S6 Ep15: Beyond Cancer— Improving Quality of Life Through Personalized Lifestyle with Stephen Freedland M.D.
“It’s very easy to sit and read a recipe but the key is not going on a diet— you really need to adjust your way of life.” — Stephen Freedland M.D.
Eating healthy is not just about looking good, it is also about feeling good. Food has been used as medicine for centuries, and with the right knowledge and eating habits, we can use food to heal ourselves.
This week, Dr. Stephen Freedland delivers compelling reasons we must rethink our eating habits and lifestyle. Dr. Freedland is a leader in the field of urology, with expertise in the diagnosis and treatment of benign prostatic hyperplasia (BPH) and prostate cancer. He has contributed significantly to cancer prevention and awareness through a patient-centered approach that focuses on understanding the whole person rather than just the disease.
Join in as Dr. Freedland outlines a decade's worth of research on how carbohydrate affects tumor growth, the challenges of conducting a clinical trial, how a personalized lifestyle can make a greater impact, how we can gain more control over our health journey, and what can help us make better choices not only for our health but for our future.
Connect with Stephen:
Stephen Freedland, MD, is the director of the Center for Integrated Research in Cancer and Lifestyle, co-director of the Cancer Genetics and Prevention Program, and associate director for Faculty Development at the Samuel Oschin Comprehensive Cancer Institute. He is a faculty physician in the Division of Urology at the Cedars-Sinai Department of Surgery. Freedland's clinical expertise focuses on urological diseases, particularly benign prostatic hyperplasia, and prostate cancer. His approach toward cancer prevention and awareness focuses on treating the whole patient, not just the disease, by combining traditional Western medicine with complementary holistic interventions. His research interests include urological diseases and the role of diet, lifestyle, and obesity in prostate cancer development and progression, as well as prostate cancer among racial groups and risk stratification for men with prostate cancer.
Freedland has published over 400 studies, and his research has appeared in the Journal of the American Medical Association, Journal of the National Cancer Institute, Journal of Clinical Oncology, Journal of Urology, Cancer Prevention Research, Cancer and BJUI, among others. Freedland is an active reviewer for more than 50 journals. He sits on the editorial board for Cancer Prevention Research, European Urology, International Journal of Urology, Nature Reviews Urology and BJUI, and serves as editor-in-chief for Prostate Cancer and Prostatic Diseases and as a consulting editor for European Urology. Freedland earned his MD from the University of California, Davis. He completed a residency in urology at UCLA and a fellowship in urological oncology at Johns Hopkins. Before joining Cedars-Sinai, he was at Duke University, where he specialized in surgical oncology and urologic oncology, and served as an associate professor in the Division of Urology.
Connect with Cedar-Sinai Medical Center:
Episode Highlights:
01:00 The Link Between Food and Cancer
06:49 Carbohydrate and Tumor Growth
12:15 Measurable Outcomes
16:25 Personalizing Lifestyle
22:06 Be an Active Participant in Your Health Journey
30:33 Make Better Choices
Tweets:
Eating right is not just about our diet; it's also about staying healthy and preventing diseases. Learn how our eating habits and lifestyle affect our health and how we can make better, healthier choices with @jreichman and @SFreedlandMD, a faculty physician at @cedarssinai. #podcast #entrepreneurship #socialgood #inspiration #impactmatters #NextGenChef #EssentialIngredients #cancer #tumormarkers #insulin #food #Keto #lowcarbdiet #clinicaltrials #lifestyle
Inspirational Quotes:
06:51 “With clinical trials, you can only ask so many questions. There's only so many that can actually be tested in a reasonable way." —Stephen Freedland M.D.
10:55 "In our studies, we don't tell people to lose weight. We don't tell them to eat less. We just tell them don't eat sugar; don't eat carbohydrates. And on average, for doing this for six months, people lose over 20 pounds.” —Stephen Freedland M.D.
12:41 “My goal was to figure out something that could work in the real world. And to do that it has to be scalable and it has to be something someone can do on their own.” —Stephen Freedland M.D.
20:47 “The right diet for prostate cancer might be different if you're newly diagnosed.” —Stephen Freedland M.D.
22:42 “The choices you make three times a day when you sit down to eat your meal, you can either choose to take things that are going to fight your cancers or going to promote the cancer to grow.” —Stephen Freedland M.D.
27:30 “Even when you have a great idea, you got a great intervention, a great team, these are not easy to do.” —Stephen Freedland M.D.
29:04 “It's very easy to sit and read a recipe but the key is not going on a diet— you really need to adjust your way of life." —Stephen Freedland M.D.
30:33 “It would be great if we all eat perfectly every time; that's just not reality. We all have our indiscretions and when you are making a bad choice, be aware of it. It's always about being better." —Stephen Freedland M.D.
Transcriptions:
Justine Reichman Good afternoon, and welcome to Essential Ingredients. I'm Justine Reichman your host, with me today is Steve Freedland, Urologist, and he is with Cedar Sinai. Welcome, Steve.
Stephen Freedland Thanks for having me. It's good to be here.
Justine Reichman It's great to have you, Steve. I'm so glad that we got to coordinate this. I'm excited about what you're doing and introducing you to our community.
Stephen Freedland Oh, thanks for the opportunity. Yeah.
Justine Reichman So let's just talk about what you're doing. First, if you could just introduce yourself a little bit, and talk about what you're doing. But before we get going, just I know that you're also not just at Cedar Sinai, do you have some other stuff that you're working on. So I'd love for the community and just get to know a little bit about who you are what you're doing?
Stephen Freedland Yeah. Absolutely. So I'm a Urologist. So I specialize in Urological diseases and particularly prostate cancer as my area and also some benign urology, enlarged prostates. Professor at Cedars Sinai, I also have a joint appointment at the VA hospital in Durham, North Carolina. I was on faculty at Duke for many years. So, leftover from there, we have a huge research team, they're doing some great work, and got very interested in the role of diet and lifestyle and not something you hear a lot of physician was talking about. And so decided that look, I think we can actually impact who gets cancer and how bad the cancer is, and how people live with cancer by modifying people's lifestyle. And, you know, was very interested in building a team to try and do this. You know, no person is an island, we got to work as a team. And so that was really the motivation for me eight years ago to move to Cedar Sinai. And I'm the founding director of the Center for Integrated Research on Cancer and Lifestyle, we call Circle. And the idea is that we would take epidemiological observations. We've studied people, and basically say, what do you eat, how much exercise you do, and figure out who gets cancer, who doesn't. And from there, we can get some clues of luck. If you eat this way, or do this, your risk of cancer may be better or worse. And we can generate some hypothesis, some ideas. And then we can take those actually test them in mice, and see if we give them this particular food substance, do they get fewer cancers, they are less aggressive, understand the mechanisms through which these interventions work. And then ultimately bring the ones that look the most interesting back to patients in terms of clinical trials. You know, it's not ready to implement, but we got to do the science. Actually do the clinical trial and tell patients, you eat this, you eat this, let's see what happens. And ultimately, from there, you learn and you go back to the epi and it's a circle. And that was the concept that it's a full circle. That's why we came up with the name Circle. And we've actually been able to do this in some ways. You know, we've run clinical trials, we've done mouse work, we've done epidemiological work, and still a lot more work to go but so far, it's it's it's been fun has been interesting, and a lot of hard work, and certainly have a lot more work ahead of us.
Justine Reichman Wow. Well, that's super interesting. And I love the way you've connected food, because so many doctors aren't talking about the impact of food on whether it's cancer or any health issues. And for us, it's really go into the root of things for us. And so I'm excited to explore this with you and talk about, you know, what it was, you know, that really got you into this originally.
Stephen Freedland Yeah. So I would say there were two influences. One that drew me into lifestyle and diet and one that pushed me away but I found my way back in. So my dad was actually a big nutrition researcher back in the day. And you know, he's unfortunately passed away now. It's been a while coming up on 10 years now. But he grew up in an era where it was just understanding basic biochemistry and what turns on enzymes and metabolism and things. And you actually spent a year working with Hans Krebs earlier in his career. I mean, it was very successful scientist. And so I kind of grew up with nutrition. My older sister's a dietician and everything, and I said, "Look, you know, nutrition is kind of interesting, but I want nothing to do with nutrition. I'm gonna go study cancer." Because cancer is all about genes, right? There's no lifestyle and diet and cancer. It's all about the genes. So that's what I embarked upon early in my life was to go study cancer and went to medical school and residency, you know, and then in residency, we were looking at some data trying to, as prostate cancer patients, looking at who cancer would come back after surgery. What were the risk factors. And you know, our initial studies were the higher the stage, the higher the grade, the more tumor you had all predicted whose cancer would come back? Nothing earth shattering, but we played with it and you know, some ways, a little bit interesting ways to look at it. And then someone in the group, actually just why don't we look at obesity? And everyone's like, "Yeah. Obesity is not going to be linked with, you know, cancer outcomes. That doesn't make any sense but sure, the data were there so let's look at, you know" So there'll be a quick little paper, and then we'll get back to what we're doing. And sure enough, we actually found that obese patients are actually much more likely to have the cancer come back. And that was kind of the first time that I really stopped and said, Hmm, that's interesting. You know, why? What is it about being obese? Are there technical issues which is harder to operate on obese people? Are we missing the cancers? It's hard to pick up the cancers? Is it something about being obese? Is it something of a diet? Is it an exercise? and it really is prompted, I mean, that paper came out, you know, we're on 20 years ago that that paper came out. So it's really been a 20 year journey for me to really understand from that initial observations that obese people are doing worse, and data were replicated by many others, and we subsequently shown their higher risk of dying of prostate cancer and long term outcomes to really try to understand what is it that's going on, and one of those paths has really been towards diet and exercise. And so that's how we got to where we are on interest started, you know, 20 years ago.
Justine Reichman Wow. So now you're coming up to where you are, and you're doing these trials. I heard you mentioned, and we've discussed a little bit about, and so talk to you a little bit about the trials and what you've putting together and what you're hoping to achieve?
“With clinical trials, you can only ask so many questions. There's only so many that can actually be tested in a reasonable way." —Stephen Freedland M.D.
Stephen Freedland Yeah. And so, you know, with clinical trials, you know, you can only ask so many questions, right? I mean, so figuring out the ideal way of life, the ideal diet, everybody has different opinions, should you know, do you go vegan? Do go keto? Do you do whole foods? Do you do this or that? There's only so many that can actually be tested in a reasonable way. And so some of our early work, after our findings with obesity, led me, and again, pulling on work of many, many others who've shown this as well, is just the the negative impacts of insulin. And in a very simplistic way, insulin is a hormone your body makes when you eat sugar, because sugar is something you ate when there was plentiful calories around, and we're going to store those excess calories to get us help us get through the winter, so to speak. And that's what insulin does. It drives growth of things in response to sugar intake. And so in a very simplistic sense, I said, What happens if you don't eat sugar? You know, you're not gonna make insulin, and that should slow tumor growth. But you obviously have to eat something, right? You can't eat nothing. So the consequences, you're gonna be eating a little bit more fat, a little bit more protein. And so that kind of took us down the, you know, 20 years ago was the low carb kind of Atkins diet. I think we're embarking upon that research world today. And what and we are starting to make kind of a transition is more of a keto diet. It's in the same zip code, I say, but that's what started us down that path. And we had some nice animal data. And we've now run actually three, we're in our third clinical trial for prostate cancer. There the carbohydrate and prostate study caps. So we have caps one, caps two, we're about halfway through caps three. And in total it's been about 100 men or so that we've taken across these studies, randomized them to extreme low carbohydrate, and I do mean extreme versus kind of eat what you want. And collectively, we're seeing benefits and, you know, we're seeing lower insulin, we're seeing less side effects from hormones. We saw some evidence that perhaps slowed cancer growth, you know, it's nothing definitive. I'm not here to say that's the only way to eat by any stretch. But it's, you know, we had started down a path and, you know, we're starting to expand things now. But that's what we've accomplished to date and pretty proud of it. It's 10 plus years of clinical trial data for 100 patients is a lot of effort to do this. It's not easy work.
Justine Reichman What was the most surprising thing that you saw?
"In our studies, we don't tell people to lose weight. We don't tell them to eat less. We just tell them don't eat sugar; don't eat carbohydrates. And on average, for doing this for six months, people lose over 20 pounds.” —Stephen Freedland M.D.
Stephen Freedland I would say, you know, kind of two things. It's a great question. So one is just how difficult these are. You know, you think about this idea that, you know, you have this great idea. You spent years of your life working towards it, and you finally get the funding to do it, which takes years just to get the funding to actually do the study. And then you approach to the patient, they're like, yeah, not interested, not interested, or Wow, this sounds great. I'm just gonna go on the low carb diet. I'm like, no, no, no, that's you have to be like, willing to have to, no no no. I'm going on a diet you sold me. So it's like this the challenges and running a clinical trial. It's all sounds great. And it's, you know, there's very good observational data following patients, you know, 1000s of patients and different things. But the challenge is, you know, we don't actually know if you make one change in your diet, but not everything else, is that going to make the difference. And so the actually testing that has been extremely difficult. And I think the other thing that was surprising is, I mean, the responses we've seen, on the one hand, have been much, much more profound than I would have thought. Another hand is not everybody that responds, it's just the heterogeneity of people. So in our studies, for example, we don't tell people to lose weight. We don't tell them to eat less. We just tell them don't eat sugar, don't eat carbohydrates. And on average, for doing this for six months, people lose over 20 pounds, on average. We've had patients lose 40 pounds by just giving up sugar for six months. We don't tell them eat less lose weight, anything. And so that's been way stronger than I would have expected. We have some patients that really don't make any-- don't lose tons of weight at all. You know, it's very heterogeneous. Witt some evidence, women may not lose as much, our studies have been prostate so we don't have that. But talking to people who've done breast cancer and other studies. And so there's just a lot, you know, it's easy enough to treat a mouse, you know, they're inbred mouse, they're all the same genetics, they're in a cage, they only get to eat, they don't snack on the side, you know, go run and grab the Snickers bar, you know, it's a very controlled environment. But as you get to the human studies, this is tough work. And the responses can be even greater in some cases, but less than others.
Justine Reichman Well, you know, that's the one thing I was gonna ask you is when you're working with humans, and humans can tell you they're doing something but you don't really actually know, right?
“My goal was to figure out something that could work in the real world. And to do that it has to be scalable and it has to be something someone can do on their own.” —Stephen Freedland M.D.
Stephen Freedland Corrent. Right. And that's the challenge. And so the studies, there are studies that will deliver food to patients, right? There's feeding studies and different things. If you really want to know the metabolic effects, it's actually bringing them in the hospital and 24 hours, you know, and you're feeding them specific foods and, you know, they're not snacking on the side and things. But you know, ultimately, my goal was to figure out something that could work in the real world. And to do that it has to be scalable and it has to be something someone can do on their own. If they're only can do it when I'm shipping them food that's not scalable. So we give them great advice. We have phenomenal dieticians. Aubrey Jarman, who's helped us tremendously is phenomenal. We call the patients weekly for three months, and then every other week for the next three months. So it's really intensive dietician, counseling, to degree that scale on real life, I don't know. But again, they're choosing their own food. So yeah, we're going by what they tell us. They eat, but we are measuring them on the scale. So I don't know, it's not that I don't trust them, but there's no way to verify their eating what they're telling me. But I do tell you, whatever change they've made they are lossing 20 pounds, so they're doing something,
Justine Reichman Right. And it seems like you're seeing an impact.
Stephen Freedland Right. And we are. And that's the thing, we can measure tumor markers, we can measure insulin levels, measuring the amount of fat that they have, you know, had been done DEXA scans of body compositions. And so we can measure we see metabolic changes, pretty much all in the direction that we would have predict. So again, they are doing something.
Justine Reichman And what's the feedback you're getting from the patients that are participating in the study? How are they finding it to participate? Are they finding it difficult? Are they finding it challenging? Do they feel supportive-- supported, sorry.
Stephen Freedland No. It's a great question. And I think, in general, I think the patients have really enjoyed it. Particularly the ones that have gone on the diets and in our more recent studies, everybody's getting the diet. They're getting it now or six months from now. Because we were concerned that we are increasingly seeing the diet has benefits. Again, not to say this is the only diet that its benefits, but relative to the Western diet, I think it does. And so we want to make sure everyone can benefit and we don't want to lose patients of launch could go do the diet on my own. No, no, no. Just wait six months, we'll do it with you. And so during that period of time, you know, my experience is the patients generally are happy with it. One of the things you get with low carb is you lose have a fair amount of weight pretty quickly. And yes, it's water weight. But I mean, you can lose five pounds in the first week. And yes, it's water weight, there's some side effects with that. You can get like little flu like symptoms, maybe a little bit of a headache and things. But patients very quickly are seeing the effect on the scale. They're weighing themselves. They're seeing that and they're like, all right, yes, I'm not feeling as great today but I've seen the change, I'm going to stick with it. And, you know, see the patients during the study and by and large they're really happy with it. And we have some very, very small numbers versus ingestion that actually their fatigue levels actually improve anecdotally, the cognitive function, their mental acuity, their awareness seems to go up. We don't have quantitative numbers on that. We've published the fatigue data, and then a small numbers. So I think, you know, the first few weeks can be a little rough but after they get through that, they're feeling better, they have more energy, they're losing weight. So all in all, it's been pretty positive, I would say.
Justine Reichman So that's all sounds so positive. And it sounds like you have a lot to look forward to as you continue to roll out these studies. What's the path look like going forward for the studies and for your goals? What are you looking to achieve in the short term and in the long term?
Stephen Freedland Yeah. It's great question. So I mean, the short term is we're embarking on two new studies that I'm really excited about. I'll tell you about a second, but long term is really to understand the role of lifestyle, and where it can play a role in cancer prevention, improvement of symptoms, delaying progression, and I think beyond cancer as well, would be the big picture vision. And, you know, ultimately, you know, there's a lot of people looking at this, I don't think we're there yet, but personalized lifestyle, understanding your genetics, understanding your tumors genetics. If you have tumor understanding and disease, understanding your microbiome, something that's extremely important, it's just your taste buds. Do you like sugar and you're not gonna be able to deal with a keto diet or, you know, you really want meats, you don't want meat? What is your personal taste buds, because that's going to help dictate the direction to go and come up with some sort of personalized medicine approach to lifestyle. And so that's the big long term picture. I mean, I think that's far off in the future. But that that would be the big picture vision. But then the short term, you know, what we're spending a lot of time we have two new studies that we're embarking upon that I'm really excited. They're really taking the lessons we've learned from those three smaller studies, and really taking to the next level. So one of them is actually taking on the low carb world that we've been in. But again, morphing into keto is working with one of the neuro oncologist at Cedars, Jethro Hu, another amazing dietitian, L.J. Amaral, and the team here is looking at ketogenic diets for patients newly diagnosed with brain tumors. And so this is a disease where median survival is a year and a half. So half the patients are dead within two years. I mean, it's really it's a horrible disease. And it's your brain. It's who we are as humans that's being taken over by this tumor, awful disease. And we, you know, the team, Jethro, L.J., and others, Gillian, Greshams, very involved, ran a phase one trial. Took 14 patients, put them on the diet, and you know, look like the survival is twice as long as we would have expected. Small numbers, but we just got notice a few months ago that NCI wants to fund the study and give us a bunch of money. And so we're gonna be opening it coming up in probably the next few weeks, month or two. We're really excited. And, you know, that to me, is probably one of the most impactful studies, if not the most impactful, because we're able to show a benefit, and really show that this diet can improve the quality and quantity of life of these patients that's changing the field. Tthat's really in one study could change the field for brain tumor. So I'm really excited about that. Second study we have going on and again, that's a huge team. It's hard to mention everybody, but we have huge teams doing this stuff. So the second study is a study looking at fasting mimetic diet. And so this is pulling on Valter Longo work from USC. So it's basically five days a month you take supplements, super low calorie, and 23 days a month, you know, basically kind of healthy, five days a month really starving yourself and you shown great metabolic responses in trauma and breast cancer through doing this in patients with advanced prostate cancer. And working with Tanya Dorff, and Poa-Hwa Lin at Duke, again, we have multiple sites, multiple other people are involved in this. And we're excited to get that going as well. So, you know, really, in both those studies are over 100 people that we're looking to enroll. So taking what we've done to date, 10 years, 100 patients, we're now over the next five years gonna be looking to triple those numbers that we've enrolled. And really--
Justine Reichman There's so much-- it's exciting.
“The right diet for prostate cancer might be different if you're newly diagnosed.” —Stephen Freedland M.D.
Stephen Freedland Correct. And that's the thing, and then, you know, we tend to look a little bit in breast cancer. I mean, think about every possible cancer and every disease and then every possible diets and the right diet for prostate cancer might be different if you're newly diagnosed, or you got a very advanced, and you get into the complexity, and how do we study this scientifically. It's daunting, you know, doesn't leave a lot of time for sleep here.
Justine Reichman Well, you got to make sure you eat properly.
Stephen Freedland Exactly.
Justine Reichman Who I'm talking to someone who says like putting gas in the car gives you fuel to go, right?
Stephen Freedland Exactly. You got to eat enough to keep your energy up. But I think just the enthusiasm for asking the scientific questions and changing the field. I think that's what we're really in the long run, that is our goal is to change the field and help people live better and longer.
Justine Reichman I think so. And I think what you're doing is amazing. And I think the initial studies that you did only are just the beginning. And now where you're heading off is just going to, you know, it's going to expand the research, the lives, the conversation for people to begin to be more curious, and to have more of an opportunity to better understand the options and make more informed choices and be able to take part of it into their own hands too, because they can take ownership with you as you lead them down the path, and as you get more information, and you delve into these studies.
“The choices you make three times a day when you sit down to eat your meal, you can either choose to take things that are going to fight your cancers or going to promote the cancer to grow.” —Stephen Freedland M.D.
Stephen Freedland Oh, absolutely. I think that's really important seeing cancer patients. You know, on cancer patients, there's a sense of helplessness, right? I mean, you come in to the doctor, you sit in the chair, and they put the IV in and fuse chemo. You undergo radiation therapy, you come in, you lie on the table, they do their CT scans, and the radiation. You undergo, you know, lie on the table, and we do surgery. The patient is very passive. I mean, they're obviously making the decisions about which therapy to go, once they decided it's very much the doctors and the care team doing those interventions. So this is, you know, I tell patients, look, the choices you make, three times a day, when you sit down to eat your meal, you can either choose to take things that are gonna fight your cancers, or going to promote the cancer to grow. So three times a day, you're going to make the choice whether to fight the cancer or make it grow faster. And then you throw in the exercise, there's so much that is in their control and at the end of the day, you know, there's a lot that's not in their control, there's bad luck, there's genes that go awry, that have nothing to do, you can do everything right and still have genes go awry and things. And that's, you know, so that's what part of his understanding which tumors are sensitive to these lifestyle interventions, and which aren't. So there's a lot of questions, but it's a partnership with patients. We're very appreciative to the patients who've been on these studies, been a part of our future studies, help support us financially with donations. I mean, there's not pharmaceutical companies that want to fund this research, right? There's not a drug that you can license. Pharmaceutical companies do wonderful work. I'm not here to bash them. But there's no pill or drugs. So it's trying to get money from NIH and the National Cancer Institute foundations have a lot of it's supported by, you know, private citizens who want to value the work we're doing and and wanted to continue.
Justine Reichman So 10 years ago, when you first got this funding, how challenging was it to be able to go get that funding?
Stephen Freedland So it was challenging. I mean, so the first studies we embarked upon were actually from the-- the first clinical trial was funded by the Prostate Cancer Foundation, which is a private foundation that raises money from donors. And that so it's basically private philanthropy money but we had to go out and compete for. We had a good idea and but you know, the standard, this brain tumor one that we were, again, we're about to launch to put it in perspective. So we submitted, it took us three times, three submissions for NCI to fund the National Cancer Fund and say, Yes, this is good. We want to fund it. And the third submission was a year ago and we're just starting to trial now. So it took us about two and a half years of multiple tries, multiple submission, and that was with the phase one clinical trial already done and completed. And so, you know, it took multiple years and that was funded by internal funds from Cedars Sinai that helps support that. So is multiple years of work and effort to get the data to be able to even apply for one of these grants. And then two and a half years, lots of work, National Cancer Institute right now they're funding one out of every 10 grants. So 90% of the grants that get submitted, they say no. And so we feel very fortunate to have two of these starting at the same time, but it's a long, hard track.
Justine Reichman Why do you think they said yes to you?
Stephen Freedland I think they saw the excitement. They saw the potential. They saw that, look, patients are interested in this. It was interesting, there's actually a way you can search Google to figure out what other people are searching for. It's called Google Trends. It's actually figure number one in the grant application is Google Trends searches for keto and cancer.
Justine Reichman Interesting.
“Even when you have a great idea, you got a great intervention, a great team, these are not easy to do.” —Stephen Freedland M.D.
Stephen Freedland So patients are asking these questions, these are questions we're getting in the clinic, we need to answer. And yes, we hope the diet will be good and have all these benefits but if it doesn't, we need to know that too. And hopefully not, but it's possible these diet is bad. We need to know that as well, because patients are doing this. So I think it was that excitement and enthusiasm that they saw and but still you need to do solid science, just a great idea. You need to have a team. And so building the team asking the right questions, the right ways to analyze the samples and things. And so you know, the first time we submitted the grant, but half the grants get what we call triage not even reviewed. It's not even good enough for them to discuss. You got three people who looked over and said, No, not that good. So the second time we submitted, they actually said, our this is good enough for at least to discuss. And it was like in the top quartile or so of grants. So obviously not in the top 10%. The third time and again, we're now like two years down the road. By the third time we submitted, this grant was in the top 3% of all grants submitted to the National Cancer Institute. So there's a lot of enthusiasm, excitement, but even with when you have a great idea, you got a great intervention, a great team, you know, these are not easy to do. And that's why it's exciting to now actually be able to launch these trials. We spent so long talking and planning about it to actually be able to do it. I mean, it's an exciting time, exciting time.
Justine Reichman So for our viewers and our listeners that want to find out more about this, right? And people that are interested in food as medicine and how they can integrate this into their lifestyle, what's the best way for them to-- what are best action steps or ways to get more information on this? And if they want to learn more about what you're doing, how can they follow along?
“It's very easy to sit and read a recipe but the key is not going on a diet— you really need to adjust your way of life." —Stephen Freedland M.D.
Stephen Freedland Yeah. So absolutely. So they can reach out to me, you know, circle the Center for Integrated research in cancer, the lifestyle has a website through Cedars, I'm on Twitter. I'm on email. I'm Googlable. It's very easy to find. So feel free to reach out to me. And I think in terms of just living better eating, I mean, the challenge is, first off, there's tons and tons of information out there, one. Two, the information doesn't always agree with each other. So you read one article, you read one person, and they're gonna disagree with someone else. And so that creates a challenge. I think the third is you, you know, really working with experts. So dietitians out there and nutrition coaches, exercise physiologist, trainers really can work with you because things need to be personalized. It's very easy to sit and read a recipe and say, this is what I'm going to do. But, you know, it's interesting, if you go to the word diet, and look up the word diet, it's actually from Greek origin, it means a way of life. And I think that's the key is you're not going to go on a diet, you really need to adjust your way of life and you need a team, you need support, you need your significant others and your family to be on board as well. It's not easy to change your way of life, but it is possible.
Justine Reichman So Steve, when we met in person, you made a comment that I still take with me because I thought it was so smart. And I thought it was a really nice way to present something and you said it's about making better choices for you. And you use the example about, it doesn't always have to be an apple or an orange. Right? This example that you tell–
Stephen Freedland I do. I do. Very clearly and exactly. And I think the the example I gave was actually a patient, no identifying information, but we were discussing what snacks he was going to have. And he was asking, Is it okay to have like a Ritz cracker?
Justine Reichman That's exactly the one that you gave me.
Stephen Freedland Exactly. My question to him, which in hindsight, you know, it was new to me this way of thinking, but I said, Well, if you didn't eat the Ritz, what would you eat instead? And I was hoping he would say, you know, I have broccoli and cauliflower or something, you know, and he's like, Well, if I didn't eat the Ritz, I would have an Oreo cookie. So I'm like, eat the Ritz, your crackers. You know, you're right. It's constantly trying to make better choices. Yes, it would be great if we all eat perfectly every time. That's just not reality is not the real world. We all have our indiscretions, its birthdays, it's always a reason to celebrate something and it's about making better choices. And when you are making a bad choice to be aware of it, you know, you want the sundae and piece of cake on your birthday but don't eat the whole cake, maybe only part of the cake, you know. And so, exactly. It's always about being better.
Justine Reichman See, gluten doesn't agree with me so I eat the icing and I just have a little spoonful.
Stephen Freedland Yeah.
“It would be great if we all eat perfectly every time; that's just not reality. We all have our indiscretions and when you are making a bad choice, be aware of it. It's always about being better." —Stephen Freedland M.D.
Justine Reichman You see. Steve, thank you so much for joining me today. It was great to catch up. It was great to learn about what you're doing, all the successes you're having, and I wish you so many more successes. And I only want to keep, you know, in connection with you so that I can continue to follow along and hear what's going on.
Stephen Freedland Absolutely. And thank you to the listeners as well for, you know, the opportunity to talk to you are excited about where the field is going. And we got a long road ahead, but there's a lot of really good people working on it. So we're excited.
Justine Reichman Awesome. Thank you so much.
