Preventing prostate cancer with simple, proactive choices [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“You have the power to make healthier choices to reduce your risk for prostate cancer. While things like genetics are out of your control, there is a wealth of research showing that there are simple ways to reduce your risk for prostate cancer that are within your control. Over the course of this book, we review healthy lifestyle choices, from diet to routine medical screenings, you can integrate into your daily practices to reduce your prostate cancer risk.

You have the power to possibly prevent prostate cancer and this power comes in the form of daily lifestyle choices. Use this information to take ownership of your health. Empower yourself. There is no time like the present.”

Benny Gavi is an internal medicine physician.

He shares his story and discusses his book, Preventing Prostate Cancer: Reduce Your Risk With Simple, Proactive Choices.

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

With so many demands on their time, physicians today report record levels of burnout. Burnout is caused by many factors, one of which is clinical documentation. Studies indicate physicians spend two hours documenting care for every hour spent with patients.

At Nuance, we are committed to helping physicians do what you love – care for patients – and spend less time on clinical documentation. The Nuance Dragon Ambient eXperience, or DAX for short, is an AI-powered, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.

Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RATE AND REVIEW → https://kevinmd.com/rate

FOLLOW ON INSTAGRAM → https://www.instagram.com/kevinphomd

FOLLOW ON TIKTOK → https://www.tiktok.com/@kevinphomd

GET CME FOR THIS EPISODE → https://earnc.me/IQDYCq

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at kevinmd.com/rate. Subscribe at kevinmd.com/podcast. Today on the show we have Benny Gavi. He’s an internal medicine physician and author of the book Preventing Prostate Cancer: Reduce Your Risk With Simple, Proactive Choices, and we’re going to talk about his book and the excerpt from it on KevinMD. Benny, welcome to the show.

Benny Gavi: Thank you, Kevin. Thank you very much for inviting me to be part of the show. I look forward to our conversation.

Kevin Pho: So we’ll get into your book and excerpt in a little bit. First off, briefly share your story and journey to where you are today.

Benny Gavi: Great. I’ve been a doctor for almost 25 years, the first 15 years primarily as a hospitalist at Harvard Medical School, and then at Stanford for the last 15 years. About 10 years ago, I transitioned to primary care, and when I got into primary care, I was focusing more on lifestyle and health-related issues, somewhat different than in the hospital. I was really inspired by information that I came across on the role of lifestyle and its impact on people’s health outcomes.

It’s kind of interesting to me. I was at Harvard and Stanford for many years, yet I really didn’t have a lot of nutrition knowledge or experience talking to people about nutrition, and I didn’t really delve into the studies to any great degree. However, when I started reading some of the work, I was really inspired by the dozens and dozens of researchers all over the world, in prestigious universities, committing their lives to doing nutrition research. In particular, I was inspired by the American College of Lifestyle Medicine, by Dean Ornish, who you may be familiar with, and also by Michael Greger, who wrote a book called How Not to Die and has a really wonderful website called Nutrition Facts.

So I transitioned into primary care and got into learning about nutrition, partly because I was new to primary care. I was a seasoned hospitalist. I came into primary care partly because I have four kids and I needed more control of my schedule, and in primary care you can kind of schedule patients, so it works a little better. But I was kind of mid-career, and I think I maybe approached medicine a little bit differently than I would have had I come into primary care when I first came out of residency. I had perhaps more perspective and maturity, and I really gravitated toward the role of lifestyle medicine, thinking about our lifestyle and how that impacts health and disease.

What’s also wonderful about lifestyle medicine is that it’s not only about the health of the patient; the health and lifestyle of the doctor is really integral. You really can’t be talking to patients about nutrition, activity, good sleep, and stress management if the doctor is, you know, kind of not in a good place. It just wouldn’t come off as authentic, and it wouldn’t come off right. So one of the beautiful challenges of lifestyle medicine is that it actually calls upon clinicians to also reflect on our own lifestyle as we try to learn about, understand, and counsel our patients.

Kevin Pho: So give us some specific ways you would incorporate lifestyle medicine and nutrition into a typical office visit.

Benny Gavi: So I think it’s highly variable. Patients are very different, and they come with different expectations. I have some patients who are completely plant-based, and some patients who are still eating cheeseburgers a couple of times a week. So people are at different places, and it’s a conversation. Unlike more traditional medical work, which is more prescriptive, lifestyle medicine is more of a conversation: Where are you? What do you enjoy doing? We really can’t have people do lifestyle medicine if they are not going to enjoy what they’re doing.

Food is so personal. Activity is so personal. I really try to get a sense of who people are, and I really like to incorporate pleasure, because if we don’t have pleasure, I think it’s just hard to maintain things. I think willpower is not a good engine for change. Willpower is a limited commodity, and by the end of the day we’re all pretty exhausted. So we need interventions that support us, rather than ones that are difficult or challenging, especially for the long term.

So it’s a conversation. I’m also careful to share what I do and the challenges that I have. For example, when I wrote the book, you know, I don’t eat plants at every meal. Dairy wasn’t so hot in terms of the data that we found in our review of about 100 studies, but I still like milk in my coffee, and I’m going to continue to do that. So I share with them what I do, I share with them some of my struggles, and we have a conversation about that.

Kevin Pho: All right. So speaking of conversation, I know that’s an integral part of prostate cancer screening in the primary care setting, and you wrote a book about it, Preventing Prostate Cancer: Reduce Your Risk With Simple, Proactive Choices. Now, before talking about the book itself, tell us about the events that led up to you writing it.

Benny Gavi: Yeah, thank you. There are a few events. One is, you know, as a hospitalist I really didn’t think of prostate cancer as a really serious disease, because you think, “Oh, this affects older people, and usually it’s not fatal. It’s kind of low grade.”

I think what changed when I came into primary care is that I saw people in their 50s and 60s and 70s who were healthy, who were functioning in the world, and all of a sudden, you know, they have prostate cancer. While they didn’t die from it, it had a huge impact on their quality of life. They needed to, you know, the testosterone levels weren’t really low, their energy level was low, obviously libido and sexual function went down, and there were issues with bladder control. And guess what? Men weren’t going to talk about it. They’re not going to have a march for prostate-related symptoms, because men are just different than women, you know, who, just on average, are more out there with emotions than men. So I really felt and saw that men kind of suffered privately with some of the symptoms of prostate cancer, which sometimes is a chronic disease.

Kevin Pho: And what are some of the chronic symptoms of prostate cancer that they have to suffer in silence with?

Benny Gavi: Well, I think probably a big one is self-esteem and a sense of self, a sense of being strong and having energy. Their sexual function may be an important way by which they connect with their partner. So their sense of identity and their energy level can be affected, and obviously they worry about bladder function as well.

I also had men who were dealing with prostate disease who were single and actually were hoping to date, and so that obviously became another complex issue that they would need to disclose to their potential romantic partner. So there was a fair bit of burden, and I think it was hidden, and I was moved to try to understand more by getting to know the men and the kinds of symptoms that they’re managing.

Kevin Pho: All right. So tell us about the book itself. There is an excerpt of it on KevinMD, “Preventing prostate cancer with simple, proactive choices.” So tell us the main messages.

Benny Gavi: Sure. One main message is that a lot of smart people have been thinking about this for decades, and I think most doctors were just not tuned into that, because we’re so focused on, you know, maybe day-to-day pressing issues. So there’s a lot of science out there. I was really surprised by the amount of science.

The other main message is, well, I guess what first convinced me to look into this more was looking at some of the twin studies. If you look at genetically identical twins, and there have been some large studies, it looks like about 50 percent of the twins will get prostate cancer and the other 50 percent will not. That suggests to me that, given that they have an identical genetic code, the genetic component is approximately 50 percent, if you average some of the studies. So the other 50 percent is something else, and we’re trying to learn what that other 50 percent is.

Maya Eylon and I looked at about 100 studies, and repeatedly it came back as plant-based. Certain types of plants had a lot of impact, a 30, 40, 50 percent reduction in some of the studies, and also physical activity and also maintaining a healthy weight. The nice thing about these interventions is that, OK, you’ll do this, but by the way, it’ll also drop your risk of heart disease and stroke and other cancers, and it’s probably good for the planet. So there’s a lot of benefit that goes even beyond prostate cancer.

But the studies were around certain types of food, especially tomatoes; cruciferous vegetables, which are broccoli, Brussels sprouts, and cauliflower; soy; and green tea. Those were the big ones. You know, it’s pretty easy to make a cup of green tea in the afternoon. It doesn’t take a lot of work.

And over time, for example, I’ve incorporated these foods more and more into my diet. For example, let’s say my family has broccoli the night before and the kids don’t want to finish it. I’ll probably take it the next day and throw it in a smoothie or something like that. I try to go to the farmers market and buy some really fresh, great-tasting tomatoes that just smell really wonderful, you know, tasty or heirloom tomatoes. The point is to also have fun and enjoyment and pleasure, but armed with some knowledge, we’re making decisions that are healthy for us but can also maintain pleasure.

Kevin Pho: Now, just to be clear, in terms of the studies that you cited, how much of a plant-based diet or plant-based lifestyle intervention does one have to undertake to notice that appreciable decrease in prostate cancer risk?

Benny Gavi: That’s a really great question, and there are a lot of studies. You know, one of the strengths of our book is that we looked at about 100 studies. This isn’t a book about, “Oh, you know, this is what I did, and this is how I feel.” In a way, we try to kind of get out of the way and let the studies speak for themselves. Many of the chapters have about five or 10 studies to support the chapter, and then frankly, because it was so scientifically dense, there were another five to 10 chapters that are in the annotated bibliography that are not in the main text, because we didn’t want it to read like a really dense nutrition textbook.

So there are a lot of studies, but I would say that two or three servings a day of vegetables, so maybe two or three cupfuls a day of vegetables, is probably a good amount. But I think, you know, the other thing that I would say is that more is better, but even a little is better than none. My sense of the literature is that it’s probably graduated. In other words, the more that you eat, the more the benefit. So a small amount helps a little bit, an intermediate amount helps more, and eating even more has more of an impact. So I think it depends on where people are, and I try to incorporate it into their lifestyle in a way that is sustainable.

Kevin Pho: So we talked about nutrition and diet having an impact. What are some other ways that patients can reduce the risk of prostate cancer?

Benny Gavi: Exercise, physical activity, and movement are really strong. There are really, you know, interesting studies in the book where people exercise, and then researchers take the plasma or the serum of the people who exercised, actually put it into Petri dishes, and can show that cancer cells can be inhibited by the serum of people who exercised. But you know, even putting that aside, there are just a lot of epidemiological studies that show that people who exercise and maintain a lean body weight appear to have less prostate cancer.

There is also, on the flip side, dairy, which didn’t get, you know, it’s kind of either neutral to potentially harmful. We kind of recommend limiting dairy, but you know, I have an egg once in a while, and I have milk in my coffee, and I have some baked goods. So I don’t think the point is to have zero. Maybe I just have it with a cup of green tea or something like that. And I think that animal-based products, red meat, like in other studies, are probably something that we do better eating less of.

Kevin Pho: So you’re a primary care physician like myself, and as you know, we have 10, 15 minutes for each visit. Sometimes, for a lot of doctors, “Eat more plants, exercise” is pretty much the only way that they could convey that message to patients. You do this all the time, so what are some effective ways we can communicate that message given the time constraints that we have?

Benny Gavi: You know, that’s a real challenge. I think sometimes, frankly, it’s just difficult. But I think patients respect doctors, and I think even a small comment can go a long way. I think we’re there as a resource for patients. We’re not going to bring it up every time, but I think that over time my patients know me, and I bring it up periodically, even if it’s incidentally when we’re reviewing the cholesterol or the labs or things like that. So you know, I don’t know if there’s an easy way to do it or any kind of shortcut. There’s a lot to do, and we just do the best that we can when we can. We know that many times office visits are busy, but sometimes it’s less busy. You know, people are there for something that’s quick or short, and then we have a little bit of time. So obviously we won’t be able to do this at all times.

You know, one message that I also wanted to communicate to the clinicians in your audience is this. I think one of the fun things for me about this project is that I’m not a nutritionist. I’m a busy primary care doctor. I work as a hospitalist. I have four kids. But I had an idea, and the idea was, you know, somebody should write this book. It took me two or three years. I spent about an hour or two a week over a period of three years, and I became sort of an expert.

You know, the thing about us doctors is that we sort of major in the practice of medicine, but it’s actually not that hard to become an expert in something if you spend a small amount of time over a long period of time, just because of the nature of how well trained we are and the depth and breadth of our practice. So one message that I want to share with people is that if people have something that inspires them, it really doesn’t take that much time to become an expert and to be able to contribute to society in a slightly different way. For me, this has been a source of creativity, inspiration, and positive energy in my practice, and it helps with professional satisfaction and reducing burnout.

So I think that if something surprised me about this work, it’s that I was able to get it done. I don’t think I believed that I’d be able to write the book, just because I’m not an author. I’m not a researcher. I don’t have grants. I’m kind of primarily clinical, seeing patients in the office and in the hospital. So the fact that I was able to put out a book: If I can do it, a lot of people can do it, or complete a project that is a special interest or passion and reaches people on a much bigger scale. It really does just take a little bit of commitment over a long period of time.

I do also want to mention the importance of a team. Maya was applying to medical school, and so having an energetic young person work with me was invaluable. And I’m really impressed by the publisher and how they were able to take my notes and put them into a book.

Kevin Pho: We’re talking to Benny Gavi. He’s the co-author of the book Preventing Prostate Cancer: Reduce Your Risk With Simple, Proactive Choices. Benny, what are some of your take-home messages that you want to leave with the KevinMD audience?

Benny Gavi: If you have an area of interest or passion, pursue it. It’s important. It’s important to your sense of well-being, professional satisfaction, professional fulfillment, and sense of meaning in your work. And getting engaged with lifestyle medicine is not only good for patients; it’s good for the doctor and the other clinicians.

Kevin Pho: Benny, thank you so much for sharing your time and insight. Thanks again for being on the show.

Benny Gavi: My pleasure. Thank you.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes