The BMI Paradox

LEAH: 1:32

I've told my caliper story before I went to a gym and I got like the free evaluation that they they offer at certain, like chain gyms or whatever. And that employee did the calipers on me and at the time, My B m I was less than 20

Tina: 1:49

Mm-hmm.

LEAH: 1:51

and they did the calipers and the guy was like, okay, this shows that you're obese. And I looked at them like, hello?

Tina: 1:58

You were skinny fat.

LEAH: 1:59

I was skinny fat. Yes. But it, it was like, cause they grabbed skin from my waist. I could pinch more than an inch. And did I go on special K? No, I did not.

Tina: 2:10

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

LEAH: 2:14

and I'm Dr Leah Sherman and on the cancer inside

Tina: 2:17

And we're two naturopathic doctors who practice integrative cancer care

LEAH: 2:21

But we're not your doctors

Tina: 2:23

This is for education entertainment and informational purposes only

LEAH: 2:28

do not apply any of this information without first speaking to your doctor

Tina: 2:32

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

LEAH: 2:38

Welcome to the cancer pod Hey Tina.

Tina: 2:57

Hey, Leah.

LEAH: 2:58

Today we're talking about the obesity paradox, the B M I paradox, body composition. What role does that play in cancer?

Tina: 3:08

Medically what we say, when we mean obesity, it may or may not benefit people or lead to more risk. It depends on the condition we're talking about and and how much access adiposity there is. So it's interesting'cause there's the cultural aspect and then there is the medical aspect.

LEAH: 3:25

It's confusing because I have a lot of patients that are referred to me, these are mostly stage one endometrial cancer patients. They're referred to me for a referral to our exercise program that we have through the hospital as part of their survivorship, and so they are told losing weight. Will help to decrease your risk of recurrence. And these patients are also aware that because of their weight that increased their getting endometrial cancer in the first place

Tina: 3:55

Yeah, and can we, we can just address that as in any other risk factor. Once you are diagnosed with cancer and you're going through treatment, should you really be talking about what got you there? I mean, unless you're inquiring about it from a practitioner point of view, we really shouldn't be bringing that up. Like someone walks in with lung cancer, I don't say it's'cause you smoked.

LEAH: 4:10

But people ask people, right? People wanna know, how did I get my cancer? and also, I'm not saying everyone is told that, but they're definitely told once they've had their treatment. This is how you reduce your risk and that's why I see them and I talk to them about, you know, weight and I don't talk about weight loss. I talk about weight management and increasing muscle mass and really encouraging people to do any sort of resistance exercise,

Tina: 4:34

Right, which builds muscle

LEAH: 4:36

right.

Tina: 4:37

So when you build muscle, you're actually gonna put on pounds. You're not gonna take off pounds by building muscle.

LEAH: 4:41

Right. That's why I say like, you know, it's weight management more, but I guess it's more body composition management. But for certain cancers, there is a greater risk. Colon, breast, endometrial. There's one other cancer. Where there's a greater risk in people who have higher body weights or worse body composition. Um, there are certain weight classes. That's how obesity is now referred to as class one, class two, class three. Um, so patients who are overweight and class one obese. Class one obese is a B M I of 30 to like less than 35,

Tina: 5:17

Just so the listener understands, b m I is based on what the scale says in total pounds and your height. That's it. So it's, so it's kilograms per.

LEAH: 5:26

Squared. Yeah. So it's not differentiating between if you are Arnold Schwartzenegger at his, like, you know, most buff worked out physique and what's its name? Blobby guy from Ghostbusters, the blobby Green Ghost. I don't even know if he weighs anything. I was just trying to think of something that was the polar opposite. What's his name? How come I don't know his name. I love Ghostbusters anyways. It's not differentiating between fat and muscle. Um, but patients who are overweight, and I didn't clarify, so overweight is A B M I between 25 and 30.

Tina: 6:03

Mm-hmm.

LEAH: 6:03

Those patients have a lower risk of overall mortality after a cancer diagnosis.

Tina: 6:10

Right.

LEAH: 6:11

So it's this weird paradox where you're told, okay, obesity can increase your risk of cancer, but at the same time, if you're of a certain, weight parameters, I don't know what the word is, if you're in within a certain weight, I'm doing things with my hands.

Tina: 6:27

I don't know. sure what you're doing. Vogue.

LEAH: 6:30

I don't know what I'm trying to

Tina: 6:31

I thought you were doing Madonna's Vogue.

LEAH: 6:33

No, I just, I don't know what I'm trying to say. Um, if you're within a certain weight frame, weight scale, I don't know what the words are.

Tina: 6:39

If you're within a certain weight parameters, I think you said it.

LEAH: 6:43

So if you're within a certain weight parameter, then that may actually have a beneficial effect once a person has a cancer diagnosis.

Tina: 6:50

Mm-hmm.

LEAH: 6:50

So you're damned if you do and you're damned if you don't.

Tina: 6:54

Right. and. Overlay all of this.'cause we're just talking about the medical literature with societal pressures in whatever direction your culture takes you. So there's, there's also just being out in society and are you swimming with the stream? Are you swimming upstream? Are you, I don't know, there's a lot more about weight no matter where you live. Then just the science. I mean, you and I will stick to the facts here and just lay them out, but, um, the psychology of it, there's all the, body image stuff. There's fit at any size, there's

LEAH: 7:28

Your cultural background, you know, the, I guess the stigma that it carries within certain, Within certain

Tina: 7:35

mm-hmm. And what is normal? I mean, what is normal in your culture may or may not be healthy. so well, let's just stick to the facts when it comes to cancer care and overall health and body composition, and apologize in advance for any way that this pushes people's cognitive dissonance where we say something that kinda makes you feel upset.

LEAH: 7:58

Yeah, we're not. Looking to point fingers at anyone. We're just talking about this phenomena that has been seen in studies and you know, retrospective studies and just kind of over the course of when people started looking at it or you know, clinicians started seeing, Hey, these patients are doing better.

Tina: 8:14

It's kind of like, there were studies, just cancer aside, there were studies that showed people who were over the age of 65, they were overweight, not obese. They had greater longevity than people who were underweight. And so I. I say that because sometimes I think that people are never satisfied until they're super skinny sometimes and, and maybe that's not to their advantage in the long run.

LEAH: 8:36

Right. Isn't that something that we even learned, like in geriatrics, because people tend to eat less, take in less nutrition and then they'll, have nutrient deficiencies and that leads to osteoporosis and All kinds of things.

Tina: 8:49

Yes, and I will say, yeah, the fall risk after a certain age in life, it is better to fall with some cushioning on your body than it is to fall without cushioning. You will break a bone more easily if you're thin.

LEAH: 9:00

Oh yeah. So, and then when it comes to somebody who's going through cancer treatment, I think One of the two articles that we're gonna post as a reference, uh, brought up was having greater stores because you are at risk for nutrient deficiencies, weight loss during treatment. Just having that extra storage probably plays a part in, in why the higher B M I is associated with, better outcomes.

Tina: 9:29

That's funny that you say that. I was just watching a comedian who said that she took her cat to the vet and her cat had some kind of condition and the vet said, well, the good thing is your cat is overweight a little bit, because you know, that'll provide some. leeway when it comes to losing weight with this particular condition. And you know, she was overweight herself as she was delivering this. And she's like, my doctor's never said that to me. Like, I was, it was really good. I was like, well, it's okay for animals.

LEAH: 9:55

Except for corgis.

Tina: 9:56

Oh, well look, got that long back.

LEAH: 9:58

Yeah. Um, so I guess we should talk about like, what are fat cells? Let's kind of start at the basic, like what is fat? Like, what does fat do? Yeah. What are fat cells?

Tina: 10:08

so fat or adipose. Is a tissue, right? So we talk about fat tissue, adipose tissue, and the actual cells that make up adipose are called adipocytes, and they are a storage of energy. Their role really is, you know, when we used to have a time of feast and famine, you know, when we were hunters and gatherers, or we just had bad seasons on the farm and you couldn't eat much, you had fat that you could then use for energy in lieu of food. So it's real biological role is a fat storage center now. It has more effects in real time than just merely storing. It's actually an metabolically active tissue.

LEAH: 10:49

It's an endocrine organ

Tina: 10:51

Yes, it's an endocrine organ. And when we say endocrine organ, people think of thyroid or they think of pancreas or like

LEAH: 10:59

ovaries.

Tina: 10:59

ovaries. You think of endocrine organs. An endocrine organ, merely means that it's an, an organ in the body that makes molecules that travel into circulation and have effects on distant tissues. So your fat is not just sitting there. Hanging out, collecting fatty acids and growing or shrinking. They're actually metabolically active. your fat cells at any given time are making molecules that go into circulation into your bloodstream, and they go to your bones and they go to your brain and they go to your heart and they go all over It's communicating with your immune system at all times. So it's an active, metabolically active tissue, and this kind of idea is relatively recent. It's really important to understand because it has a lot to do with what we're gonna talk about as far as risks or benefits of having some fat on the body. And long story short, muscle is similar in that it too now is known as an endocrine tissue. So muscle itself does way more than just move your body parts around. Muscle makes molecules. Within its own cells that then travel outta the muscle into the bloodstream and affect all your other organs. by definition, when an organ makes a molecule, it travels to another tissue. Now it's an endocrine organ. And we call these myokines if it's from the muscle,'cause myo means muscle or adipokines if it's from adipose tissue. So adipokines are derived of of fat tissue and. Those two organs, fat and muscle, make molecules that often oppose each other. So if the fat tissue makes molecules that are inflammatory and it does, it makes a lot of molecules that have a net inflammatory effect muscle, interestingly, makes molecules that oppose those and it actually is anti-inflammatory. So you can see where we're going with this body composition. We always talk about you and I, um, and that is you want more muscle, less fat, If you have that ratio as good as you can get it, then you're gonna be less inflamed systemically. And that really is the goal overall.

LEAH: 13:08

Because some of the risks of having that highly inflammatory, fat and there are different kinds of fat, which we're gonna talk about in a second. But, in it increases your risk of type two diabetes. Hypertension, and as we mentioned certain cancers.

Tina: 13:23

Mm-hmm.

LEAH: 13:24

yeah, I mean this whole, this whole thing, it's kind of like a slippery slope, but I think a really important part to bring up is that there are different kinds of fat. There's subcutaneous fat, which is the fat that you see, right?

Tina: 13:35

Right. If you're old enough, this is the fat that they referred to in the Special K commercials when they would say, can you pinch more than an inch? That's what they were talking about. That's fat.

LEAH: 13:47

yeah. And then now that I'm of a certain age, that's also skin. That's also skin that's not so taught.

Tina: 13:56

Well, that's true.

LEAH: 13:57

So that's the subcutaneous fat. The visceral fat is the one that I think of as the super scary fat.'cause this is the stuff you don't see. This is the stuff that's behind that omentum. The omentum is that tissue that holds all of our organs in.

Tina: 14:12

Mm-hmm.

LEAH: 14:13

The visceral fat is the inflammatory fat. And another point of interest is women tend to have less visceral fat up until menopause, and then they have more visceral fat compared to men.

Tina: 14:27

Yes.

LEAH: 14:28

menopause.

Tina: 14:29

Anyone who has been through menopause knows that you gotta fight the muffin. The muffin meaning

LEAH: 14:36

Oh my God. That's a T-shirt. Yeah, the the muffin top. But that's a T-shirt right there. Fight the muffin.

Tina: 14:43

Fight the,

LEAH: 14:45

Damn. You muffin.

Tina: 14:47

So that, that re that the reason for that, and then it happens also when people go on those anti-estrogen agents and anti hormonal agents or have their ovaries removed. Um, it's basically cortisol. It's a, it's really influenced by high levels of cortisol. So, Things that will add to visceral fat are sleep disruption. Meaning if your sleep disruption is due to high cortisol levels, it could lead to more visceral fat accumulation. And that is again, the stuff that's way deep inside and it is linked to a lot more risk for cardiovascular risk and cancer, and it's more inflammatory. You know, it's known to be highly inflammatory in comparison with subq fat, but postmenopausally, when your body is no longer making progesterone. It will make more cortisol in general, which leads to sleep disruption. the loss of progesterone also leads to sleep disruption because progesterone is broken down into some molecules that are s somewhat sedating, but that's another story. but anyways, this is why perimenopause postmenopausally, you gotta fight the, uh, midsection expansion, we'll call it.

LEAH: 15:49

You gotta fight the muffin.

Tina: 15:51

Mm-hmm.

LEAH: 15:52

And I guess the same would be, or similar would be for men who are on anti-androgen treatments for prostate cancer.

Tina: 15:59

Absolutely. Yep. Same effect. Mm-hmm.

LEAH: 16:02

So it's the visceral fat and. Another kind of interesting thing is visceral fat is actually easier to lose than subcutaneous fat.

Tina: 16:10

Do tell.

LEAH: 16:11

Well, visceral fat can be, reduced through exercise and through making dietary changes. So reducing that high sugary intake, There are gonna be people out there who are like, well, I don't eat high carby sugary foods and I still have the muffin, but you know, maybe it's re-looking at the type of exercise that you're doing. And that's one of the reasons I refer other patients to the exercise program is because maybe the exercises that they've been doing have not been the ones that are addressing, That sort of postmenopausal cortisol, you know, metabolism type thing.

Tina: 16:44

And, and I have noticed that carbohydrate restriction actually works better for losing visceral fat than just calorie restriction. So carb restriction I can tell you just from an observation, from a clinician standpoint, when people cut carbs, they could lose their visceral fat more easily. And this was regardless of age. you know,'cause visceral fat comes on with age, so it is harder to fight it as we get postmenopausal or you get older. It doesn't matter if you're a man or woman, but as we get older it gets harder because that deposition happens in the middle. and if you cut carbohydrates along with exercise and eating properly and you know eating well and resistive training, so I always tell people, restrict the carbs for a while and have patience. We're not measuring this type of weight loss in weeks. Don't expect it to happen in weeks. You have to be very patient. And that goes for anyone trying to lose weight. Past the age of 50. It doesn't happen like when you're 25, you're, you're measuring it in months. Like if you could trend downward, even if it's a pound. You wanna lose 10, give yourself a year. I mean, don't expect to lose that in three months. I think this is really a mind game in some ways of just trending in the right direction pretty consistently. And sometimes you'll level off, you'll be like two, three months, nothing changes. Or you go up, you're like, ah, all this work and I go up. But the trend you have to look at, you have to pan way back and look at it in a year, two years, three years, and be like, oh, look at that. Over the last three years, I've lost 15 pounds. Great. I mean, patience is a, is definitely needed as you try to lose weight when you're older. If you wanna lose it healthily or fat, I should say lose fat.

LEAH: 18:19

So I wanna go back and talk about the muffin or, or the spare tire, depending on, you know,

Tina: 18:24

Okay.

LEAH: 18:25

waist circumference is kind of more what people are leaning to in place of B M I. And I looked up to see how you measure your waist, because from my background in fashion, illustration, blah, blah, blah, the waist is typically, you know, the smallest part of your, your torso. But for measuring in terms of, seeing your, body composition or you know, your, your risk factors, you're looking at. The circumference around your belly button, which is looking at that, I'm like poking my hips right now. It's like at the top of your hips. So where your belly button lies,

Tina: 19:06

That's the circumference they're talking about.

LEAH: 19:08

that's the circumference that you're looking at. Yeah. So you have b m I as a way of measuring, you have waste circumference. Like what? What would be the ideal. Method to measure body composition. If it's not B M I, which we have used for so long.

Tina: 19:25

Yeah, I think some of this, and even the simplicity of the b m, I think that it's because research needs lines in the sand to use to categorize people. As you know, when you look at risk or you look at longevity or whatever you're researching, you need to put, lines, you need measurements, so, For individuals, for us, I think looking at composition of the actual body is our best bet as individuals to assess our risk and have goals for changing it. So I know a lot of gyms are doing this now, like the bio impedance analysis, which is using just a small. electrical current that goes to the body and basically looking at the impedance of various tissues, muscle, um, and then deducing how much fat from that with their calculations.

LEAH: 20:13

Oh yeah. They put, like, they put little tabs on certain parts of your body as you're laying down. Yeah. We used to do that at, at both the cancer centers that. I've worked at.

Tina: 20:23

Yeah. The reason that's not used in research is it's a cumbersome, right? You have to put these tabs on people, you have calculations to do. There's a, there's a visit that's involved. And so getting on a scale, people can self-report and taking a measuring tape to their stomach, they can self-report. And so I think there's a little bit of a hurdle in using the technology, although the technology is probably our best bet because the reason that. Research is so mixed. on weight and b m I is, those don't take into account composition. And so if you do have adequate muscle under your fat, you are gonna have a different risk than somebody who has very little muscle but weighs exactly the same because they're, they have more adipose tissue on their body, so, so I think anything that can analyze the muscle and fat ratio is our best bet. as individuals who want to assess our own risk going forward and do something about it.

LEAH: 21:13

And there are these machines.'cause I know at um, C T C A, they had these machines that patients would stand on barefoot. And then, I don't remember if you hold the bars or not, but that was another way of looking at the, the bio impedance. cause they're all, and I you've mentioned in a previous episode about you could buy scales as well that do that.

Tina: 21:35

Yeah, yeah. There's a home scale that's under a hundred dollars by Omron, O M R. O N and we had it in our office and it.

LEAH: 21:43

Not our sponsored we're, we're not sponsored by them. We're.

Tina: 21:47

No, they are not our sponsor and I do not work for them. Um, but it's great because the more points the better. So there's scales out there where you just put your feet on them and it, and it estimates your bio impedance. But these are scales where you put your hands on the handles and you hold it straight out. Um, it gives all sorts of instructions, but you have bare feet, bare hands. You put your hands straight out in it. Reads the bio impedance between your hands and your feet and does a calculation. it's guesstimating your bone mass and it's gonna get that wrong if you have osteoporosis.'cause it's not, it's under a hundred dollars. So it's not that intelligent of a scale. used to use that. Now my understanding is this is how Aura. Apple watches and even I think Garmin might've come out with a, a bio impedance that they're using. Obviously if you only have one point, you can only get so much information. So I'm not sure how they're doing this. Yeah,

LEAH: 22:35

If you have osteopenia or osteoporosis, it's not gonna be accurate anyways.

Tina: 22:39

no.'cause one thing to know about bio impedance analysis, no matter how it's done, is it's, it's. Really looking at how much water there is in your tissue and it's, it's using the impedance of water. It's assuming a number for your muscle mass, and then from there calculating the rest. And so it's allowing a certain amount for your bone and it's a, it's assuming that you're hydrated and so there's a lot of,

LEAH: 23:01

Assumptions.

Tina: 23:02

assumptions built in.

LEAH: 23:04

And you know what they say about assuming,

Tina: 23:06

when you assume you make an ass out of you and me.

LEAH: 23:08

don't assume,

Tina: 23:10

Yeah, so I mean, I should look up how these devices are doing it. Um, but I think there's gonna be a lot of, um, a large margin of error in the, the wearables

LEAH: 23:21

well, we see the large margin of error in wearables in terms of how many steps you've taken, and I've looked at mine before and my heart rate's like one 16, and I'm like, You know, I check my pulse. I'm like, yeah, no it's not. So there, I wouldn't rely on those completely. Um, there is also a DEXA body composition scan that I noticed, kind of popping up in gyms, sports medicine type environments. And so some of us going who have been through treatment are familiar with the DEXA for looking at our bone density. But it can actually look at more than just. Bone.

Tina: 23:58

Yeah. Yeah, I've had a few patients do that. We had a mobile unit in Portland. I don't know if it's still there. I, last time I used it was pre Covid. You never know post covid. But, um, but it was great. It came out. It, it was, it was a really useful tool to see people's body mass and their bones and work on it from there. Because one of the things that we talked about in our bone episode, bone health episode was if you wanna build bone, build muscle. And so what I liked about this, Being able to see composition, so you see the bone mass and the muscle mass and the fat mass altogether in one. Then it really gives you a good measure of what you can do to build bone. You're like, oh, my, my muscle mass is 24% or whatever it is, and you, you've got room to increase it. You can see that go up in. I mentioned muscles are an endocrine organ. One of the molecules that muscle makes actually tells your bone, travels from your muscle to the bone and says, lay down more bone.'cause we're, we got more muscle coming. So some of these messengers literally tell the bone a message from your muscle we're building up so you gotta build up too. You can't have large muscle on small bone. So, and the body knows that. So.

LEAH: 25:08

I think one of the most powerful images that I saw, at least when I was, I was in school, I remember them showing it was of an M R I.'cause M r i is another way to assess the body composition. Really expensive way to assess body composition. Not something that somebody just like makes an appointment and you know, gets an M R I. But there is an. Image that really sticks out in my mind. And it was the cross section of, I guess it was like the thigh of two different elderly men. They were probably, uh, same or similar age, one more athletic than the other. And you could see in the cross section the amount of muscle versus fat. Both of them, and it's really striking. It's, it's super impactful when you realize that as we age and you know, we all know you start to lose your muscle starting at 30 and it just kind of ramps up from there. Yeah. I, I don't know if you're familiar with that particular image that I'm, I'm speaking of, but I don't know. It's, you know, at that point you're just kind of like, You can imagine just the frailty of the person who has next to no visible muscle on that cross section.

Tina: 26:30

Right.

LEAH: 26:30

know, the other guy's probably like, I dunno, mountain biker, you know, hiking marathons at like 78 or whatever, you know.

Tina: 26:39

That reminds me that, you know, just the aging process alone, if we exercise as we age, if you could just maintain your muscle mass. So if your muscle mass at 75 is the same muscle mass you had at 65, and it's the same that you had at 55, that is a huge. Success'cause left to its own devices.

LEAH: 26:59

Yeah, that's a gain. That's a win.

Tina: 27:01

huge win. Huge win as far as reducing your risk for pretty much everything and having better quality of life and better balance and you know, not falling, which is huge as you get from 75 to 80, 85. As we age, the better our balance and the stronger our muscles, basically, the less likely anyone is to end up having a major injury.

LEAH: 27:20

I mean constantly, like my new thing to tell patients is, You're exercising'cause you're in training just to do the things that you need to do day to day. You know, it's not necessarily for weight loss, it's for gardening, it's for golfing, it's for going to the grocery store, you know, and not having to lean on that cart, you know.

Tina: 27:44

And this is why I would say after a certain age, Certainly I did this as a clinician. I believe it wholeheartedly after a certain age, your muscle mass is more important than the weight on the scale.

LEAH: 27:55

Yes, absolutely.

Tina: 27:57

I mean, I don't know what that age is, but I would say 65 to 70 is like after that age. Just like if you can maintain muscle mass, if you can be strong. Your fat is less of an issue anyways. And again, it goes back to that how much systemic inflammation do you have? If you have plenty of muscle, you have less of it no matter what. Fat is overlying the muscle. So yeah, it's, and it's really hard to lose weight after a certain age. I think fat just doesn't burn as easily when you're older, as it does when you're younger. And it has to do with all sorts of hormonal changes, growth hormone changes, Insulin changes everything. There's a, there's so much that goes into this, but burning fat, as we say, you know, like really chewing up fat is so much easier when you're young. Postmenopausally gets harder and as you get older it gets harder and harder. And that's why I also say pan way back and measure things in months and years, not in weeks. Like you could, you know, when you were younger,

LEAH: 28:47

Okay, let's take a break. I'm gonna run to the bathroom and. When we come back, um, we're gonna talk kind of how all of this kind of plays a role in cancer.

Tina: 28:58

All right. Sounds good.

LEAH: 29:07

Okay, I am back from the bathroom.

Tina: 29:11

That's all the detail we need just for the record.

LEAH: 29:14

Oh, that's all you're getting. Uh, you know what, I'm drinking a lot of green tea, you know, refer back to green tea episode. But yeah, I've been just kind of on a green tea kick, so, okay. So what's our take home message in terms of obesity slash b m i paradox and Cancer?

Tina: 29:34

I think we can say as a tourism. There are certain cancers where the ratio of fat to muscle, if it's too much fat relative to how much muscle you have, there is a higher risk of certain cancers, often called obesity in the literature. But I'm, as a naturopath, I firmly believe that if there's enough muscle under the fat, it would lower people's risk, even though I do not have outcome data to prove that all rational. Thought brings us to that.

LEAH: 30:04

Also, you know, there is the phenomenon of what we've referred to as skinny fat, where somebody can look thin, but they have such low muscle mass that you know, their ratio would be in favor of the adipose tissue. I.

Tina: 30:20

Yeah, so, so it is, it's all about the ratio between the two tissues. And like I said, if you can't lose. The fat then build the muscle, and the net physiologic effect is very similar to just losing the adipose. So we're a little bit, I think, I think our research skews us into the direction of just looking at fat and obesity, because that's easier to measure. A total number on a scale is much easier to track. But if we had the means, and I think we're getting there to track body composition, we'll see more precision in that data.

LEAH: 30:52

And by reducing certain foods like ultra processed carbohydrate, you know, high sugary foods as well as exercising, you're reducing that inflammatory fat, the visceral fat. So there may still be subcutaneous fat, but you're getting rid of the super bad evil adipose.

Tina: 31:14

Evil Abdi Post. I like that.

LEAH: 31:17

That's gonna be a T-shirt too. Evil adipose. Now that's the name of my band. That's my band name. So, and, and so this is something that I, I wanna emphasize because I don't know how to relay this to patients.'cause I talk about this pretty much every appointment. To maintain that muscle mass, do some sort of exercise. People are like, I'm busy through the day. I'm busy at my job. I'm, you know, busy around the house, so I'm active, but I want people to actually use resistance bands, use weights, maintain that muscle mass because going through treatment, These types of exercises, weightbearing and resistance training helps to reduce treatment side effects. we talked about this with Sarah Court, the physical therapist that we interviewed a while back. It improves quality of life as you're going through treatment. I hear so often. When I'm done with treatment, when, when treatment's done, you know, I'll, I'll get to it. I'll get to exercise. No, now is the time to do that.

Tina: 32:24

Yeah, and it's hard'cause there's a lot of fatigue during treatment that can, can be part of the treatment, naturally, your body wanting to take a break. So yeah, you gotta dig deep. During treatment to do that.

LEAH: 32:35

Oh, and I know, I know that feeling and Sarah talked about that feeling and she forced herself to go and do the weights, you know, work out the way that she would recommend to, to her clients. Um, I am completely familiar. I. With that fatigue and I did nothing. I laid on the couch'cause I was busy at work, I was running around, I was getting my steps in, you know, and then, yeah, one day seated on the sidewalk could not get up without the assistance of an elderly woman who kindly offered her hand. So you deconditioned so quickly. Because you're resting and you know, rest is important. But more and more we're learning that using muscle building muscle is, it's gonna be found to be far more, if not already, It's far more important.

Tina: 33:24

it's important to know that muscle mass begets muscle mass. In other words, if you continue to use it, you do tend to build it. So, just putting it in place, putting that habit in place is the most important part. And I'm guilty of, you know, since doing a textbook a few years ago, I would say I have slowed down in my own exercise. the content of this podcast definitely has me. Rethinking about how I need to get back on my bike more often. so yeah, so that's my promise from here on in. So check back later.

LEAH: 33:54

Well, good congratulations, but, and I've been caring, um, I have different, Resistance bands, um, and I've been carrying one in my purse. And so when I'm at work in between charting, I am using the bands, because yeah, I am completely one to come home from work, take care of the dog, and then just veg because I'm just so spent from my day. but yeah, it's, you know, we, we fall into our, our habits and sometimes those are bad habits. We need to start falling into our good habits.

Tina: 34:26

That's a good way to put it. Yep.

LEAH: 34:27

Anything else we need to add?

Tina: 34:29

So I don't know if we, I think we emphasize everything, but in a nutshell, yes, having adequate muscle mass and maybe even having a slightly higher B M I after treatment does appear to be, Associated with better outcomes. and maybe being healthy is most important, regardless of what we call it or how it's labeled in your culture, wherever you are in the world. just knowing that you have the strength to do everything you wanna do in a day, and that your muscle mass is adequate relative to your adipose tissue deposition. Deposition, big word, relative to your fat mass. And with that, Leah, is there anything new that you wanted to add to this, to the end of this episode

LEAH: 35:12

Well, not pertaining to the episode, I think we kind of covered everything, but I do wanna encourage people to go to our new website. Um, we are no longer on the Squarespace. We are using.

Tina: 35:23

POD page?

LEAH: 35:24

Pod page. Yeah. So it's supposed to be more more easily integrating with other, um, apps or programs that we use.

Tina: 35:32

one thing you can do on there is ask a question, like auditory question. You can click on a button, ask your question, and we can bring you on the podcast, your voice and all if we think it's appropriate.

LEAH: 35:44

Um, I also wanted to shout out to one of our listeners. Paula, she sent us a letter that was really interesting and it kind of drove me down the rabbit hole of investigating the differences between what is a dietician and a nutritionist. And she brought up some really good points. So we're gonna do some sort of either a. Write, we'll write something for the blog or we'll just do like a, a special episode, kind of delving more into what is the difference between a nutritionist and a dietician. But yeah, I just wanted to say thanks for, for bringing those points to our attention.

Tina: 36:23

Yeah, and if anyone else wants to write to us, feel free. We're always at the cancer pod@gmaildot.com or just use our new website.

LEAH: 36:31

Yeah, that's right. We, we like all of the, the feedback that we do get and, um, I also want to say hi to our listeners out there. They don't necessarily have names or faces, but, you know, checking on the back end of things, I see that the most listeners we have are in Portland, Oregon.

Tina: 36:51

It's not surprising. We know a lot of people there.

LEAH: 36:54

hometown, you know, well not, you know, whatever. Um, Seattle comes in second and then some other places that we have listeners, Madison, Mississippi.

Tina: 37:03

That's interesting. so if you're a listener and you're in Madison, Mississippi, email us. Say, Hey,

LEAH: 37:08

that's me. But we also have listeners in Dublin, in Ireland, Saskatoon, that's Can Canadian,

Tina: 37:19

yeah.

LEAH: 37:20

And Grand Haven, Michigan.

Tina: 37:22

Yeah. And you know, overall, 90% of our listeners, or almost 90% are in the United States, but um, 10% are the rest of the world, so we do. Appreciate all of our listeners out there, and if this is helpful, send it to a friend or a loved

LEAH: 37:38

Oh, and to that listener, we have a listener in Turks and Caicos, and so if you want us to make a personal appearance, Just let us know.

Tina: 37:49

Yeah.

LEAH: 37:50

We'll do just say hi, you know, come on out and, you know, we'll do a live show from Turks and Caicos. so on that note, I'm Dr. Leia Sherman,

Tina: 38:04

And I'm Dr. Tina Kaser.

LEAH: 38:06

this is the Cancer Pod.

Tina: 38:07

Until next time.

LEAH: 38:08

Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The cancer pod is hosted by me, Dr. Lea Sherman. And by Dr. Tina Caer music is by Kevin McLeod. See you next time.