236: Dr. Simran Malhotra | The Angelina Effect: Why I Decided to Have Preventative Cancer Surgery

[00:00:00] Dr. Simran Malhotra: I don't think we realize how big of an impact this has not only on a person's mental and emotional health, but also how this affects their families, and so I think talking about body confidence and ways to improve mental and emotional confidence after surgeries, whether you're a previvor or a survivor, is so important. 

[00:00:23] Maya Acosta: You have more power over your health than what you've been told. This is the Healthy Lifestyle Solutions Podcast. I'm Maya Acosta, and I'm passionate about finding healthy lifestyle solutions to support optimal human health. If you're willing to go with me, together we can discover how simple lifestyle choices can help improve our quality of life and increase longevity in a big way.

[00:00:47] Maya Acosta: Let's get started. Dr. Simran Malhotra is a physician and certified wellness coach specializing in helping women at high risk of cancer by assisting them to reduce the risk and improve their quality of life. When Dr. Simran was only 13 years old, her mother was diagnosed with breast cancer. While in medical school, Dr.

[00:01:12] Maya Acosta: Simran discovered a strong family history of female reproductive cancers. She immediately requested genetic testing revealing that she had the BRCA1 gene mutation. It's also known as BRCA1. When we're talking about the risk of cancer as a genetic mutation carrier, we're talking about an 80% lifetime risk of breast cancer, and that's huge.

[00:01:38] Maya Acosta: Considering the average woman, it's like seven or eight times more. Dr. Simran is here today to share her journey as a survivor of breast cancer. She consulted with a group of physicians who recommended she have a prophylactic Bilateral mastectomy and hysterectomy to prevent the cancers often seen in her family.

[00:01:58] Maya Acosta: We will learn about her genetic mutation, the choices she made as a result, and how it has impacted her life. As always, the full bio and show notes of each of my guests can be found on the website healthy lifestyle solutions.org. All right, welcome back to another episode of the Healthy Lifestyle Solutions Podcast. I'm your host, Maya Acosta, and this month we continue to talk about breast cancer awareness, and I'm so honored that today I have Dr. Simran, who is going to tell us her story. And so Dr. Simran Malhotra is a triple board-certified physician in internal medicine, hospice, and palliative care, and lifestyle medicine.

[00:02:37] Maya Acosta: She completed the T.Collin Campbell plant-based nutrition certificate in 2019. The Chef Culinary Coaching Certification in 2020 and is now  WellCoaches certified health wellness coach. She is a member of the ACLM women’s health member interest group and serves as the co-chair of the breast cancer subcommittee alongside Dr. Amy Comander. And as you remember, last week we had Dr. Comander on the show. She's also a mother of two kids and a BRCA1 previvor with a strong family history of breast and female reproductive cancers, Dr. Simran underwent a risk-reducing bilateral mastectomy and total hysterectomy in 2020. Outside of her palliative care practice, she recently started Coach Sim MD, a platform she uses to empower and educate and guide women, particularly at high risk for cancer, with or without genetic mutations, on the powerful impact that positive lifestyle changes can have on their quality of life and even longevity.

[00:03:36] Maya Acosta: Welcome back, Dr. Simran. Thank you so much for having me. I'm so glad that you're returning to share your personal story. I'm gonna put a link in the show notes. Below of your previous visit when we were just really celebrating cancer survivorship month, and you were on with Dr. Amy Comander, and we talked a little bit about your story, but it really did not get in-depth, didn't talk too much about it, so, and I really was eager to hear more about what it's like to be an individual who has the BRCA1 gene.

[00:04:05] Maya Acosta: Many of my listeners have no idea what that is. So before we get started in your story about that, tell us a little bit more about you. I know about, well, coaches I know. WellCoaches does nice job of partnering with ACLM so that you can be certified in lifestyle medicine. Tell us more about your coaching practice.

[00:04:23] Dr. Simran Malhotra: Well, it's actually a pure labor of love for me. I think after I went through a lot of my experience through the previvorship journey, and then I discovered lifestyle medicine, and through the years I've been practicing in the traditional healthcare model, I just never found a set of tools that was so empowering for patients.

[00:04:45] Dr. Simran Malhotra: And the first patient that I used them on was myself. And so once I discovered lifestyle as medicine, and I saw how my life was changing, and the lives of my friends and my family was changing, I was like, I need to share this information with everyone. And I learned and consumed all the evidence, right? I got board certified, all of that.

[00:05:03] Dr. Simran Malhotra: But then I was like, Okay, so I have the knowledge part, I have the expert part, but then. How do I help people, you know, incorporate this into their life? And that's where the coaching piece came in, which is another piece that we don't learn in kind of the traditional medical model. So that's kind of where I was like, well, you know, how can I use my experience to help other women in my shoes kind of get from where I was at 26 to where I am now, but ease their pain in the process.

[00:05:33] Dr. Simran Malhotra: A little bit more, and that's where Coach Simran MD came to life last year, really. So I'm still working as a palliative care physician and a full-time busy mom, but Coach Simran MD is really my passion of love on the side.

[00:05:46] Maya Acosta: Wonderful. And so, who can reach out and work with you closely? Anybody? I'm assuming that you offer like sort of a telehealth platform as well.

[00:05:54]Dr. Simran Malhotra: Yeah, so everything I do right now is through Tele-coaching. If you. If you go on my website, you'll see everything in terms of what my offerings are. But I specifically have a very soft spot for women like me who are at high risk of cancer because of a genetic mutation or because of like a very strong family history but no known gene mutation.

[00:06:16] Dr. Simran Malhotra: Women who really wanna take control using their lifestyle to reduce their risk of cancer, and in the process, just craft the best possible living experience and quality of life for them. And that's kind of my niche. But really, I've worked with several other people. I've worked with people who are cancer survivors, people who are currently still undergoing cancer treatment.

[00:06:37] Dr. Simran Malhotra: And I've even had a few people reach out who have nothing to do with cancer. We're a good fit. And so we worked on just lifestyle modifications, and their goals were around weight loss or improving other kinds of things that they had going on. So I could work with anyone. I specifically work with a lot of people who are at risk for cancer.

[00:06:56] Maya Acosta: Mm-hmm. Thank you. 

[00:06:58] Dr. Simran Malhotra: And I'm also working on a few other ways to work with me indirectly. You know, coaching may not be for everyone at this moment in their life. And so I'm actually working on creating some courses, and one of my specific passions is Food as medicine, right? Like the power of plants is incredible.

[00:07:15] Dr. Simran Malhotra: And that's the other piece is like, okay, great, all of these foods are good for me, but I don't know how to cook. And so that's another passion I've developed over the past few years, which is why I did the culinary coaching piece as well. So I'm working on making a couple of courses of teaching the evidence behind nutrition, but then also how you apply it in the kitchen.

[00:07:32] Dr. Simran Malhotra: So hopefully, those will come out soon.

[00:07:33] Maya Acosta: That sounds exciting. So I always say this, but one of the benefits about a physician who's trained in lifestyle medicine and then moves on to sort of that coaching space is that we are lucky enough to have an individual who has the science. And is prepared in terms of prescribing or doing procedures, well-trained as a physician, and then the lifestyle pillars, the modifications that we can make to improve our health that are not necessarily offered in medical school.

[00:08:01] Maya Acosta: So we're very lucky to have physicians who are trained as specialist in the field. You have all the science. But as well, you have all the other things that we're not necessarily taught in medical school, and that really helps to empower us, the patients. So I appreciate that, and you're moving into that coaching space.

[00:08:18] Maya Acosta: But I wanna emphasize to listeners that that's sort of what we wish we had access to. Like a longer time with our physician who actually knows how to answer the question, What are we supposed to eat? Cause that's the biggest component. Like what should we eat? And most of our physicians, you know, Throw out a couple of things that they might know, but in their defense, they're not necessarily trained in that.

[00:08:40] Dr. Simran Malhotra: And also that every single person is so unique. The standard recommendation is going to apply to every single person. And so the coaching model really allows you to personalize and meet that person exactly where they are and then get them to where they want to be. So it's a very personalized model. Yes, which is what I love about it.

[00:08:59] Maya Acosta: Perfect. So, as I was mentioning, Dr. Amy Comander was on the show last week, and we had a wonderful conversation about the work that she does with breast cancer patients. And we even talked about paving the path in terms of the program that she developed to continue to offer support for those individuals who are in remission.

[00:09:18] Maya Acosta: I guess that's the best way that we can put it, and are sent home to thrive and live their lives, and so it was a wonderful conversation. 

[00:09:27] Dr. Simran Malhotra: Yeah, she's doing great work. I believe that every single cancer center and breast cancer center should have a program like that because that's one of the main things that I hear.

[00:09:34] Dr. Simran Malhotra: I'm not just a doctor, but I'm also a patient. I'm in a lot of support groups, and so a lot of the women in those groups who are either, you know, survivors like me or they're going through cancer treatment or their survivors say they wish they had more of a approach. Where they're empowered to take control of their own life, where they're in a group setting with other women that are going through what they're going through so that they can be accountable.

[00:09:59] Dr. Simran Malhotra: And I just feel like what they're doing with pain and passive of wellness is just incredible.

[00:10:03] Maya Acosta: Yes, absolutely. Maybe it can be a model for other cancer centers to adopt something like that. Okay, so Dr. Comander also spoke with us about the Angelina Effect, and so we're sort of gonna talk about that with you.

[00:10:16] Maya Acosta: So it was the first time that I and probably many people saw that Angelina Jolie, and then later on Christina Applegate, because, you know, these are some of the celebrities that we know of that made it personal decision when they discovered they had that genetic mutation that could put them at risk for developing breast cancer.

[00:10:33] Maya Acosta: And so we don't typically know of everyday people who make a. A decision like this. So I was wondering if you can tell us your story, your family history, and then what it meant for you when you discovered that you had the BRCA1 genetic mutation and the choices that you made as a result of that.

[00:10:51] Dr. Simran Malhotra: Cancer and I, I guess the way I always tell people is we were introduced, To each other very young in my life. I was 13 years old when my mom was first diagnosed with breast cancer. She was 33 at the time. Again, I also come from an Indian culture, which is probably very similar to the Hispanic culture, where when something like this happens, you don't really talk about it out loud.

[00:11:11] Dr. Simran Malhotra: Everything happens behind. Closed doors. Okay. We get the chemo, we get the surgery, we get the radiation, and then we move on with our life and try to go back to normal. And that's kinda what I experienced my mom's cancer journey to be like the first time. And so it just kind of happened. No one really talked about why it happened.

[00:11:27] Dr. Simran Malhotra: It just happened, and then we moved on. But then over the years, you know, I went into medicine, and then during residency, I kind of just started diving more into my family history. And I discovered that there was several women, not just my mom, but her several aunts and the. People who had some female reproductive cancer, sometimes it was called stomach cancer, sometimes it was breast cancer.

[00:11:48] Dr. Simran Malhotra: But, like, no one really spoke about it. And so what I realized by the time, I think a second-year resident was at, wow, there's a very strong family history here. And I spoke to one of my colleagues, and they were like, You know, you should really tell your mom to consider getting genetic testing again because it's something that's evolving.

[00:12:03] Dr. Simran Malhotra: So if someone had genetic testing in the past and they were negative, and it's been five or seven or 10 years, they can get genetic testing again, which they may have found more genes along the way. And so that's exactly what happened. So my mom got tested again, and this time she was found to have the BRCA1 mutation.

[00:12:19] Dr. Simran Malhotra: And for those people that don't know what BRCA1 is, BRC one and two are genes that we all have. And it's a gene that actually protects you from cancer. But when you have a mutation in that gene, basically what that means is now you're prone to some of these cancers and particularly female cancer. Like breast and ovarian cancer.

[00:12:39] Dr. Simran Malhotra: And so at that time, then I decided that I also wanted to find out, cause I was about to get married, and so I wanted to make sure that my husband was fully informed into what he was getting into with me. And so, you know, we decided before I decided, before we got engaged, that I really wanted to know so that he had this information.

[00:12:58] Dr. Simran Malhotra: And so we got tested. I found out that I carry the same genetic mutation as my mom. And essentially, I was 26 years old at the time. Basically met with a group of doctors, um, genetic counselor, oncologists, breast surgeons, and essentially they just said, You should have your children back to back or be done with childbearing as soon as you can because your mom was 33 at the time of diagnosis.

[00:13:19] Dr. Simran Malhotra: So we want you to have at least a mastectomy before you're 33 and then consider a hysterectomy as well to reduce your risk of ovarian cancer. And it was all for preventative. So that's what the research shows is that women that carry these genetic mutations, they recommend prophylactic surgeries to radically.

[00:13:36] Dr. Simran Malhotra: Their risk of cancer in terms of, like, what I decided to do. That's like a whole nother chapter, which, you know, if we can talk about right now or if you wanna take a pause there. Cause I just shared a lot of information.

[00:13:48] Maya Acosta: Well, I remember. I'm glad we're having this conversation because it's like anything else. The more you know, the more informed you are, the more you can understand how one can be impacted by discovering that they have, for example, the genetic mutation. I remember when the whole story with Angelina Jolie happened. I was in. And mind you, I did not know anything about lifestyle medicine. I'm not a physician.

[00:14:09] Maya Acosta: I don't have any training in any of this, but I was really shocked because I was into holistic medicine. So I'm that person that prefers the alternative as opposed to medications and procedures. And today, I have a different perspective because I know better. Like I understand that there's only a small percentage of individuals who carry that genetic mutation. Is that right? 

[00:14:30] Dr. Simran Malhotra: Yeah. It's about five to 10% of the population that has a genetic mutation, which is really interesting when you think about it because a lot of people, when they have either chronic illness Or you're having a conversation with them, they'll often say, Oh, well, there's nothing really I can do because it's in my family history.

[00:14:44] Dr. Simran Malhotra: But the reality is I think it's above 85%. I think it's like 87 or 88% of women who are diagnosed with breast cancer don't even have one first-degree relative that have had a history of breast cancer. So this population of people that we're talking about that have this genetic. Is actually really, really small. and

[00:15:02] Maya Acosta: And it seems as sort of like you're taking a chance, like in terms of whether you decide to just live your life, pray that nothing happens, or like you said, and even Dr. Comander was talking about the fact that some individuals may have a mutation and never develop cancer. And then some individuals who may not even have any risk factors could develop breast cancer. So it's almost like you just have to be on top of all of this. 

[00:15:28] Dr. Simran Malhotra:  I also think for me it very, very unique circumstances cause I'm a palliative care physician, so what that means is I see people every day with serious illness. Oftentimes I've cared for people at the end of life with cancer. And so for me, I've always. Looked at my genetic mutation as a blessing in disguise because I was given the choice to do something to reduce my risk of cancer. And when we're talking about risk of cancer as a genetic mutation carrier, you're talking about like an 80% lifetime risk of like breast cancer and somewhere between 40 and 60% risk of ovarian cancer.

[00:16:04] Dr. Simran Malhotra: And that's huge considering, you know, the average woman. Like seven, eight times more. So for me, it was always like, okay, you know, you have this blessing in disguise to do something about reducing that risk that one mom didn't get. And two, so many of my patients who I witnessed dying and they left their young children at their bedside like these are women that died of breast, ovarian cancer, and some of them had the same mutation as me.

[00:16:30] Dr. Simran Malhotra: So for me, if I'm being completely honest, it was never a matter. If I'm going to have preventative surgeries, it was more like, when am I going to do it? And there was a period of time, if I'm being honest, right? Like when I found out about lifestyle medicine, I was like, Could this be the answer? Like, could I just do this as pristinely as possible?

[00:16:48] Dr. Simran Malhotra: Live the cleanest life, and maybe that's enough. That's when I found Dr. Kristi Funk, who is the surgeon that did Angelina Jolie surgeries and she kind of brought it all together for me in perspective of like the best chance of reducing your risk is to do the preventative surgeries and use lifestyle to synergistically continue to reduce your risk because she also really advocates for lifestyle medicine and plant-based nutrition.

[00:17:15] Dr. Simran Malhotra: And so once I heard it from her, it really helped me feel good that this is the best decision. For me to make, in order to be there in the long run for my children. 

[00:17:25] Maya Acosta: And I get it. You worked so closely with cancer patients, you know what that looks like, the potential of what you could have been going through yourself. I will agree with you that Dr. Kristi Funk’s work, I read her book, but just her work, in general, is what got me started in taking breast cancer seriously. Again, I wanna credit lifestyle medicine because my husband got involved in it, and then I learned more about it. And the more that I read, again, the more that I understand how much I have to take care of myself and how important the mammograms are.

[00:17:52] Maya Acosta: And having had Dr. Comander on the show was the reason that I decided to continue and to do the mammograms because I was one of those individuals who was afraid of all of this. You talking about working closely with, uh, cancer patients? I feel like I can't really relate. I'm not a physician, but seeing my husband and what he works with, the individuals that he treats to have advanced disease and spend the rest of their lives suffering, is the reason why I too wanna be on top of my health because I know what happens.

[00:18:21] Maya Acosta: I know what the cases look like, I know what the risk for so many other conditions are as a result of the work that he does with patients. So, Or that for sharing that as well. And you're right, you were, with your family history, you were at higher risk, so of course, if given the choice, why not take this route as well?

[00:18:40] Dr. Simran Malhotra: Yeah, and I think a lot of times people, and this is still true in the medical community, is that it's like, oh, you have a genetic mutation. So lifestyle doesn't. Really mean anything, it won't do anything. And that's what I experienced. Like in 2015, when I found out about my mutation, I saw a whole plethora of doctors, but not a single one mention anything about what I could be doing in my everyday life to reduce my risk.

[00:19:04] Dr. Simran Malhotra: And I even asked, and I didn't really get any information. I wish I knew Amy Comander then cause that's who I needed. But, like, after I found out about mutation, I kind of put it on the back burner. Cause I was in the middle of fellowship. I quickly got pregnant right after that, and it was this one patient that I met, she had the same mutation as me, and we got fairly close.

[00:19:23] Dr. Simran Malhotra: I actually took care of her in hospice, and she found out that I had the same mutation as her. And so she shared these words with me, and she said, You know, someone, do whatever you need to do to live a full life and be here for your future kids. Mm-hmm. , you have a choice. She didn't say anything else to me.

[00:19:39] Dr. Simran Malhotra: I didn't know at that time what that meant, but her words stayed with me for the next several years, and I was going through cancer screenings, right? The mammograms, the MRIs. A few times, they found little things, and as a pre-bi, every time they find something on a screening test, they now wanna biopsy to make sure that because you're such high risk.

[00:19:58] Dr. Simran Malhotra: So I went through the biopsies, and there was so much anxiety, fear associated with that. Right. And then I was a new doctor. I had two back-to-back pregnancies within 18 months. I was sleep deprived, I was breastfeeding, I was pumping, like the last thing on my mind was my lifestyle. Like I was literally in survival mode.

[00:20:16] Dr. Simran Malhotra: But I don't know, her voice was always in the back of my head, like, Simran, this is something you need to stay on top of. And so the doctor's telling me there was nothing I could do was never enough cause for me there's always something you can do, and that's when one night, I don't know like I probably sleep deprived.

[00:20:33] Dr. Simran Malhotra: I was probably pumping or breastfeeding, and I was on Google, and I found Dr. Michael Greger, and he changed my life, like the next day after I read something on the internet about his grandma and how she was diagnosed with end-stage heart disease in her 60’s was sent to hospice. Something I'm very familiar with.

[00:20:51] Dr. Simran Malhotra: And you know, ended up going to the Pritikin program in California, completely reversed her disease, and ended up living another 30 years and dying in her 90’s. Those are stories you don't hear about, you know, and don't see when you're training. But she didn't do anything crazy, right? She just did really aggressive lifestyle interventions, and to me, it was like, why don't I know this?

[00:21:14] Dr. Simran Malhotra: Why don't I know this for my patients? And why don't I know this for myself, like, why didn't I learn this science? And so that just like completely changed my life. After that 2015, we went vegetarian in 2018, we went vegan plant-based. And like I said, the ripple effect it's had on my family has been amazing.

[00:21:32] Dr. Simran Malhotra: Like my husband, when I first met him 10 years ago, he was borderline high blood pressure, cholesterol, probably 15, 20 pounds overweight, constipated, all sorts of things. And he's an ICU doctor, so you can probably relate to the craziness of that schedule being married to your husband. So all these things just melted away.

[00:21:50] Dr. Simran Malhotra: My mom's health improved. Like, just by me taking the first step of like starting to eat more plants and seeing the ripple effect on my family has just been phenomenal. And so like it's, in my opinion, the one thing that you can control that influences your genes when you can't control the genes that you're dealt is your lifestyle.

[00:22:11] Maya Acosta: Definitely, yes. As a matter of fact, I'm glad that you talked about that. I was recently mentioning in September, we talk about mental health, and I think you also talk about it related to previvors and survivors. That's another component of lifestyle medicine that we don't just work on the physical health, but we also wanna emphasize on mental health. Do you wanna talk a little bit about that? 

[00:22:33] Dr. Simran Malhotra: I think mental health is something that is not discussed enough in general, as you said, but particularly in the cancer world for previvors, drivers and survivors. And so, for me, I think the first thing I would want people to know, a big pillar of lifestyle medicine is social connection, right?

[00:22:50] Dr. Simran Malhotra: And we thrive as human beings when we know that we're not alone, and so anyone that I think is in this world, the first thing I would say that was most helpful to me is to find a group of people. And I'm not necessarily, I mean, obviously friends and family are really important, but in this journey, find a group of people that are going through similar things to what you are going through so that you realize that you're not alone, and to realize that when you see something as possible, you see a survivor who went through the exact same thing as you, and you see that they're alive, and they're well, and they're thriving, and you can see that it's possible for you.

[00:23:29] Dr. Simran Malhotra: And I think that was so big for me. Remember one of the things before my surgeries, cuz I had a preventative mastectomy and a total hysterectomy at the age of 32. So in September of 2020 is, ultimately when I ended up having my surgeries snack in the middle of Covid. And one of the things that I was most fearful of was the menopause piece.

[00:23:48] Dr. Simran Malhotra: Cuz here I am, like 32 years young, right? Like if I put myself into menopause, Surgical menopause, like, what's it gonna do to my mood? What's it gonna do to my sexual health? What's it gonna do to my bones? What are my brain, my heart? Like, what about all of these things? Like I was so fearful and had so much anxiety of that.

[00:24:04] Dr. Simran Malhotra: I wasn't even worried about the mastectomy, to be honest. Like it was more the menopause piece, and I found this one person online who was in her early thirties. She was a mom of three. She had gone through the same surgeries as me, and one day she reached out to me on Instagram as she saw my pre-op stuff I was posting on Instagram, and she reached out, and she just told me she's like, Simran, you're gonna be okay.

[00:24:26] Dr. Simran Malhotra: Like, everything is going to work out. You know, Sex life's gonna be good. You're gonna find ways with your lifestyle to manage your bones and your brain and your heart, and that one simple message from her. So empowering just to know that, like, hey, there's someone that's gone through this exact same thing as me, Who's the exact same age?

[00:24:45] Dr. Simran Malhotra: If she can be okay and she is okay and she's still thriving as a wife, I will be too. And so that sense of like community and connection is so, so important. And I think it's even harder when you're young because the traditional cancer support groups and the traditional cancer infusion centers that you go to that are affiliated with hospitals, a lot of the people will say, Well, I was the only young one, or I was the only colored woman, or I was the young colored woman who's also a mom, right? And so I think that's where social media and the internet has completely changed things for people because there's so many online support groups where you can find that one person, someone in the world who can be your buddy to remind you that it's gonna be okay.

[00:25:24] Dr. Simran Malhotra: That's right. So, That was huge for me. And I think the other piece, and I'll talk about this, I might have mentioned this to you before, I think, but the emotional piece and the mental piece for me was also the fear. I guess when you're a doctor, you know too much, right? So it was the fear of having pretty extensive surgeries.

[00:25:43] Dr. Simran Malhotra: I mean, my surgery was almost seven hours long and there's the worst-case scenario that could happen, and my kids were two and three and a half when I had surgery, and so it was more like, I'm doing this to reduce my risk so I can be here for a long time, but there's also the chance that something goes wrong in surgery and I could die.

[00:26:02] Dr. Simran Malhotra: Not that that was what I was thinking of, but I think the one piece from a emotional and mental health standpoint that, again, coming back to, like, what is it? I can do to regain autonomy and control of my life. And so what I ended up doing was this concept of legacy-making, which is also something that I talked to my patients and families a lot about.

[00:26:23] Dr. Simran Malhotra: And I wrote out, and I've done this with a few of my young patients who were moms, is I wrote out 18 letters two weeks before my surgeries. 18 letters for several different milestones in my kids' lives, and 18 for each of them. And that was probably one of the biggest game changers because it was like, no matter what happens now, these letters are there and everything I could possibly wanna tell my kids.

[00:26:45] Dr. Simran Malhotra: For them to know they're gonna have now. And that, for me, from a mental health standpoint, allowed me so much to go into this with confidence, knowing that, like, I'm gonna be okay and they're gonna be okay. And I don't think doctors talk about this enough. I don't think that we realize how big of an impact that this has, Not only on a person’s mental and emotional health but also how this affects their families. And so I think talking about body confidence and ways to improve mental and emotional confidence after surgeries like this, whether you're a previvor or whether you're a survivor, is so, so important.

[00:27:23] Maya Acosta: Mm-hmm. I'm getting emotional as you speak about the letters that you wrote to your children because you made this decision for them, and at the same time, during your surgery, you could always, like you said, be at risk for complications.

[00:27:36] Maya Acosta: Also, I wondered if, because I'm beginning to understand it through the field of positive psychology, that reminiscing and journaling can contribute to positive emotions that, in some ways, by thinking about the future and seeing your children facing or going through those milestones, you were sort of, your energy was there, that spiritual component was there, gave you sort of hope to continue through these scary moments.

[00:28:02] Maya Acosta: Cuz in a. They were very scary. I wanna add to that. I appreciate your vulnerability because I do believe that physicians can be the worst patients in a way. I mean, it's all individual, but you have so much knowledge about the field that, in a sense, to know that you become a patient can affect one's pride in a way everyone's different, but I appreciate your vulnerability because I feel that in general, most individuals, a lot of women, can relate to the pain that you're going as a young mother and knowing that there's nothing that you did wrong to be in this situation. It was a genetic mutation that you knew could take you down a very dark path, and you took control of your health and you made these decisions for the sake of your own health and your family, really.

[00:28:46] Dr. Simran Malhotra: Yeah. No, I think for me, it was always like, Okay, how do I turn this ear into gratitude? And that was so big, like, and kind of that kind of ties into the positive psychology piece, right? Like before surgery and after surgery, regaining my confidence. A lot of what I did was. So the writing of the letters was one piece, but I also created like a vision board.

[00:29:10] Dr. Simran Malhotra: I called it my healing Vision board. And I had all sorts of quotes and like pictures and all sorts of things that were very empowering to me and brought me joy so that every morning when I woke up in my recliner, that was the first thing I saw. And so that was, So important after surgery and before surgery.

[00:29:28] Dr. Simran Malhotra: And this is the difference between a previvor and a survivor. I think previvors have the opportunity to have more time. They have the opportunity to talk to people, to do their research, to really come to grips with like the decisions that they're making on their time, right? Whereas as a survivor, you find out about this diagnosis, and it completely turns your life upside down, and then at that point, you're just in survival mode from, like, To the next surgery, to the next treatment.

[00:29:53] Dr. Simran Malhotra: And so a lot of the healing that survivors end up doing is after they go through everything, right, surgery and chemo and radiation, and then a lot of times they're lifted through that process. They have people around them, but then after they ring the chemo bell or finished radiation, oftentimes everyone kind of goes back to their own lives.

[00:30:12] Dr. Simran Malhotra: And this person is left, completely changed, but expected to just go back to life as usual. But now they're no longer the same person. And that was like, in my experience, what I was so grateful for, because I had several months before my surgeries, actually years, because I found out at 26 to really process what I was, this emotional trauma that I was dealing with and what I was about to do, which a lot of people in the community I'm in, they refer to these as amputations, right? I had a mastectomy. I chose not to have reconstruction, which is like a whole nother conversation, but a hysterectomy, like, and so one of the things that I did, this is very difficult to do, but like sit in that grief, right? That I'm about to lose these very, very special parts of my body that are not just part of my womanhood, but like they gave me my children, right? And they fed my children for the first year of each of their lives, and they grew them into these beautiful, magnificent beings. And so one of the things that was so powerful for me was, Just what you said, journaling. So before my surgeries, I wrote a letter to my breasts, and I wrote a letter to my ovaries thanking them for the gifts that they gave me.

[00:31:22] Dr. Simran Malhotra: I got some paintings done, and so I created some tribute pieces. So to look at these paintings and to look at these letters to me is like so empowering. Cuz it reminds me of why I did what I did, but it also brings me back to the gratitude that I had. I had the ability to do something that so many women wish they had as well.

[00:31:41] Maya Acosta: Yes. That's so beautiful. Do you have a support group, or are you in a support group where you talk about these things? This is where

[00:31:48] Dr. Simran Malhotra: This is where like, the coaching piece comes in when you're coaching with somebody who's been through this, and now you are about to get on this journey. It's. Helpful to hear all of these things and get all of these ideas when you're kind of just in this frenzy of emotion.

[00:32:03] Dr. Simran Malhotra: So that would be one on one support. Right. But in terms of like an online support group, I belong to a couple of them. One of them that I love is the Breasteses. And then another one is Know Your Lemons. There's a few really good ones on Instagram, and I gotta say, like over the past three years, I've met so many incredible women, and I've become so close with them, and some of them I've never met in real life. It's pretty cool. So.

[00:32:25] Maya Acosta: I love support groups. I really love that we are able to connect, even if it's just by Facebook or WhatsApp, or whatever it may be. I have a couple of questions related to your experience in general. So one of 'em. What physical changes did you go through? Were you kicked into menopause, or has lifestyle medicine helped you in that sense through eating the right foods? Are you having like any hot flashes or any of those typical symptoms that we hear women have when they're in menopause? 

[00:32:56] Dr. Simran Malhotra: I think the caveat here is that I am a previvor, and one of the first things I remember my husband and I had our consult with a Gynoc to talk about my surgery, and I remember both of us were holding hands sitting on the table and both of us he was really teary-eyed.

[00:33:12] Dr. Simran Malhotra: I was actually crying, and she walked into the room, and it was like such a, such a difficult decision for us, right? Cuz here we are sitting in that room, going to make a decision. To reduce my risk of a disease I didn't have, but in hopes that I could live a very long time with him and our children, but at the same time making a decision that could destroy my mood and my sex life and a lot of things that could destroy our relationship.

[00:33:39] Dr. Simran Malhotra: It was like a very difficult decision for us to make. And so I remember that day the Gynoc walked into the room, and she just, Smile on her face when she looked at me, and she said, What are you most worried about? I had the best doctors. She said, What are you most worried about? And I said, Menopause. I'm worried about what it's gonna do to my relationship with my husband.

[00:33:57] Dr. Simran Malhotra: And she was like, Well, you don't have to worry about that. And they said, Okay. I was really confused. And she said We're gonna put you on a low-dose hormone estrogen patch. And there's good evidence to suggest that women under the age of 40 who are thrown into surgical menopause for the reason that you will be will benefit from a low-dose estrogen patch.

[00:34:16] Dr. Simran Malhotra: And I think this comes back to there's a lot of like controversy around hormone therapy. And so I think it comes back to research and advocating for yourself and making sure that you're talking to your doctors and the right people to know what is an option. So I'm so grateful that I'm on a very low-dose estrogen patch since a week after my surgeries, and I have not had any menopausal symptoms.

[00:34:41] Dr. Simran Malhotra: Having said that, I also know women who are on the patch, who in the same situation as me, who do have symptoms of menopause. And so my added caveat is that I believe it's not only the patch but. Also, the way that I live my lifestyle that is preventing me from having these menopausal symptoms. And so when it comes to menopause in a healthy lifestyle, right?

[00:35:06] Dr. Simran Malhotra: Aerobic exercise, weight training, strength training, those are things that are part of my life. When it comes to a diet, I incorporate a lot of whole-on-processed soy foods, which have been shown to reduce risk of vasomotor symptoms like hot flashes that you're talking about, and then a lot of calcium-rich leafy greens.

[00:35:25] Dr. Simran Malhotra: And there was actually a really great article that I had pulled up in Gem, it's actually, actually from the women's health study. So they looked at over a hundred thousand postmenopausal women who were followed for 18 years. And what they found out was women that had a greater intake of plant proteins, right? So beans and nuts and legumes, all things that I eat, was actually associated with a decrease in all-cause mortality, all-cause cardiovascular mortality, and dementia mortality.

[00:35:51] Dr. Simran Malhotra: So that to me was amazing because, like, that means I'm doing everything that I can to reduce my risk of all of the things that I was most fearful of. So those are the main things that I really focus on when it comes to menopause is movement, diet, and then I think this is another piece that I talk about, which is often hush, hush, just like mental health.

[00:36:13] Dr. Simran Malhotra: But sexual health, right? So it's kind of the concept of continuing to make sure that I'm making that time with my husband. And, you know, we like, I guess the concept is if you don't use it, you lose it. So I think in menopause, the idea of self-love is really important because there's just a lot of, like, Oh, in menopause, sex is not good.

[00:36:33] Dr. Simran Malhotra: You don't have libido, you don't, But it's about the mindset, right? So if you, you believe that sex is gonna be good, and you want to have sex, and you wanna create that intimacy with your partner, You can do it, and it can be good.

[00:36:44] Maya Acosta: Mm-hmm. Yes. Yes, it can. Alright, so a couple of more questions because I'm wondering if my listeners may have these questions as well. Alright, so your genetic mutation is still in your body. It did not leave. However, and you might have just answered the question. By adopting these pillars of lifestyle medicine, you've reduced your risk. Not only. For the breast cancer itself, but other cancers and other chronic conditions because you have the bilateral mastectomy.

[00:37:12] Maya Acosta: Does that mean that you're, and I asked Dr. Comander this question, but does that put you at zero chance of developing breast cancer, and does that depend on whether you still have a little bit of breast tissue? How does that work?

[00:37:26] Dr. Simran Malhotra: Yeah, that's a great question. So, getting a preventative mastectomy, if you are a genetic mutation carrier, like uh, BRCA1, BRCA2, and several others, does not decrease your risk to 0% because there's always some breast cells that can remain on the chest wall that they can't get rid of.

[00:37:42] Dr. Simran Malhotra: So, but it does reduce your risk by like 90 to 95%. So now it kind of brings your risk back to what it would be for the general. Female population. And for ovarian cancer, it's very similar, but you can't go to zero risk because there's, you know, the lining of the abdominal area. You can develop a certain cancer, which is thought to originate from ovarian cells, which is known as primary peritoneal cancer.

[00:38:10] Dr. Simran Malhotra: So you can't a hundred percent eliminate your risk, but I think synergistically using surgery and treatments like these that we have, That plus your lifestyle, can radically reduce your risk of not only cancer, but you know, all the other horrible epidemics we have going on in our country. You know, obesity, diabetes, heart disease, as we talked about.

[00:38:32] Maya Acosta: That's right. Now we may have listeners who do have family history, family members that have had breast cancer, and they might have a concern of whether they do have BRCA1 mutation. So what advice would you give’em? Also, does insurance company cover the preventative bilateral mastectomy? I don't know if you can talk about like the cost, cuz I think of the fact that sometimes health comes when we have the financial resources, it's easier for us to take care of our health.

[00:39:00] Dr. Simran Malhotra: So typically, if you have a genetic mutation, unknown genetic mutation, then insurance will cover high risk screening, and that usually includes more than a mammogram, That'll include like a screening MRI and then also the preventative surgery. And any other treatments that you may need. So the first step is if you are not sure if you have a family history.

[00:39:23] Dr. Simran Malhotra: So the first step is talk to your family, right? Start an open conversation, and this is like a special message for my communities. Of people of color, right? I'm South Asian. It's just not a conversation we have. We don't like to talk about sickness, we don't like to talk about cancer, diseases, any of that.

[00:39:40] Dr. Simran Malhotra: And so starting that dialogue in your family is the first step. And kind of like me, as you start to uncover. If you uncover like, Hey, there's this interesting pattern of cancer in my family, then the next step is to talk to your healthcare provider, who can then refer you to like a genetic counselor, and they can really help you map out your family history and determine does it make sense to get genetic testing?

[00:40:03] Dr. Simran Malhotra: And if it does make sense, then yes, insurance will usually cover it. There's a lot of now genetic testing panels that you can also buy on the internet that are much cheaper. They're not as extensive as the one that your doctors would do, but if you're battling insurance and you really feel like you need to get some sort of genetic paneling done, that would be an option.

[00:40:23] Dr. Simran Malhotra: But again, it's not as extensive. So if you have a serious pattern of cancer in your family, then I would really go see a genetic counselor and figure out what the next steps are. But I feel like insurance can definitely, Be a barrier for sure, for many people.

[00:40:36] Maya Acosta: Right. And also, it's difficult to know about family history when you come from a culture or family like myself that they typically don't go to the physician anyway. So how would you know if there's anything going on? Sometimes, you know, in my family, people just die of complications. They may not know what may have happened. What might have contributed to their chronic diseases? 

[00:40:59] Dr. Simran Malhotra: There's that piece. But then there's also the piece of like people who go through the genetic testing, and they're negative, but they have a very strong family history.

[00:41:08] Dr. Simran Malhotra: So that also complicates things with insurance cuz oftentimes they may not cover it if you don't have a known genetic mutation. Even if you have a strong family history, that's why I advocate for, like, you know, if it's been five or seven years since your family member has had genetic testing, or since you've had genetic testing, to consider getting it again because they're always uncovering new genes.

[00:41:29] Dr. Simran Malhotra: Like my mom at 33 was negative. Her gene panel was negative. But then, at 45, 46 when she got retested, that's when they uncovered the gene mutation that she had. Mm-hmm. . Okay. But it's a challenge because sometimes, and I've come across scenarios like this too, where it's like if you know which specific gene mutation that your family member has, it makes it much easier when they're doing your genetic testing cuz they're kind of, they know like what they're looking for.

[00:41:58] Dr. Simran Malhotra: But there's a lot of times where family members they don't want to know, or getting them to want to get tested is a challenge. So I don't think there's any right or wrong answers here. I think it's just continued to advocate for yourself, talk to your family, talk to your doctors and figure out what is an option for you, and then at the same time, realize that there's this whole world of epigenetics that is currently being discovered and epigenetics.

[00:42:26] Dr. Simran Malhotra: So your genes are what you’re dealt, you can't change your gene, but the epigenetics or the epigenome you can think of as the switches that turn on or off gene expression. And you're probably familiar with Dr. Dean Ornish's work. He did incredible study the Geminal study and prostate cancer patient where he showed that an intensive lifestyle can turn on or off specific genes like good jeans and, you know, turn on good jeans and turn off bad genes and the four specific lifestyle factors that we know for a fact change. Our epigenetics are diet, physical activity, sleep, and obesity. And so while you are in this game of do I have a genetic mutation, do I not, What's my family history? Like all of that, you can still take control of your destiny simply through the actions that you take every single.

[00:43:13] Dr. Simran Malhotra: Absolutely. So I don't know who said it, but I think Dr. Dean Ornish says, right, our genes are, are not our destiny. Lifestyle is the, um, I'm totally messing it up, but like, our genes are not our destiny, but our lifestyle is a trigger that can change that. And actually, there was a really great study that I also pulled up last year.

[00:43:30] Dr. Simran Malhotra: It was a very large population-based study in the UK that looked at the association between healthy lifestyle, genetic risk, and the risk of colorectal cancer. And this was really exciting because there's not a lot of studies out there on lifestyle and cancer and genetic risks. So this was, I thought, fascinating cuz what they found was people that are at high genetic risk, right?

[00:43:49] Dr. Simran Malhotra: Who maintained a healthy lifestyle, and this was a healthy lifestyle by definition of the American Cancer Society guidelines. But what they found is they had an almost. 40% risk reduction of cancer compared to only a 25 risk reduction in people who had a low genetic risk. And then they also found that people that had a high genetic risk who had unhealthy lifestyles were three times as likely to get colorectal cancer.

[00:44:13] Dr. Simran Malhotra: So now we have a study showing us that if you live a healthier lifestyle, even as a genetic mutation carrier, you can reduce your risk of cancer. The opposite, it's also true, is that if you lead an unhealthy lifestyle, you are radically increasing of cancer that's already heightened, to begin with, because of your genetic mutation.

[00:44:32] Dr. Simran Malhotra: So that's what I find fascinating about all of this is we have so much more control as genetic mutation carriers than we're led to believe.

[00:44:39] Maya Acosta: That's absolutely right. I was wondering also, thank you for sharing, by the way, that information on the study on cancer, because I think that gives us a lot of hope when we see the science behind this.

[00:44:50] Maya Acosta: It's like we are more likely to buy into all of these. I was wondering if you could also just briefly address the importance of just having the mammogram, annual mammogram as a preventative measure. And also Dr. Comander did talk about the non-modifiable and modifiable risk factors. You know, Dr. Kristi Funk has her program where she encourages women to adopt a predominantly plant-based lifestyle.

[00:45:13] Maya Acosta: And I told Dr. Comander, one thing I no longer do is I just no longer drink alcohol because I now know the risk associated not only you. Drinking alcohol puts me at a higher risk for developing all sorts of cancer, including breast cancer, and also weight can be a contributing factor and also just aging as a woman.

[00:45:33] Maya Acosta: So if you'd like to talk about any of those things if you have a little bit more time, what else can we do? Or if you'd like to talk about the modifiable risk factors. 

[00:45:42] Dr. Simran Malhotra: Yeah, I mean, I think you hit on all of them. I think in terms of screening mammography, it's kind of like the sooner you can catch something going on, the faster they can treat you.

[00:45:53] Dr. Simran Malhotra: And breast cancer, when caught early, is actually. Could be more of a curable disease now. And so again, it's kind of like, like you said, the more you know, right? So if you know that there's something going on, you can get it taken care of earlier as opposed to living in the dark, and then you keep putting off your screening, and then now all of a sudden you're dealing with a stage three or four, which is definitely much more challenging treat. So I think advocating for yourself and your body, and again, not just mammograms, but also pap smears and colon cancer screening, all of the other screenings that are recommended, they've been shown to reduce mortality. So I definitely think that it's something that we should do, and I.

[00:46:32] Dr. Simran Malhotra: In, in terms of everything else that you mentioned, You know, for breast cancer, in particular, physical activity is so, so strongly linked, along with reducing, uh, limiting alcohol is so strongly linked to reducing risk of breast cancer and also risk of recurrence of breast cancer. So I always see like looking for the easy things that you can implement to reduce your risk, right?

[00:46:55] Dr. Simran Malhotra: Improving your sleep and, like I said, social connections, and some of them we don't have the evidence yet. And so while I'm always like, Yeah, show me the evidence. Where's the science? Some things are also just common sense, and you don't need the science, right? You just do them because they make you feel good, and at the same time, they will help you live a healthier, happier life.

[00:47:14] Dr. Simran Malhotra: And as somebody in palliative care who has seen the sickest of the sick people living with pain and suffering, and debility and inability to get out of bed. Sometimes I just shift the perspective, right, of, I don't have to do this. I don't have to eat this food. I don't have to move my body. I don't have to sleep seven or eight hours, but I get to do these things. Right? So bringing it back to the perspective of gratitude, I think, is so, so important.

[00:47:44] Maya Acosta: Finally, two final questions. So one of 'em, and. Dr. Comander as well, because I always wonder, like as an individual right now, I'm fine. I haven't been diagnosed with cancer, but how can I support a breast cancer survivor, a family member, a loved one who is currently undergoing treatments or maybe now in remission, what's the best way that I can support that individual? And then the other question is if there's anyone that's interested in working with you directly, what is the best way for them to contact you? 

[00:48:15] Dr. Simran Malhotra: Great question. So for the first piece, I would say sometimes just being present. And listening is one of the most powerful things that you can do for a loved one going through cancer or having gone through cancer.

[00:48:27] Dr. Simran Malhotra: And I think as family members and friends, sometimes it can be very intimidating cuz we don't know what to say. We don't know what to do. And so sometimes we just go in our shell and do nothing at all. We, I think, is actually worse than doing nothing. And so sometimes just showing up and saying, Hey, I'm here for you, and just letting the rest unfold because it will, I believe, especially as a palliative care physician, that listening is one of the most powerful things that you can do for somebody. So that's one. I think I find the lifestyle piece very incredible because I think as someone that is, living with cancer, going through cancer treatment, they are often not the ones that are cooking and doing kind of the everyday activities.

[00:49:09] Dr. Simran Malhotra: And so as the tribe, as the family member, as the friend, doing this sort of research and figuring out what kind of foods or smoothies or things that have phytochemicals and cancer-fighting properties, how can you bring more of this into your loved one's life? So just you know, being the person that brings them the green smoothie, you could sign yourself up for something like that without even asking.

[00:49:33] Dr. Simran Malhotra: And so that would be empowering not just for you but also for your loved one to show that you care. Also for family members. Some of my favorite resources specifically for cancer are AICR. I know, I'm sure Amy has mentioned that, but that's the American Institute for Cancer Research. They have amazing material.

[00:49:50] Dr. Simran Malhotra: And then obviously ACLM. They have tons of free handout. Specifically, Amy and I created one for providers for breast cancer risk reduction, and they're free to download. And there's also one for breast cancer survivors as well, PCRM. I know you're familiar with that. Physicians Committee for Responsible Medicine.

[00:50:05] Dr. Simran Malhotra: And then, of course, Dr. Kristi Funk. I love her work. And Dr. Michael Greger. So those are all great resources. If you're looking for me, you can find me @coachsimranmd.com, and I have tons of free resources on my website, and all of these links are there as well. And if you're interested in working more closely with me, there's a booking link on my website.

[00:50:25] Dr. Simran Malhotra: You can find me there. And I would love to chat with you to see how I could, or with any of your audience members to see how I could support them on their journey. And then I'm on Instagram, I'm always doing all the funny trends and everything, so trying to educate.

[00:50:37] Maya Acosta: Alright. I was gonna say we'll definitely put your links to the social media because you are very active. The fun side of you that I enjoy looking at or watching on Instagram. Lots of great stuff. Dr. Simran, this has been so meaningful. I am so glad that we were able to make this happen, that you were able to come on the show again and share your personal story. I feel like a lot of people will appreciate that and hopefully will encourage more and more women to make sure they get the annual screenings and look into their family history.

[00:51:07] Maya Acosta: That's how important. After this call, I'm definitely going to send a message to the women in my family and ask once again if we have a family history for various cancers, but also, of course, breast cancer. And I'm wearing pink in honor of breast cancer Awareness month. And I really just wanna encourage women in general to download these resources.

[00:51:27] Maya Acosta: We'll include them in the show notes and take control of your own health. Let's support one another by doing the preventative stuff that we can do. So again, Dr. Simran, thank you. And just if you have one final message. Otherwise, thank you so much for your time. 

[00:51:44] Dr. Simran Malhotra: Start living with an attitude of gratitude. Oh, I love that.

[00:51:48] Dr. Simran Malhotra: Thanks so much, Maya. I really appreciate it. 

[00:51:49] Maya Acosta: Thank you, Dr. Simran Malhotra, for sharing your personal story and for being so vulnerable. Let's recap my conversation with Dr. Simran. Dr. Simran Malhotra is a board-certified physician specializing in lifestyle medicine and coaching. She's the founder of Coach Simran MD, a coaching practice that helps women at high risk of cancer reduce their risk by improving their quality of life.

[00:52:17] Maya Acosta: When Dr. Simran was only 13 years old, her mother was diagnosed with breast cancer at age 33. Due to her concerns about her family history of cancer. Dr. Simran underwent genetic testing and discovered that she had the genetic mutation, BRCA1 as a palliative care physician, Dr. Simran wanted to reduce her risk of developing breast cancer and ovarian cancer.

[00:52:40] Maya Acosta: She knows all too well what cancer patients and their families endure and wants to do all that she can to prevent breast cancer. We discuss the Angelina Jolie effect, a name after the actress Angelina Jolie when she went public about her medical decision to have a bilateral mastectomy. After discovering that she was a genetic mutation carrier, Angelina allows her mother to breast cancer.

[00:53:05] Maya Acosta: For her, the decision was a preventative one. After consulting various specialists, Dr. Simran underwent a preventative bilateral mastectomy and total hysterectomy. As a result of the Angelina's story, there was a significant spike in genetic testing to screen for BRCA1 and BRCA2 mutations. As a result, more women have odd dip for the prophylactic mastectomies to reduce the risk of cancer significantly, while only five to 10% of breast cancer cases are due to these genetic mutations, the mutations put women at a much higher risk.

[00:53:43] Maya Acosta: Dr. Simran's story touches all of us. She made this decision for herself and for her family. Two weeks before her surgery, she wrote 18 letters to each of her children, each addressing a milestone that her children would experience. She wrote a letter to her breasts and ovaries, thanking them for the gifts they gave her.

[00:54:04] Maya Acosta: She also painted some tribute pieces today she supports other women with similar stories. If you have concerns associated with family history, talk to your doctor about options. There are genetic testing panels that you can buy on the internet. If you have a genetic mutation, your insurance may cover high risk screening, Here are the steps that you need to follow to reduce cancer Risk number one, get genetic testing done if there is a strong family history of cancer. Number two, if you have a mutation, you can work with your doctor to develop a plan to reduce your cancer risk. A preventative plan can include prophylactic surgery, lifestyle changes, and or regular screening.

[00:54:47] Maya Acosta: Number three, don't assume that just because cancer runs in your family, you are doomed to get it. However, you can reduce your risk of cancer by reducing your alcohol intake, maintaining in healthy weight, eating more plant-based foods, and getting regular exercise, cancer is not necessarily a death sentence, even if it runs in your family.

[00:55:10] Maya Acosta: Many treatments available today can help you manage the disease and live a long, healthy life. Don't give up hope. If you're diagnosed with cancer, there are many resources available to help you through this difficult time. If you have a story of surviving breast cancer, please share it with me. You can now leave me a voice message@speakpipe.com/hls.

[00:55:34] Maya Acosta: I'll include that link in the show notes, my friends, I hope that you found this episode to be valuable, and I hope that you can share it with one remarkable woman that you know. Thanks again for being a listener. You've been listening to the Healthy Lifestyle Solutions podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode.

[00:56:00] Maya Acosta: Feel free to leave us an honest review on Apple Podcast that helps us to spread our message. Thanks for listening.