestyle, whether it's nutrition or exercise or stress or smoking, that can cause changes in the expression of our genes. And we've had studies showing that. I know I can see Michelle is nodding. She knows all of these. So it's very exciting.

Michelle: It is. So your genes are not a life sentence, right? So if you're carrying a BRCA gene, for example, it doesn't mean that you're doomed.

Zahra: That's correct. That's correct. And, you know, when we look at the cancer literature, you do see that epigenetic changes are one of the key factors in the development of cancer as well. But that also means that you, as you just said, Michelle, that the opposite can happen, that you can actually reduce that risk by addressing that.

Michelle: So for somebody already diagnosed with cancer, Zahra, what would you say to them in terms of how their nutrition and their lifestyle can influence how they experience treatment and after treatment?

Zahra: Yes, there's not as much literature during treatment, but there is some and there is some quite exciting studies that are coming up now. So we can we have seen as we've seen one study that came out a couple of years ago for people undergoing chemotherapy for breast cancer. The authors did a randomized control study and they asked patients to follow the plant based cancer guidelines for nutrition and do exercise during the treatment. And they found that those patients who did those two interventions had an increased chance of a complete pathological response to the chemotherapy by a margin of 30 percent. So that was very exciting, very exciting. It was a well done study. It was a randomized control study, which, as you know, is our gold standard. So that was very interesting to see. We had a subgroup analysis from patients with colorectal cancer who have metastatic disease. Those following a more plant based nutrition pattern had a longer survival. So that was very interesting. We have studies looking at quality of life and fatigue and cognition during treatment for metastatic breast cancer. And we that was done by Dr. Campbell and they showed that a vegan diet improved fatigue scores, improved the perception of their cognitive health. So that is for people who have metastatic disease as well, that it might help improve your quality of life. And then the final piece is the number of studies that are coming out for people who are on immunotherapy for various cancers, usually in the metastatic setting in the studies that I've seen and have shown that those eating more plant foods in their diet, it's associated with a longer progression, free survival and maybe less side effects. So and maybe increased response rates. So that's very, very interesting. And, you know, when we think about why that might be, when we think about how nutrition interacts with the microbiome, which then interacts with the immune system and then the immunotherapies that are there to boost your own immune system to kill the cancer cells, that that does actually make sense.

Michelle: Right.

Zahra: So there's lots of early but very interesting research coming out for people who are going through treatment in terms of improving their response, but also their quality of life. Now, you do have to balance that with the multiple other aspects that patients undergoing treatment have are having to take on. You know, some patients may have side effects such as nausea and reduced appetite from their treatments. So you definitely have to balance, you know, and very much individualize what you're talking to patients about. But we have lots of patients who can eat well while going through their treatments. And I think it's important that we talk to them about these aspects as well. But if you look at the literature, it's very there is it's consistently inconsistent when you look at what what recommendations people give to people during their treatment.

Michelle: Yeah. You know, I had an experience with a girl that I was helping that had an HER2 positive breast cancer and she's very young and she was super eager. She had a lot of support at home and it's probably the most compliant nutrition client that I've ever had the pleasure of coaching. And she I wouldn't say she sailed through her treatments because it's very difficult. But she did remark that when she looked around at the other people that were in the same, you know, getting their treatment at the same time as her, that they kept saying, wow, you look so good. And and, you know, she was able to eat. So the the difficulty with the appetite and the nausea, it wasn't wasn't completely, you know, gone, but it was so much markedly, in her opinion, better than the other people she was going through that journey with. And, you know, she's she's now like been thriving. This is, gosh, I don't know, six, seven years later and she's married and has a baby and and, you know, stuff that she was very fearful wasn't going to happen. It's so wonderful to hear that this is growing and that it's just unfortunate, Zahra, for me that you have to develop a chronic disease before you patients really hear about the power of nutrition.

Zahra: Yes. And it's interesting, Michelle, because, you know, we we talk about not really being operationalized on the ground, but it is in our guidelines. It's in our guidelines, cardiology guidelines, cancer guidelines, diabetes guidelines for prevention as well as management. But you're not seeing it, even though all that science did get into the guidelines, that next big step to get it into practice is is the big hurdle now. And there is no time in a really, you know, time strapped system that is being overburdened. But when we talk about prevention, we're talking about the sustainability of our health care system as well. And if you can reduce the incidence of chronic disease, you'll reduce the impact on the health system. Maybe you'll free up some time to address these other really important aspects.

Michelle: Yeah. So so how do you work that into your visit in terms of time? I know that you provided some amazing resources to us, which, Kevin, which we'll put in the show notes to to provide to anybody that listens to this episode. But I'm imagining that your patient interaction isn't that much more generous than any other profession who has to see so many patients in a day. How do you work that in? Is it through providing tools or let us know your secret?

Zahra: It's really hard because, yes, you have to get through your clinic and people are waiting for you. And it's about planting the seeds. And I try and I just say, can I just take five minutes of your time? Can I just run through some of these things with you and then tell me where you think that you can make some changes if you would like to? And I'll give you the additional resources. So I do try and touch on my my top points, which are don't don't drink alcohol because we know alcohol is a carcinogen. We talk about, you know, trying to incorporate physical activity into their routine. The ideal is 150 minutes of aerobic type of exercise per week. And we talk about doing that in exercise snacks or any way that people want to and can fit it into their lifestyle, such as brisk walking. It doesn't have to be going to the gym. It doesn't have to be running marathons. We talk about trying to optimize rest and sleep. And we talk about stress management. And I tell them about the resources we have at the cancer center. And I always try and say to my patients, you have to prioritize yourself. There are so many people who don't prioritize themselves, especially the women who are just always thinking about the rest of their family and how they're dealing with this diagnosis. And then we talk about nutrition in very general terms, the way we've talked about the guidelines. I talk to them about increasing their plant foods, whatever they like, and reducing their red meat and processed meat. And I talk to them about I always tell my patients to look at the Gilders Club Toronto free nutrition guide, which is by which is by Amy Symington, who's a chef and professor at George Brown University and is doing completing her PhD at the University of Toronto now. And she's worked with Gilders Club for many years. They have free recipes online. Her cookbook is free to download as well. Wonderful. That's amazing to have that resource because that cuts down the need for me to do so much talking. And I, you know, if people are interested and, you know, we can think we will talk about ways to increase their plant foods. So, for example, we might talk about having a smoothie in the morning and that sort of takes the pressure off the rest of the day. They know they've got something good in already first thing in the morning. So I try and do five minutes of a bit of blurb and then I ask them if they have any questions and we try and take it from there. And usually I'm seeing them again during their treatment on a weekly basis. So I have another opportunity to go through things with them or answer any questions. But you're right. It's not just planting the seeds. It's like, what's next?

Michelle: Yeah. Yeah. Where's that support? Yeah, exactly. Now, if a patient doesn't happen to have the incredible team that that you're part of that will bring this into the conversation, but they happen to be listening to this. Do you have any advice of how a patient might broach this with their care provider where they they might feel a little intimidated? Is there an elegant way to try to nudge their provider to help support them in this way?

Zahra: That's it's tricky because as we've discussed, our providers don't have education in this area. And although we've talked about increased knowledge amongst some people, there are still pushbacks from the providers, even like for me. I've had notes back from other oncologists at a different center saying the patient asked me about the interaction of food and cancer. And I told them that there's no interaction. That's even in the notes. So we found in the studies that actually so Dr. Avishar did a study looking to to get patients perception and how many patients asked their provider to about food and only a small proportion were able to get advice from their provider on this. So I think broaching it by asking, you know, about food and the interaction and the impact on cancer just to ask them. And then you'll find out very quickly whether your provider is open to it or not. And we also just published a survey, Shireen, myself and Irvi did a survey to oncologists asking about their knowledge and attitudes towards plant based eating. Many of them are not educated on this. Many of them, most of them have not got education on it. Many of them are open to talking about this, but have identified a number of barriers, time, lack of leadership support, lack of dietitians to refer to. So there's lots of barriers in place, even if your health care provider wants to to offer you that advice. And one of the interesting things, which is not really surprising that we found from the study, is that those who are already following a plant based diet are much more likely to offer the same advice to their patients.

Michelle: Right, for sure. Oh, I can see we're almost out of time. Oh, no. So something listeners can also know, Dr. Zahra Kassam has co-authored Eating Plant Based, which is an incredible book. We actually gave that as a Dora Prize at our nutrition conference. Some lucky family doctor won that. But that's a great resource. Do you want to just quickly plug your the conference? Because the conference is open to anyone. Anyone can go to it, right? Whether they're, you know, whether they're a medical professional or not. So let our listeners know.

Zahra: Absolutely. Thank you so much. So our seventh annual Canadian Plant Based Nutrition and Health Conference is on the 30th of May, and that will be held in downtown Toronto. But there is a virtual option as well. Very accessible prices. We do educational, evidence based talks on personal health, on planetary health, the impact of food on the planet, and also practical tools as well. And this year we've got an amazing lineup. We have Dr. Scott Stoll as one of our keynote speakers from the Plant Fission Project. He's so inspiring. And we also have Dr. Amar Laila from the Eat Lancet report. He was one of the authors of the social justice piece. That's an absolutely seminal piece of work on food systems and how we are going to eat for health and for the planet and keep within our planetary boundaries. So these are our two keynotes. It's going to be spectacular. And you'll be able to see all the Canadians doing that work. So other than Dr. Scott Stoll, the rest are Canadian experts in this area.

Michelle: Yeah, well, just the energy in the room is just so incredible. And it really does, for me as attendee, make me feel like you're not alone in this interest and this passion, that there is a whole community, a whole Canadian community that is increasing in numbers every single day. And it's wonderful. So thank you so much for all that work that you do. I wish we had more time. We'll have to get you back later. I know there's so many things that you're involved in that we haven't even touched on that even I know about, but I have to contain myself.

Zahra: Thank you so much. Thank you. You guys are just wonderful. I'm so happy to see this wonderful podcast and how it's educating people. Thank you so much.

Michelle: Oh, thank you. So now it's on time for Kevin, Kevin's shining moment.

Kevin: Exactly. Well, thank you for joining us. I really appreciate that. And as a parting gift, it's time for the dad joke. So how does Darth Vader like his morning bagel toasted?

Michelle: I don't know.

Kevin: On the dark side.

Michelle: Oh, no.

Kevin: That was a horrible Darth Vader impression.

Zahra: Oh, that was pretty good.

Kevin: Well, thank you for joining us, Zara. And as Michelle mentioned, we will put all of your contact information, your home phone number, your home address. We're not going to talk soon. But all the socials that you want published, we'll throw them in the notes.

Michelle: No wonder we have a couple of taglines that we sign off with, Zara. Do you have one?

Zahra: Oh, sure. There is no human activity that has a deeper impact on the planet and our health than what we eat. And we have the power to improve our lives, improve the health of our planet. And it's all the same. The power is on our plate and choosing more plants.

Kevin: Well said.

Michelle: Wow. I can't top that. That is boom. That is that is being real right there for me. That is like be real, everyone. Just like just like Dr. Zargislam.

Kevin: I can top that. Eat your greens.

Michelle: Eat your greens. Yes. Wonderful. What a pleasure. Thank you so much.

Kevin: OK, thank you, Zara.

Michelle: Thank you.

Kevin: This has been Nutrition for Noobs. We hope you're a bit more enlightened about how your fantastic and complicated body works with the food you put into it. If you have a question or a topic you'd like Michelle to discuss, drop us a line at n4noobs at gmail.com. That's the letter N, the number four. N-O-O-B-S at gmail.com. If you haven't already, you can subscribe to the podcast on whatever your favorite platform might be. Also, please consider leaving a review or telling your friends. That's the best way to spread the word. We'll see you next time with another interesting topic. The views and opinions expressed on Nutrition for Noobs are those of the hosts. It is not intended to be a substitute for medical, nutritional or health advice. Listeners should seek a personal consultation with a qualified practitioner if they have any concerns or before commencing any actions mentioned in the podcast.