Can Diet Really Lower Colorectal Cancer Risk? With Dr. Fred Tabung

Can what you eat influence your risk of colorectal cancer?

In this episode of Causes or Cures, Dr. Eeks speaks with Dr. Fred Tabung, PhD, MSPH, a researcher studying diet, metabolism, and cancer prevention, about how certain dietary patterns may reduce colorectal cancer risk.

Drawing on data from nearly one million people across the United States and Europe, Dr. Tabung explains how low insulinemic and anti-inflammatory diets are linked to lower colorectal cancer risk, and what this means for real-world prevention.

We explore how insulin and inflammation may influence cancer pathways, how diet connects to obesity and Type 2 diabetes, and how those conditions are linked to cancer. We also discuss why early onset colorectal cancer is increasing in younger adults.

The conversation also covers childhood and early life exposures, the microbiome, and what a population level approach to diet and cancer prevention could realistically look like.

What we cover

•  What low insulinemic and anti-inflammatory diets actually mean 
•  Foods associated with lower colorectal cancer risk 
•  How insulin and inflammation may influence cancer development 
•  The link between diet, obesity, Type 2 diabetes, and cancer 
•  Why early onset colorectal cancer may be increasing 
•  What a population level nutrition strategy for cancer prevention might look like

Dr. Fred Tabung is an Associate Professor of Internal Medicine at The Ohio State University and a researcher at the Ohio State University Comprehensive Cancer Center – James, where he leads the Diet, Metabolism, and Cancer Prevention Outcomes Lab. His work focuses on how dietary patterns influence cancer risk and progression, particularly through pathways related to inflammation and insulin. Using large-scale population studies and clinical research, he aims to identify practical, evidence-based dietary strategies for cancer prevention and improved outcomes across the cancer continuum.  

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Transcript

SPEAKER_01 0:00

Welcome to the Causes or Cures Podcast, your gateway to understanding health and groundbreaking medical research in a fun and easy to understand way. With Dr. Eeks as your host, join us as we sit down with the world's leading doctors and scientists to unravel the mysteries of health. From practical tips on well-being to the latest breakthroughs in medical research, we cover it all. Don't forget to subscribe. Let's ignite our curiosity and together dive into today's episode.

SPEAKER_02 0:31

Hello everybody, and welcome to this episode of Causes or Cures. I'm Dr. Ekes, your host, and thanks so much for joining in. So, colorectal cancer. It's one of the most common cancers worldwide, and lately, a lot of people are asking, why is it showing up earlier, as in people under 50? We hear a lot about healthy eating, but what does that actually mean when it comes to cancer risk? Today I'm talking with Dr. Fred Tabung, who studies how diet, metabolism, and inflammation shape cancer risk. Using data from people across the US and Europe, his work looks at whether specific dietary patterns, patterns, like those that reduce insulin spikes and inflammation might actually lower the risk of colorectal cancer, which again, this is a very timely question. So we get into what those diets look like in real life, how food might influence cancer through biological pathways, and what this could mean for prevention both individually and at the population level. Okay. So give me a few seconds here while we connect to Dr. Tabung. All right, everyone, we are connecting with Dr. Fred Tabung, and he's a researcher doing really cool stuff in the area of cancer and prevention. But first, Dr. Tabung, thank you so much for joining. And I was wondering if you could tell our listeners a little bit about yourself and the type of work that you do.

SPEAKER_00 2:15

Great. Thank you so much. So my name is Fred Tabung, and I am an associate professor in the College of Medicine here at the Ohio State University, and comprehensive, affiliated with the Comprehensive Cancer Center, where my lab focuses on the role of diet in cancer prevention, treatment response, and uh survivorship. And we focus on dietary patterns, like we the patterns of eating, not necessarily on specific foods or specific nutrients. And that approach that captures the context in which nutrients are consumed seem to So we do not only study patterns of eating, we also identify potential biological mechanisms that may underlie the role of diet in cancer. Um, focusing on especially on uh pathways that may involve inflammation and insulin uh uh hyposecretion. So that's what I do here at the uh Ohio State uh University Comprehensive Cancer Center.

SPEAKER_02 3:29

Well, it's certainly timely. I mean, there's a lot of focus, mainstream focus now on you know how diet impacts uh cancer risk. So, and we're gonna focus on colorectal cancer today because that's the paper that I read. Of course, feel free to chime in about other types of cancer. But the paper that I read, and for our listeners, you looked at data from nearly one million individuals in the US and Europe, and you observed a significant colorectal cancer risk reduction with habitual intake of low insulinemic and anti-inflammatory dietary patterns comparable with higher overall dietary quality. But let's just start with those words, low insulinemic and anti-inflammatory dietary patterns. Maybe just tell our listeners what does that mean?

SPEAKER_00 4:22

So we consume foods and uh so first of all, let me step back and say that inflammation is an important thing as part of our physiology, how our bodies work. Insulin is also very important. It is how our bodies uh work normally, physio normal physiology. When we lack insulin, then we become sick. Like this how type 1 diabetes happens, right? Inflammation is part of our immune system. It helps us to heal. Like when it does that, when inflammation has helped us to heal, it should then resolve. It should go away. If inflammation hangs around longer than is necessary, it becomes bad. It becomes chronic inflammation. And uh that's what our bodies don't want. Insulin, like I mentioned, is also important for our normal physiology. It helps us take it helps the cells to take in energy, the energy that we eat from foods. And but if insulin is always hanging around at a very high level, then it also tells the body to do other things, which may not be all very good things, right? It might also be telling uh the cells, oh, there is enough food. There is a lot of food and energy around, you should divide, divide, divide, and divide. And anytime that cells are dividing unnecessarily is always an opportunity for uh for cancer to happen, for something to go wrong, you know, in in cell division. And that is part of the uh the cancer process. So we there are many factors that can lead to insulin always hanging around at very high levels, which is not good, which is what we describe as hyperinsulinemia, right, which is not good, or chronic systemic inflammation, which is not good. One of the such factors is the food that we eat. And I'm talking about habitual eating patterns. Like if you eat breakfast, snacks, lunch, snacks, dinner, snacks in a way that keeps your insulin at very high levels, that is not a good thing. If you eat in such a way that your system is always engaged uh in bringing down levels of inflammation that are caused by the food that we eat, that is not a good thing. So the the pattern of eating, the dietary patterns that we develop are meant to optimize levels of insulin, optimize inflammation levels. So we looked at dietary patterns, which means that we are talking about foods to increase in the dietary patterns and foods to decrease in the dietary patterns so that inflammation is at an or insulin hypersecretion is at an optimal level. The other thing is these processes are going in inside of us, and we are not even aware that the way we eat is causing a lot of havoc because it takes time for these things to happen, for them to become evident in terms of disease, right? Whether it is coming, it is showing up several years uh later as obesity, type 2 diabetes, or cancer. These are some of the intermediate things that happen metabolically. You know, when havoc is wrecked in our bodies because of what we eat or our lifestyles more generally, it might lead to obesity and type 2 diabetes, which are closer to the diet, but they are also closer to cancer. So we tend to study metabolic imbalances that are diet related. And we first of all look at how these metabolic diet-related metabolic imbalances impact obesity and type 2 diabetes as intermediates in the cancer process, in the carcinogenesis process.

SPEAKER_02 8:28

Right, because obesity itself is a risk factor for cancer.

SPEAKER_00 8:33

Right, absolutely. In fact, obesity and type 2 diabetes have been linked to 12 to 15 different cancer types, and they are very similar cancers, meaning that the two are they go hand in glove.

SPEAKER_02 8:48

Wow. And for the average person at home, I mean doesn't necessarily have you know training in nutrition or science, when you talk about, let's say, an anti-inflammatory dietary pattern, can you give an example of what you mean? Yeah.

SPEAKER_00 9:05

Absolutely. So the way we approach, the way let me let me just say the way we approach uh diet research is that we ask the question. So we collect diet using, you know, uh long questionnaires applied in large population-based studies, like hundreds of thousands of people who provide dietary data, and they also donate a blood sample. And so we look at the diet that the these hundreds of thousands of people have uh provided, and we ask the question: what combination of foods and beverages would lead to optimal levels of inflammation? We could ask the question, what combination of foods and beverages would lead to higher levels of inflammation, which is not good, or lead to higher levels of sustained insulin hypersecretion, uh, which is not good. And so we use statistical approaches to get the answer, right? And the answer provides a combination of a limited set of foods that are representative of a low inflammatory dietary pattern or a low insulinic dietary pattern. I say representative because it could be a list of about 18 foods and beverages. And then what we are doing is to translate that into uh into the clinic into a dietary pattern that you know people can use. Now, to answer your question uh a little bit more specifically, that would be a dietary pattern that has more of vegetables and legumes, more whole grains and fiber-rich foods, more coffee and tea as beverages and water, more fish and lean poultry, more vegetable oils, and a dietary pattern that is also less in sugar-sweetened beverages, refined grains such as white bread and white rice, uh, processed meats that is less in red meat overall, and that is less in ultra-processed foods. Now, did I say something that is strange here? The foods that I just listed are very familiar to you, right? Good. That is the big picture. We drill down a little bit further than that. Okay, some of the key facts are that the way we approach this is that no single food is key. What I just described to you is not a list of superfoods, right? It is not a prescription.

SPEAKER_02 11:47

Right.

SPEAKER_00 11:47

The way that these foods are combined and consumed is very important. What you combine with what. Food preparation also determines the metabolic benefits of the meal. For us, it is about metabolism, it's about what the food does to metabolism. In fact, that is how we define a healthy food by what it does to metabolism, not whether it contains calories or the nutrient content of the food. No. We define a healthy food based on what that food does to metabolism. And we have we have come up with very amazing results. Sustainability is critical. Making small changes that are sustainable over time is really critical. And I say small changes because some people may make changes and don't and feel like they need to overhaul the whole the entire system before they can benefit from you know diet changes in terms of metabolism. Of course, it takes time for some of these benefits to become evident in the numbers, like when you go for a physical and you ask for your metabolism to be looked at. So the reason that I said this is the big picture is because when I say vegetables, we are going to classify vegetables into three groups. Vegetables to prioritize, which, if taken in bigger quantities, would do more for your inflammation and insulin hypersecretion. Vegetables in the middle, where we don't have a lot of information and we are still studying. And vegetables on this other side to avoid or to reduce because they won't do much for your in for your inflammation. But if you are eating vegetables overall, that is good. It it is more aligned like with the dietary guidelines for Americans. But we are saying if within the category of vegetables, we can further break it down so that we can have more out of diet for our metabolism. So that is our approach. The same for fruits, the same for dairy. Like we say prioritize cheese and yogurt as fermented dairy kefir, as fermented dairy, whether it is um and unprocessed cheeses, you know, and this is whole dairy. I know that in dietary guidelines for Americans now um I recommend whole dairy, but the process of coming up with that recommendation is totally out of line with the normal process that things uh happen with the dietary guidelines for Americans. But we encourage whole dairy because of what our data shows, right? Okay. Yeah.

SPEAKER_02 14:28

So whole dairy you support.

SPEAKER_00 14:30

Yes. Okay. But the fermented dairy.

SPEAKER_02 14:33

Ferment, yes.

SPEAKER_00 14:34

Yeah. You got kefir um and cheese compared to all others. Yeah. And it is the same for fish. If you eat any fish compared with red meat, that is better. But we are saying if you can prioritize these specific types of fish, it's going to do more for your metabolism than if you were eating all types of fish. So you see how we are going, drilling down a little bit. I that's why I said what I just described is the big picture.

SPEAKER_02 15:05

I got that.

SPEAKER_00 15:06

Then we drill down a little bit further to identify specific foods that can do more metabolism. Yeah.

SPEAKER_02 15:14

Right. But for the listener at home, I think it sounds like small changes, big picture changes can make a big difference in terms of okay.

SPEAKER_00 15:24

Just think of something like changing to eat whole bread rather than whole grain bread rather than uh refined grain. You know, I asked my son the other day if he knows if to tell me what he ate for breakfast. And he told me he ate waffles, he made waffles, and he uh what else? He added uh some type of syrup to it. And and say, okay. I said, did you what was was it refined grain or whole grain? And he said he never ate grains. I said, your waffle is made up of what? Say uh flour. I said flour is grain, right? So making small changes might not seem like a lot, you know, just saying that you are going to swap out, you know, white bread and replace it with whole grain bread. Another key that I think a lot of people don't take into consideration is just looking at the nutrition level. The bread may be brown, may look brown, but it is not whole grain bread. Look at if you could take the two and compare the levels, you'll see that the fiber in the whole grain bread is a lot higher for serving size compared to the fiber in the in the white bread. Right. So another aspect too could even just be like fermented bread, the sourdough types, and you know, yeah, it might not be whole grain, but it is also very healthy simply because it is fermented.

SPEAKER_02 17:03

Right. Uh I I started eating a lot of fermented foods and kefir I drink daily for the prebiotics too. But yeah. Yeah. So did you notice a significant difference? Like, was it a big effect in terms of if you follow these diets, low inflammation, low insulinemic? How big was the effect in terms of reducing risk of colorectal cancer? Well, were you happy with it? Like, were you like, wow, this is significant?

SPEAKER_00 17:32

Or we were blown away by the findings. And I will mention a couple of things. So these low insulinic anti-inflammatory dietary patterns that we developed in US populations, specifically using data from the Harvard cohorts, our approach was one that was not intuitive that we can apply the same dietary indices that we developed in the Harvard cohorts elsewhere. But we have succeeded not to only implement them elsewhere in North American populations. That study was the first study in which we applied it outside of American uh populations.

SPEAKER_02 18:12

Right.

SPEAKER_00 18:12

Using uh data from about half a million people from Europe, including 10 different counties from Europe and Finland. And we have now extended it to Asia using dietary data from um from Asia. So that is an important uh development for us, that we can be able to extend that approach outside of American populations out to the world more globally. It is an approach that we didn't think can be implemented in other populations within North America, but we have gone way further than that to say that uh so those two dietary patterns, we also added the dietary guidelines for Americans computed using the Healthy Eating Index, um, Healthy Eating Index uh 2020 as a comparison. And so we also found that if if somebody adhered to the dietary guidelines for Americans, they would have reduced risk of colorectal cancer. Uh so we found about a 20% uh risk reduction for those who were in the classified in the highest fifth compared to those in the lowest fifth who were consuming a more pro-inflammatory or a more hyper-insulinic uh dietary pattern. The second thing that we found, which was really important, and I already talked about making small changes, is that those who were classified in the second quintile, that is those who made very little changes, could also see a benefit. It was probably not 20% like those in the highest fifth, but there was risk reduction apparent as from the uh from the second quintile compared with the with the first. That's also the benefit of having a larger study sample because there's a lot of statistical noise in the data that kind of blurts out the signal, you know, in large population studies like that. So when you combine, you increase the statistical power to be able to uh to detect changes. The third lessons we learn from it is that there is more than one way to a healthy dietary pattern, right? We you don't it the it is not a prescription. And number number number four is that every culture can eat according to a low insulinic dietary pattern or a low inflammatory dietary pattern. There are foods in every culture that can optimize uh levels of inflammation and and insulin and insulin response. So again, it is not a prescription that was limited only to North American populations. And number five is that we did begin to see a lot of differences when you compare to one-size-fit-all general eating guidelines. When you go into subgroups like the different racial subgroups, like Hispanics, like African Americans, we could see bigger differences for those who were consuming a lower in insulinemic dietary pattern or a lower inflammatory dietary pattern compared to the dietary guidelines for Americans, which was mainly uh associated with risk reduction amongst uh amongst white uh participants, uh, not amongst uh those in other racial subgroups. So those are some of the things that if we were translating those findings into an intervention, we would try to do it based on culture. We will not design one diet and apply it to everybody. We will try to tailor it down, you know, um, by culture, by food availability. That is really the first study that has applied our approach on a multicontinental level and found risk reduction in cancer. Yeah, we have uh there are other lines of inquiry that we are currently working on, but that study has really uh broadened up the dietary pattern approach on a global scale that can now be applied. Uh we created the infrastructure for for that, and that in and of itself is uh is a big development for us who work in this uh uh in this space.

SPEAKER_02 22:36

Absolutely. I know you talked about it a little bit at the beginning of the podcast, but can you just give like a brief overview for folks? Insulin and inflammation influence the development of colorectal cancer. Can you explain, like at a very basic level, like why that is, like the pathways, just very basic.

SPEAKER_00 22:58

Okay. So as I mentioned, insulin is a good thing for the way our bodies function. But when the body is seeing a lot of insulin at very high levels, it is not a good thing. And insulin would be giving other signals to the cells, like division, unnecessarily dividing. And cell division is one of the ways that cancer develops. Cancer is not something that comes into our bodies like a virus, although viruses do cause cancer, but I just want to draw the parallel that, um, or the contrast that is with infectious disease. If you have a virus or a bacteria in you, there are drugs that are designed to target that bacteria or virus and eliminate it. It is not the same as cancer. And that is why cancer is having stressors that takes our normal physiological mechanism, the checks and balances, it takes our normal physiology into overdrive. Remove the checks and balances. So, for example, when insulin is secreted to help reduce glucose after a meal, then you can see the insulin going down as the glucose is going down, right? And when the glucose has gone down to non-ar levels, then the insulin gradually goes down to base base level. And when it is at that lower level, then you know it is not telling cells to do something uh uh different. But when it is always at this high level, that's where the problem is. And then eventually it leads to insulin resistance. Insulin resistance is at the base of a lot of cancers, it's been associated with a lot of cancers. You know, and so the best way to then treat a cancer is to surgically remove it if we can detect it early and in an organ that is amenable to resection, surgical resection, right? Right. When you do that, it can really cure the cancer. Otherwise, chemotherapy steps in and then we are thinking of you know things like inhibitors. You probably have heard of uh therapies like the uh PI3 kinase inhibitors. Now, the PI3 kinase pathway is a pathway that is involved in nutrient metabolism, it's a pathway that is involved with insulin a lot, and so it's a pathway that is also mutated or changed a lot in many cancers. And so when the approach is trying to inhibit that pathway, you know, you are inhibiting a pathway that is what that is supposed to help our normal physiology, and when you do that, then there is toxicity, right? There is a lot of toxicity, and so can we eat in a way that we can help the therapy work better by reducing that toxicity? Is one of the one of the one of the ways that we try to study cancer within the uh the treatment phase. Can we eat in a way that that pathway continues to function normally in our bodies without having to go into overdrive?

SPEAKER_01 26:30

Right.

SPEAKER_00 26:31

Right? So those are some of the ways that we try to approach uh diet research. I think I should have stepped back to really tell you how research in my lab is organized. Research in my lab is organized in three interrelated focal areas. We have population uh science and data integration, which is like studying where we develop these dietary patterns in large population-based studies where people tell us what they normally eat, and then we see whether we develop these dietary patterns that these dietary indices, metrics that measure the ability of the diet to contribute to chronic systemic inflammation or insulin hyposecretion. The second focal area of research in the lab is clinical and mechanistic research, where we are basically asking the question: Does diet impact the tumor microenvironment? Does diet have an impact within the tumor? So when I'm talking of this PI3 kinase pathway, it's really looking at what is happening within the cell. In large population-based studies, we are asking the question in circulation what is happening within the circulation using blood samples?

SPEAKER_02 27:44

Okay.

SPEAKER_00 27:45

And then in clinical studies, when we look, we we the finding would solidify what we find in large population-based studies. Like we are seeing that the low insulin diet is impacting markers within, up and down the PI3 kinase pathway within the tumor, within within the tumor itself, or looking at the tumor microbiome. Does it impact the tumor microbiome in any meaningful way? Now, the third focal area is translational research, where we bring findings from these two focal other focal areas into the clinic. Like I said, it is one thing to use a metric that is composed of 18 foods and beverages in large population-based studies, like we did in that study that we are discussing now, versus bringing it down to the clinic and actually translating those representative 18 foods and beverages into an actual dietary pattern that somebody can relate with, that somebody can eat for a reasonable amount of time. And that's right. We just recently completed the first such intervention study where we translated the low insulinic dietary pattern into the clinic amongst women at high risk for breast cancer. We were very excited about that. We completed that intervention study in December now, analyzing the data.

SPEAKER_02 29:07

Oh. Can you say anything about the results yet? Or not yet?

SPEAKER_00 29:11

Um, the the big picture that came out of that study is that uh we enrolled to the two women who started the study. And so the outcome in the study was just feasibility and compliance.

SPEAKER_02 29:22

Okay, okay.

SPEAKER_00 29:23

We be able to translate this from large epidemiology studies into the clinic, right? And people would actually make those changes and adhere to them for 12 weeks. This was a 12-week pylon intervention.

SPEAKER_02 29:36

Right, right.

SPEAKER_00 29:36

So the two women were in enrolled and they completed all the 12 weeks providing us food records every four weeks. So we analyzed data on 384 food records. They came to group sessions, you know, where they had food demonstrations, and we tailored the meals to their preferences, and we send them grocery uh shipments whereby based on what they said they prefer to eat, and it aligns with the low insulinic dietary pattern, we will send it to them. That's great. And it wasn't a lot, like just about$35 worth of groceries every two weeks, you know, because it was a small study, we are limited by funding and things like that. Yeah, the compliance data was really, really great. Uh, that came out of it. So we are looking now to move into stage two, where we are going to ask the question if women can make changes according to this low insulinic dietary pattern for a longer period of time, maybe six months, can they make a difference in biomarkers that are important for cancer and cardiometabolic disease uh more generally? Yeah.

SPEAKER_02 30:51

Right. That's really interesting. And so let's talk about the early onset colorectal cancer because I'm sure you've it's in the news. I mean, even people who totally aren't interested in medical and science, you know, they're worried about it because they see it in the news and they see maybe their friend got it. Do you think that nutrition is linked to that? And I'm just curious what your thoughts are on it, because you, you know, this is what you do for a living.

SPEAKER_00 31:20

Absolutely. Uh, by the way, our cancer center director, Dr. Kim Rathmill, just unveiled an initiative. Um, she's very, she cares passionately about um uh early onset cancers, uh, especially colorator cancer. But yes, that is a rising trend. It's a trend that has been noticed for the past couple of years, that uh it was first noticed with colorator cancer that people are getting diagnosed with colorectal cancer earlier than used to be the case. In fact, the burden of colorectal cancer is coming down amongst older folks, while among younger folks it is rising. Folks, you know, men and women uh before the age of 50. From our perspective, diet has a huge part to play because our, you know, the metabolic potential of our diet has changed a lot over time. And a lot of our kids are eating diets that are not very healthy, and as such, developing obesity and type 2 diabetes much earlier. And these are not good things for cancer down the road. In my actually accelerate the carcinogenics process uh a lot earlier. That is the way we approach it, that is our hypothesis. We are actually working to see using data from N. Haynes, which is the National Health and Nutrition Examination Survey uh from 1999 all the way to 2021, just to describe, you know, the inflammatory potential or the insulinic potential of diets of Americans over time, how that has changed, and break it down by racial, ethnic subgroup, and break it down by age. We don't have location, we could have broken it down by rural, urban location just to see what the differences are. We may not be able to study cancer incidence using those data, but at least we can describe, you know, how the diet's dietary quality based on its ability to contribute to chronic systemic inflammation or to insulin hyposecretion, how that has changed over time within different age groups, within different racial groups. You know, we might not necessarily relate that to cancer, but we can at least relate that to obesity and type 2 diabetes, right? Which are closer to diet on the one hand and to cancer on the other hand.

SPEAKER_02 33:57

Right.

SPEAKER_00 33:58

So they kind of sit in between diet and cancer. We used to study diet and cancer by jumping these intermediates. I see what you're saying. But then our framework has made us to step back and say, no, the diets that we develop, if they are going to impact the cancers that we are interested in, we must first of all see if they impact obesity and type 2 diabetes. So in preventing cancer, we can prevent obesity and type 2 diabetes.

SPEAKER_02 34:28

Right, right. And that might be the at least in like the mainstream, you know, scientific communication world, like that tidbit you just said is missing. It might be obvious to some, you know, but to others, you're like, it would be like an aha moment, like, oh, I see what he's saying there. Yeah.

SPEAKER_00 34:45

Yeah, but we have overhauled our research framework to try to uh account for you know some of those intermediate things.

SPEAKER_02 34:53

Yeah, no, that's that's fantastic. So I know you have a you have a background in public health, um, in addition to your research in your lab. Let's say you were in charge and of a population-level nutritional intervention for cancer prevention. And since this isn't real life, let's say you had all the funding and resources in the world at your disposal, what would some of the practical steps be that you would implement if you could?

SPEAKER_00 35:19

That's a very interesting question. And what I just described, the work, the study that we published here can be applied at population level, even though we have been focusing a lot on what we call precision nutrition, whereby we try to make some of these changes. Because I described the big picture, the big picture dietary low insulin and hyperinsulinic dietary pattern, right? And I ask you, is there any food or beverage there that is strange? And you said no. So that can be applied at population level, where you are not telling people a lot of nitty-gritty things, a lot of detail in their diet. We can further stratify and say, for African Americans who are at higher risk of these cancers, if we look into their diets, this is how we can further change it from that big picture population level down to this level within their culture. They are not supposed to eat outside of their culture necessary to obtain a healthy diet. And you go to the Hispanic community and you look at what they eat, it and you further break it down, right? And you go to different populations, rural, urban, what is it that they have and not have? Can what they have be made in a way that is healthier? Whether it is taking what they have and combining it in ways that can increase the metabolic potential of the of the food of the meal? You know, so that is how I tend to uh to look at this. But again, at the population level, diet is huge. It is not only what you eat, but also you know how you live, what our lifestyles are. You know, is the community amenable to you taking a walk, walking outside as you as you uh mentioned at the at the beginning of uh uh of our talk. You know, is the neighborhood friendly for such outdoor activity?

SPEAKER_01 37:29

Right.

SPEAKER_00 37:30

Right? So physical activity is is is an important is an important aspect of it. And so, yeah, I would design a study that not only fits the general population, but going down into specific segments uh of the population to say you don't have to go out of your uh but you know, socioeconomic status also is sure important to consider. Sure. You know, there are people who have the knowledge but not the means to be able to eat healthy, and there are uh people who don't just have the means know the knowledge uh to know what what is healthy to eat. So it is a multi-component approach to make uh America healthy or the world uh healthy more generally, yeah.

SPEAKER_02 38:17

Right. So, like a couple of take-home points that I'm hearing is like little changes matter, can matter a lot. And also you don't have to go outside your culture, uh, which your paper found basically. You know, you can find foods that are healthy that can reduce your risk based on your traditional foods and what you like to eat, which I think is important for people to hear. What do you hope a regular person at home listening to this gets from your research?

SPEAKER_00 38:45

That diet plays a huge part in our health, including cancer risk treatment response and survivorship. And that the way we have approached cancer research has focused heavily on the caloric content of the food and specific nutrients, which has led to a booming industry of supplements, which is not very helpful because it isolates a single nutrient, takes it out of the context in which the nutrient is consumed and then put into our system similar to a drug. Nutrition research is a little bit more complex than that. And so for us to realize the potential of diet for major chronic disease prevention, you know, it is very possible to do if we focus not on superfoods, not on supernutrients, but on the dietary pattern. What we consume on a regular basis is what our bodies care about. It is not eating a piece of cake at a birthday once in a while. That is accounted for. Our bodies account for that. It is what you eat on a habitual basis that is more important for our metabolism. But diet is very important.

SPEAKER_02 40:10

Diet is very important. That's but that's great advice too, because it's something that we can hopefully change and modify. And, you know, for the people who have less means than others, hopefully that other people will help them out or come up with ways to do that. Um, you know, that's not easy. It's definitely not easy.

SPEAKER_00 40:27

Um, it is not. Um, I know. And making these changes too, you know, even when you have the means and everything put into place, changing behavior is hard. Oh my gosh. That's why small changes are really, really critical. For you not to think that you cannot make it. You don't, like I said, over you don't need to overhaul your entire diet or lifestyle before you can reap the benefits of uh of a good diet. Now, there's something that physical activity does that may not be easily measurable. Let me just talk uh mention that uh um for your audience. So if you were to eat and quantify the caloric content of the food that you just ate, like go to a restaurant where they measure calories in the meal that you eat and you eat that, you come back, you go to a treadmill, and you walk out. See how many calories you burn, do your best and see how many calories you burn compared to the meal that you just had. It is not a lot.

SPEAKER_02 41:36

So it's not a lot. No, you're right.

SPEAKER_00 41:39

It's not so balancing between the two is good. Don't feel like you can eat whatever you want and go burn it out in on retreat meal. It's not it's not going to happen or happen quickly. Number two, putting that amount of work to do physical activity and you don't see yourself losing weight, you may easily give up. But the good thing is the physical activity is helping in ways that are not measurable, easily measurable. Like your waste may reduce after a couple of months, but just a 0.1 inch reduction in your waste is reducing the fat around the waste is the worst part metabolically. It may not reduce your general body size, but it does reduce the fat around around the waste, which is difficult to measure, but which a small change translate into disease risk or risk reduction, you know, that we may not be very common, just something that for people who may be uh involved in, you know, and then the other thing too is um the research that I described is uh in the if you were to put this in the context of obesity, it is not the treatment space. So for example, uh you may be treated for obesity, and when you get to a certain goal where you have achieved your goal of weight reduction, then you might transition out into something else. What is that something that you want to transition out to? Let's say, for example, GLP1 uh medications now are becoming you know very commonplace, and which it is great. But because of cost and other uh things like you know, side effects, people cannot realistically stay on those medications forever. But they need to be treated down to a certain level, then transition. What do you transition into? Is a question that we are looking to pick up from there and say whether these low insulinic dietary patterns or low inflammatory uh dietary patterns can be. An affordable, uh sustainable uh transition approach, you know, long-term approach after you have achieved that can maintain the benefits of treatment long-term.

SPEAKER_02 44:13

Such an important question. I mean, I know friends who have been on this, and then they they want to stop. Maybe for lots of times for side effects, a high percentage do stop, and then the weight comes on really fast. They all say the same thing. And um sometimes they'll say, you know, and everyone has their own story, but they're like, I look I'm bigger than I was before, or I look bloated in certain areas I didn't look before, and I'm saying it's an issue, it's a big problem.

SPEAKER_00 44:40

It is.

SPEAKER_02 44:41

So yeah.

SPEAKER_00 44:42

So that's one of the things that um we are also beginning to to look into.

SPEAKER_02 44:48

Very interesting, timely for sure. You're doing lots of timely stuff. But thank you so much for your time. This was great, very informative. I really appreciate you coming on.

SPEAKER_00 45:01

I'm glad. I'm glad that I was able to.

SPEAKER_02 45:03

Yeah, I'm always grateful because I'm I always tell people like, I bring on the actual researchers, I promise. So, like, you're not getting it through any filter. Like, this is the real stuff. Um, yeah. I just think it's so important that um your voice, you know, and people who have your knowledge level or are doing this research, you know, can can get it to the public so people can hear it, you know, from the actual experts. I think it's so important, uh, especially today, the digital landscape.

SPEAKER_00 45:31

Yeah, and you'll provide the uh the platform for that to happen, you know. Uh yeah, that's why I do it. Uh have a great day. Bye-bye.

SPEAKER_02 45:39

You too, you too. Bye-bye. Thank you so much for joining in. I hope you guys got something out of that, particularly how to follow a low insulin and low inflammation diet for reducing cancer risk. Something anybody can do, which is the good news. You will find a link to Dr. Tabung's website and research in the show notes in case you want to learn more. And while you're in the show notes, check out some of the other links. And hopefully you'll sign up for my newsletter where I do interviews, WTF health news blurb summaries, and other stuff that uh you won't see on social media. I love writing my newsletter. It's like this little intimate thing I do. All right, and now it's time for the closing quote. This one is from Lynn Rosetto Casper. Remember, too, that at a time when people are very concerned with their health and its relationship to what they eat, we have handed over the responsibility for our nourishment to faceless corporations. Ooh, yeah, that's a good one. That's a good one. Faceless corporations, the big machine. Why did we do that? It wasn't smart. All right. Well, that's it for today. And I hope you have a great rest of the day wherever you are in this really amazing world. Sometimes amazing, sometimes confusing, sometimes terrifying. I digress, and that's it. Goodbye for now.