Prebiotics vs. Probiotics: Supplements 101

Prebiotics feed our probiotics. So which is more important?  Should you supplement  with prebiotics?  In this episode Tina and Leah discuss the different types of prebiotics and where to find them. They also talk about ketogenic diets, when a probiotic may interfere with treatment, and the hidden benefits in potatoes, rice and pasta!

Here are the seven categories of prebiotics we talked about in this episode:
Inulin, FOS, GOS, resistant starches, arabinooxalans, pectins, and beta glucans

Links to prior episodes we mention:
Probiotics: The Bugs We Love!

Studies we mention in this episode:
Stem cell transplants in kids work better when they have high gut diversity (2014)
The microbiota can make or break the effectiveness of Checkpoint inhibitors (Highly technical!)
Antibiotics alongside Checkpoint Inhibitors can impair the effectiveness of treatment

Transcript

[00:00:00] Tina: Leah, as you well know, we have talked about probiotics in the past,

[00:00:04] Leah: Yes we have.

[00:00:05] Tina: and today we're going to talk about prebiotics.

[00:00:07] Leah: Nice.

[00:00:08] Tina: I don't think people know prebiotic, the term prebiotic, as well as we're acquainted with the word probiotic.

[00:00:14] Leah: No, and I think some people confuse the two. Like they just see the word prebiotic and they just think it's a probiotic.

[00:00:22] Tina: and if they looked it up, they might even find more biotics, such as

[00:00:26] Leah: Postbiotics

[00:00:28] Tina: postbiotics. And everybody knows antibiotic, right? Antibiotic is a word we all know, and we call antibiotics antibiotics because they are anti to life. So they kill bacteria. That's their job. As opposed to probiotics.

[00:00:44] Leah: and prebiotics, which feed bacteria, but good bacteria.

[00:00:49] Tina: Yes,

[00:00:49] Leah: And that's the difference. I mean, antibiotics can kill good and bad bacteria,

[00:00:54] Tina: yes,

[00:00:55] Leah: but the prebiotics feed the good bacteria.

[00:00:58] Tina: that's right. And they're necessary for our health.

[00:01:01] Leah: So that's what we're talking about today on this episode of The Cancer Pod.

[00:01:06] Tina: I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

[00:01:10] Leah: and I'm Dr Leah Sherman and I’m the cancer insider

[00:01:14] Tina: And we're two naturopathic doctors who practice integrative cancer care 

[00:01:18] Leah: But we're not your doctors

[00:01:20] Tina: This is for education entertainment and informational purposes only

[00:01:24] Leah: do not apply any of this information without first speaking to your doctor

[00:01:29] Tina: The views and opinions expressed on this podcast by the hosts and their guests are solely their own 

[00:01:35] Leah: Welcome to the cancer pod 

[00:01:53] Tina: Hi, Leah.

[00:01:53] Leah: Hi, Tina.

[00:01:54] Tina: So, our topic today is prebiotics, as we've already mentioned.

[00:01:59] Leah: Yes. And I like the subject because as a lot of our listeners know, we tend to really promote food over supplements and prebiotics are found in a lot of different foods. And so when working with patients, it's, you know, we can provide lists of these foods and then they can diversify their diet. It's just kind of a way of.

introducing people to more foods or letting them know that some of the foods they're eating are already good for them,

[00:02:27] Tina: Exactly. I wouldn't say it adds to our recommendations in changing anything we've ever said in our past about how to eat and having a predominantly plant-based diet, it does give everyone another explanation as to why that's so important.

[00:02:42] Leah: right?

[00:02:43] Tina: So, when we say prebiotics, I mean, the easiest thing in people's minds and associate that with something people already know is think fibers.

[00:02:51] Leah: I think what is confusing is the source of fiber. I mean people hear that word fiber and they think like they're fiber supplement. Maybe they think Metamucil or I don't know what other brands they're They're offhand, I don't know but you know, they're thinking about like that fiber pill or gummy that They take for regularity. And so prebiotics would be kind of like the next level.

[00:03:17] Tina: Yeah, so the word fiber simply means that it's a carbohydrate that We as humans cannot break down and digest. So this is why on a label when it says 10 grams of carbohydrate, but 5 grams of that carbohydrate is fiber, then only 5 grams can be absorbed into your bloodstream and change your blood glucose. So, all fibers are complex carbohydrates.

The difference with prebiotics is prebiotics are a type of fiber, so they're a complex carbohydrate of some sort that we do not digest, but goes on in our intestines and in our colon to feed good bacteria, beneficial bacteria. And those beneficial bacteria, the synonym for that is probiotics. So, all of these various probiotics in our gut, and there are thousands of different types of bacteria in our guts that provide benefit.

[00:04:10] Leah: And the difference between supplementing with a probiotic and prebiotic is with a prebiotic you're creating more diversity. Where I think we mentioned in our probiotic episode that if you take specific probiotics for long periods of time, you may crowd out, you know, the healthy gut bugs, so it favors one specific type.

And when it comes to, um, cancer care, especially for people who are undergoing immunotherapy, we don't necessarily want to favor one type over the other, and that's where food comes in. um, and that's why, we love first. 

[00:04:45] Tina: It really is a similar to a seed in a soil hypothesis where we're not talking about germ theory here. We're talking about what goes on in your gut. The seeds are the probiotics and the probiotics need the nutrients. They need the prebiotics to be healthy. And when I say this, I'm not picturing a garden.

I'm picturing something more complex, like an ecosystem, whether that's a mountain meadow or untouched desert land. It doesn't matter. But something that's very complex. Um, that complexity means diversity in life. So in our case, we're talking about bacteria in the gut. In the case of an ecosystem, you're talking about trees and shrubs.

So diversity is what we're after in our gut. It's also the healthiest ecosystems out there, the most diverse ones. 

[00:05:27] Leah: I think people are more familiar with the types of prebiotics, I may not realize that they are prebiotics, like, um, words like beta glucans, inulin is another word that you might see, especially on a probiotic because probiotics are often combined with prebiotics and inulin is a really popular one that is added. Even pectin, like anyone who does any sort of canning. Is familiar with pectin and people might not realize that that is a prebiotic.

[00:05:58] Tina: Yeah, that's a really good point. Yeah, and if people take a supplement of a probiotic, they'll often see something called FOS inside the capsule as well, which stands for fructooligosaccharides. That's a prebiotic. And so that FOS is commonly placed in there to support the probiotic growth in the gut. So, that's pretty common.

That's the part that makes people gassy if they do take a probiotic and have any reaction to it like that. 

[00:06:23] Leah: Right. And so, I usually take people off of, yeah, off of that. I, yeah, anyways, we talked about a lot of that already in our, in our probiotic episode. So, um,

[00:06:34] Tina: We missed one that's become very popular out there if you are looking around.

[00:06:39] Leah: Oh, that's right. The resistant starches 

[00:06:41] Tina: You got it. Yes. Resistant starches, which is a great term because it describes exactly what they are. They are resistant to our digestion. It's a starch like a potato or rice, but it's the part of the starch, the carbohydrate, that we cannot digest. We can't break it down, so it stays in our gut and it is a prebiotic.It feeds the beneficial bacteria downstream, so usually in the colon.

[00:07:04] Leah: And green bananas are also a resistant starch. And so, for those people who prefer a green banana Um, they're good for you. And so if you like those like really bruised bananas, that's great. But try a green banana.

[00:07:17] Tina: It's interesting because we have all those blue zones, right? And we have places in Italy, places in Japan, places around the world that are known for their longevity.

[00:07:26] Leah: Loma Linda, California. 

[00:07:28] Tina: Loma Linda, and these are places with traditionally high carbohydrate intake. And there's always been a question about that. But if you think about that, and they're having leftover rice or leftover pasta or leftover potatoes, there is a good chance that they in those meals are taking in a good amount of resistant starch.

Which means prebiotic, which means good gut bugs, which means good health. 

[00:07:48] Leah: Yeah, and so there was a study showing that when compared to freshly cooked rice, white rice even, um, the rice that was cooked and then cooled and then reheated had more resistant starch to it. And so then it had less effect on blood sugar spiking or, you know, dysregulation.

[00:08:11] Tina: That makes sense. That's the that's the part of carbohydrate intake from vegetables and starches that we need to consider in our diets. I'm a little concerned with people taking a therapeutic diet and then making it a lifestyle out there, whether that's a ketogenic diet, which is very, very, very low in carbohydrate, um, or another therapeutic diet, which is fine for a few months or maybe even a few years, these prebiotics are needed for our gut to be healthy. I'm a little bit curious to know what's going to happen to folks over time who don't feed those good beneficial bacteria in their gut. I think there'll be consequences.

[00:08:52] Leah: Yeah. And we have, I think we've touched on that where, yeah, these restrictive diets, where you're just eliminating an entire food group, group, you know, people demonize carbohydrates or they demonize lectins or, some aspect of a food that is a healthy food. I mean, there are people who yes, they do react if they have certain kinds of foods and in that case, you would avoid them but to cut out an entire food group. yeah, you're, you're depriving yourself. I mean, I don't know how somebody on a ketogenic diet is feeding their gut bugs. 

[00:09:26] Tina: Yeah. And these beneficial bacteria, one of the benefits is that they make metabolites. So all these bacteria are living beings, right? They're living inside of our gut. And like I said, there's thousands and thousands of different types and they all have different metabolites.

So they'll take in the prebiotic and then they metabolize it for their own structure and energy and then they have metabolites just like we do. We have stool. They have metabolites that they then release into the lumen of the gut and then we humans absorb those metabolites. Some of those are beneficial for us or some of these metabolites might be helpful for the lining of your colon.

So butyric acid is a probably the most well studied It's a short chain fatty acid. It's a metabolite from good bacteria and it is needed for a nice healthy colon lining. Not having that over the course of years or decades probably will have consequences for folks. So I think it's really important to emphasize that as naturopathic docs. Ketogenic diets are fine for a while, but they should be done with a lot of guidance if it's going to be a long-term thing.

[00:10:32] Leah: And I'm sure I've used this analogy before, but, I always think of our microbiome as like that scene in Men in Black, how, like, it's revealed that there's that little alien inside of the guy who's kind of like, you know, like controlling him. And that's what I, that's what I think of our microbiome, that they're just controlling us.

[00:10:52] Tina: Mm hmm.

[00:10:54] Leah: They're pulling all the strings. I mean, that's just, that's kind of my simplistic way of, of thinking of it. you know, we're not going to go into it with this episode. I think that doing a future episode where we really talk about the influence of the microbiome on health. I think of so fascinating, but, it really important to consider, especially when going through, well, with, with anything.

I mean, they talk about microbiome and skin health um, cardiovascular health and dental health. I mean, 

[00:11:21] Tina: hmm.Yeah. So, how do you feel about us going down the categories? There's one, two, three, four, five, six, seven categories. And then just mentioning a few foods from them.

[00:11:31] Leah: yeah, let's cut to a break and then we'll come back and we'll go over the categories.

[00:11:42] Tina: All right, Leah. So, we have seven categories. Seven categories for prebiotics. We have inulin, FOS, which is fructooligosaccharides, GOS, the little brother to FOS that nobody hears about, galactooligosaccharides.

[00:11:57] Leah: I think you're starting to see those on, um, probiotic bottles too

[00:12:01] Tina: Ah, okay. Then there's resistant starches, which you and I have talked about a little bit, arabino ox, ah, I need a running start for this one. Arabinooxalans, and then pectins, which you mentioned, and beta glucans, which you've already mentioned. So, let's just go through. Inulin is chicory root, Jerusalem artichoke.

[00:12:21] Leah: Oh, I have a Jerusalem artichoke story. I may have told it already. I went to a farmer's market when I was living in Northern Indiana and they had, Jerusalem artichokes, which is also known as sun chokes. And I'd never had it before. A woman who was behind the table was talking about, Oh, they're so delicious and on and on.

[00:12:43] And then she said, but my husband calls them “farta-chokes.” And yes, that's, that's kind of a warning label that should be on a Jerusalem artichoke. um, the Jerusalem artichoke isn't the one that you like get in the jar that you put on pizzas and salads. It's a different kind. It looks more, it's a root

[00:13:03] Tina: Mm hmm.

[00:13:03] Leah: looking rhizome y. Is it a rhizome? It's a, it's, it's grown underground. 

[00:13:09] Tina: I think it's a tuber. 

Leah: It's potentially a tuber. Yeah, so it doesn't look like the other artichoke, which looks like a flower.

[00:13:17] But yes, so remember that if you've never had them before and you're like, Oh, I'm really curious. I'm going to have a Jerusalem artichoke. It's a “farta-choke.”

[00:13:25] Tina: Yes. Also, in the inulin category are all of the alliums, onions and garlic and leeks, jicama,

[00:13:33] Leah: Dandelion greens.

[00:13:35] Tina: dandelion greens, which are also good for you for your spring cleanse time of year. So those come in nice young dandelion greens taste better too. Alright, so that's inulin,

[00:13:45] Tina: FOS…

[00:13:46] Leah: Oh, wait. Oh, and regular artichokes, 

[00:13:48] Tina: yes, regular artichokes also have inulin. 

[00:13:51] Leah: Yeah, the flower 

[00:13:52] Tina: the artichoke artichoke 

[00:13:53] Leah: The one you put on pizza. I put on pizza.

[00:13:56] Tina: So garlic, onion and leeks also contain FOS, as does again, chicory root. So, a lot of these contain multiple prefibers, the artichokes, asparagus, and the unripe banana that you mentioned.

[00:14:09] Leah: The green banana.

[00:14:10] Tina: And then the GOS, galactooligosaccharides, is in legumes, our beans, uh, cruciferous vegetables, which we have a whole episode on, uh, sweet potatoes, carrots, oats, almonds, and chia seeds. 

[00:14:24] Leah: Mmm. 

[00:14:25] Tina: And then resistant starches, which we've already kind of mentioned, it's potatoes and rice. It can be semolina pasta, especially if it's cooked al dente. So you haven't broken down all those carbohydrates in there. Green bananas again. Lentils. Cashews. Raw oats. And these lists are just partial lists, but they're just kind of the top of the list kind of thing.

[00:14:46] Leah: And I like how, like, things like oats, like, it's not just one type. I mean, oats is, you know, in several categories. Onions and leeks and garlic, those are in different categories. 

[00:14:56] Tina: The next category, arabinooxalans, is the bran part of a lot of grains. So this is where you want to keep the bran on your rice, if you can, uh, if you tolerate that, that kind of thing, or your whole grain bread or Ezekiel bread or whatever you can tolerate, oats and barley, which are grains,

[00:15:15] Leah: grasses? 

[00:15:16] Tina: Yeah, I, that is a question.When does a grass become a grain? 

[00:15:18] Leah: I think when it sprouts seeds? You'd think I'd know. I garden! 

[00:15:31] Tina: And then pectins, like you said, most people know what a pectin is. It's the part of the apple or citrus, that we are familiar with, the inner part. And so it's many fruits, right? And it's berries, it's cherries, it's plums, it's guava, 

[00:15:43] Leah: It's in, um, cherries.

[00:15:45] Tina: Mm hmm. Yeah, lots and lots of fruits. And then the last category is beta glucans.

[00:15:50] Leah: which I think people hear about because there are beta glucan supplements that are promoted as like good for your immune system. 

[00:15:55] Tina: Yeah, beta glucans are particularly good for your immune system because that's the active component in mushrooms and in mushroom supplements. So they'll standardize them to a particular amount of beta glucan content. but they're also found in other grains, oats and barley, some seaweeds. And legumes, and again carrots, so there's, and there's long lists to each one of these.

This is just kind of hitting things that people might be either already eating or readily available folks. So, so yeah, I mean, it's kind of what I like about prebiotics. We started out with what we like about them. I like that it's fairly simple. You don't need to know those seven categories. You don't need to name them.

[It's basically if you eat a large variety of plants, you're going to get them. You're going to get the large variety of prebiotics, which is going to come along for the ride. So on that note, large variety of plants leads to a higher diversity of these beneficial bacteria in the gut.

[00:16:50] Leah: And we have also previously talked about, I feel like I'm the, like in our previous episodes, um, we've talked about, you know, a goal for the week is to include 30 different plant foods. So if you are following that, The reason to do that is to create a more, diverse microbiome, um, that we just mentioned are perfect for doing that. 

[00:17:15] Tina: And diversity is key to health and the diversity of the gut is risk reduction for a lot of different conditions. In cancer care, we know diversity is the key to getting the best you can possibly get from any immune based treatment in oncology. So one of the things that back in 2014, I remember some of the first studies started to come out and they said, Look, these young pediatric patients who are getting a stem cell transplant to cure.

The intent was to cure their leukemia, the children with the highest diversity of bacteria in their gut had measurably and distinctly better outcomes than those who had lower diversity in their gut. And this is pre transplant. So this is not during treatment or after treatment. This is before they even went in.

So preparing yourself for treatment. One of the things to do, one of the reasons doing a broad array of various plants. Is good is just to create that diversity at this point. The way the evidence looks. I don't think that diversity ever is a bad thing. diversity is only going to be helpful or no, meaning it doesn't do anything, but it will never be contraindicated to have a nice diverse gut as you head into treatment.

[00:18:25] Leah: which is one of the reasons that people kind of steered away from recommending probiotics during immunotherapy because it wasn't maintaining a diverse gut, so. 

[00:18:36] Tina: Yeah. Yeah. So this is why prebiotics make a lot of sense. Probiotics, you must be much more selective about and skeptical about because if you take a lot of any one or even a dozen strains. Let's just say you got a supplement, a probiotic that has 12 strains or 20 strains or 36 strains in it, it's still nothing compared to the actual diversity in your GI tract.

So if you encourage one or two strains or a few different strains, Probiotic specific strains that are in your pill if you encourage their growth, you may lower diversity in the gut because now you've got dominant strains and you're simplifying the population. You don't want that. You want to as much.

diversity as possible. So you don't want to just keep pumping in lactobacillus and bifido, you know, that's not going to do you any favors. And they did show that that ran counter in that one study with, uh, PD one inhibitors, the checkpoint inhibitors, which are used for so many different cancers. they show that it's, it's potentially less effective in people who took them.

So I guess if people want to know if this is something that's relevant, the terms to use are, is the treatment you're getting considered a checkpoint inhibitor. So this checkpoint inhibitor is a large class of various monoclonal antibodies that are used now as an immune.

[00:19:55] Leah: Yeah. So, and so that Mab is the ending that, you will see on, on these drugs, the monoclonal antibody ending. So if you know that that is on the the generic name for your drug. Because they give them these fancy names, like, what is it, Ticentric, and Emphysi, and, you know, Urovoid.

They give them these, like, fancy names, and you're like, I don't know where this comes from. But if you see Mab, look for Mab, then get your prebiotics in. 

[00:20:22] Tina: And more importantly, don't take a probiotic. And the only thing that is riskier than taking a probiotic is taking an antibiotic there are definitely clinical trials out there that Show people who go from taking an antibiotic to receiving a checkpoint inhibitor, you're much, much, much less likely to respond because those checkpoint inhibitors need what we call commensal bacteria, they need some of these organisms that are beneficial bacteria in order for them to work.

So, um, I would actually have patients even stall if they had to. If they told me they took an antibiotic a month ago and they had a choice as to when to start their treatment and delaying it a couple weeks didn't matter, then we would actually delay the start of treatment to make sure that they had a better chance at responding to that immune agent.

[00:21:10] Leah: That's what I was going to ask. It's like, because when an antibiotic is prescribed, especially in oncology, there is a reason. and so if somebody is hospitalized in the middle of treatment, For whatever reason and they're given antibiotics and then when they're discharged, you know, they're to stay on track With their their treatment.

I mean, it's kind of hard. So are there things that people can do? If there is no option to delay their next cycle

[00:21:37] Tina: mean, the only thing you could do that I could think of is to eat as many prebiotics in a broad range as possible. I still would not recommend a probiotic at that point. Eat a broad range of plant foods. There's not very often that you can't delay treatment a little bit because these same checkpoint inhibitor agents, they're long lasting.

It's not a drug, a chemo drug that goes in and out of the system. These are monoclonal antibodies, and so they are circulating for a very long time after they're given. And so if someone Can take a little pause, finish their antibiotic, give it a couple weeks and then resume treatment. It's still in their best interest.

It won't be brought up usually because although The microbiome is essential, and the diversity is essential, and these commensal, good, beneficial organisms are essential for these drugs to work. In my experience, that hasn't been given kind of the, the spotlight that it deserves during treatment.

I've had to, I don't know, what's the word, bargain. I've had to bargain those. Weeks of delay just to get people to have a healthy gut before they start back on their checkpoint inhibitor. So it's it hasn't been an easy thing. It's not a it's not usually for me. It hasn't been a discussion that's been a given.

So people have to self advocate in this way.

[00:22:53] Leah: Is there a set amount of time like what would be the minimum amount of time two weeks? 

[00:22:59] Tina: The nice thing is, I would say two weeks is plenty. If you stop an antibiotic, eat really well weeks, various plant foods, as many Diverse prebiotics as you can possibly get in and then resume, the gut is incredibly resilient. And so as soon as the antibiotic is stopped, it begins to try to, you know, become healthy again.

And healthy means diverse bacteria. So I think two weeks is plenty of time. Yeah,

[00:23:23] Leah: And we probably talked about it in the probiotic episode. I don't remember at this point, but If given a probiotic while taking an antibiotic, because of possible, like, you know, diarrhea or constipation, or it causes bowel changes, is that something that, You know, you find, because there, there was a time when where anytime an antibiotic was prescribed, they were told to take a probiotic.

There are different kinds of, um, probiotics, including some that aren't actually probiotics, like Saccharomyces boulardii. Um, Saccharomyces boulardii doesn't, one's own gut microbiome.

It kind of shoves out the bad stuff, but it's not really I'm just thinking because people do have, you know, extreme reactions to taking an antibiotic because it is disrupting your microbiome, your gut flora.

And so. You can eat these prebiotic foods while you're taking the probiotic, but I don't really see things kind of stopping that diarrhea from happening. 

[00:24:27] Tina: The diarrhea from an antibiotic.

[00:24:30] Leah: yeah, 

[00:24:30] Tina: But to your point, I think that's where the Saccharomyces boulardii comes in.

[00:24:34] Leah: is that how you say it? Boulardii?

[00:24:37] Tina: boulardio, boulardiae, boulardiae, boulardium. 

[00:24:43] Leah: doo doo doo I mean, it's just this whole thing, it's such a, it's such a fine, you know, it's, it's, it's not, this is how it is for everybody all the time. I mean, there are times where yes, you're going to need to take something to help to slow down the, you know, diarrhea or to reduce your risk of C diff, you know, which is the overgrowth of a bacteria that is no bueno when you're going through treatment or anytime really, but when you're immune compromised, you're more likely to get it. you know, we're saying these things, but it's, we can't say that it's an absolute because there are times and places if you have to take an antibiotic to get the antibiotic, if you have to take a probiotic for a short period of time, make sure that you're also doing, you know, diverse probiotic foods and prebiotic foods, you know, just constantly think diversity.

[00:25:35] Tina: Exactly. Exactly. And, and on that note, cultured and fermented foods might be a better way to get those in because that also will be Adding to diversity and you're getting a whole food in and you're not getting large amounts. My concern is that people are taking, you know, there's ones out there with 400 billion organisms.

[00:25:53] It's a lot. I mean, it's nothing compared to what's actually inhabiting your gut, but it's enough to shift things in your microbiome. So shift the population around and we don't during treatment is what I'm thinking. That's when you don't want to mess with it unless it's been proven to say, okay, during this.

[00:26:09] Course of treatment with this particular probiotic or probiotic combination, there was better outcomes or there was less side effects or whatever your goal is. I think that anything we do is going to simplify the gut and simplifying the guts inhabitants doesn't seem to me to be a good idea in the grand scheme of things.

[00:26:27] Leah: Yeah, I mean, I think this whole area, it is so fascinating and we're just, every day we're learning more and more, um, about how it does influence health, not only in those receiving the immunotherapy treatments, but just in cancer overall, We may have briefly mentioned that there are supplements, um, that are prebiotic supplements. Again, I think if someone is taking that because they don't like, tolerate, You know, want to increase the foods, um, just make sure that it is one that's diverse, you know, beta glucans, that's a great supplement to take, but you want something that has a little bit more diversity in the supplement itself and make sure there aren't probiotics in there because yeah, you're going to have a party in your gut and it's going to be like eating a farta choke. 

[00:27:16] Tina: Yeah, and the reason I call them “farta chokes” is because if you take enough of any, you know, carbohydrates that we can partially digest even and, uh, you overwhelm your intestines, you will have it float down to your colon and those bacteria have a heyday with it. And their gaseous waste becomes your gaseous waste.

[00:27:38] Tina: this is where we ask people to follow us if they enjoyed this.

[00:27:43] Leah: so if you liked this episode and you want to share it with a friend who might appreciate some of this information, do so. Make sure that you follow us or subscribe whatever your podcast streaming app says so the next time an episode comes out we just pop to the top 

[00:28:01] Tina: Yeah. So whether it's Apple, Spotify, Pocket Casts, Podbean,

[00:28:06] Tina: iHeartRadio.

[00:28:07] LEAH: On that note I'm Dr. Leah sherman

[00:28:09] Tina: And I'm Dr. Tina Kaczor. 

[00:28:11] LEAH: and this is The Cancer Pod

[00:28:12] Tina: Until next time!

[00:28:13] 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.Leah Sherman. And by Dr. Tina Kaczor. Music is by Kevin McLeod. See you next time.