Joelle Kaufman: There's a whole school of science that says cancer is a inflammatory disease and don't, we think of inflammation like something's red and swollen. So could you give us a better definition? What does it mean when you say, you know you have an inflammation problem?
Dr. Mary Ann Martin: When you are doing something, either you're eating something or you're under extreme stress, or you're chronically sleep deprived, what it does is it tells certain cells in your body you're actually in a fight or flight state and in that state, all the cells are on high alert, which basically is inflammation.
Whenever there's any metabolic disorder, especially with insulin resistance, you're going to see that causes inflammation. Most people with cancer actually have insulin resistance.
When insulin is high it actually causes tumor growth.
if you stack nutrition, exercise, stress management and sleep, you've reduced your risk of chronic disease by 78%.
There have been several studies show just by adopting an anti-inflammatory diet, which it can begin as simple as this, not having processed foods, anything that comes in a bag, anything that comes in a can, right?
You're actually taking time to prepare as much of that as you can. Avoiding, of course, trans fats and really switching to healthier oils, whether it's olive oil or avocado oil. Simple things like that don't take a lot of effort.
And the best example of that is a Mediterranean diet. I'm sure many people have seen that one of the areas of the Blue Zones where people are living the longest is in Italy. A lot of seafood, a lot of vegetables, whole grains, lentils, beans, legumes. But they're also hiking hills every day.
And they're outdoors. They're not on screens all day like our culture is. So we know that an anti-inflammatory diet has to be where it starts.
yes. There are so many people who I work with and they go to Europe for two weeks. They're so scared they're gonna gain weight and because they wanna enjoy the food there, I. They actually come back and many of them have either maintained their weight or they're actually losing weight because not only are they eating better quality foods, but they're exercising and walking more as well.
A lot of people are going to be in an uproar when I say this, but alcohol is inflammatory
There really isn't a good study on what is a safe amount of alcohol.
once we get past the nutrition, which already reduces your risk, 17%. if you want to double the reduction of cancer, now you gotta add in the exercise.
It is 30 minutes, at least five days a week. I don't believe in a rest day. Now, that doesn't mean that you're in the gym making your muscles sore every single day, but I do believe we have the ability to have some healthy motion every single day.
Why should there be a day where we do nothing?
We can take a walk, we can stretch, we can do yoga, we can do something every single day. And it just stacks that habit that this is just something I do every day. No different than brushing my teeth. So once you're, you've got the exercise and the diet, you've now reduced you cancer risk by 36%.
Now you wanna stack that further. We talk about stress management, we talk about really prioritizing your sleep and what that means is setting a time where you go to bed at around the same time, ideally, to optimize your cortisol and your melatonin.
It's gonna be before 11:00 PM I have a lot of patients who tell me I get eight hours of sleep.
But they're going to bed at one in the morning and they wake up at nine. So that is not a good time for your body to restore and recover. It's usually before 11:00 PM which is ideal. And then waking up at around the same time as well. And the tricky thing is for people who work Monday through Friday and they wake up early, and then they wake up maybe at 10 30 or 11 on the weekends, that doesn't work.
You're setting a routine every single day, even on the weekends.
Joelle Kaufman: there's a test that saves lives and no one's getting it. the one you told me about was the AM Cortisol levels. So what is it? Why aren't doctors ordering it?
Dr. Mary Ann Martin: one of the key markers that detects diabetes the earliest that less than 10% of healthcare providers actually order is fasting insulin not only isn't tested in this day and age, it certainly wasn't checked, 30, 40 years ago.
the am cortisol can give us a picture of what's going on first thing in the morning. Sometime between five and eight in the morning, your cortisol rises and this allows you to wake up and get ready for the day. But if it's extremely high. It can be a signal that there is insulin resistance because we know that when cortisol is very excessively high, it drives glucose up and it causes that very nasty belly fat to start accumulating.
Belly fat is the most dangerous area to have fat. And so when we see the cortisol above 31st thing in the morning. That should be a signal that somebody should be then checked for pre-diabetes.
I'm so glad that the technology has gotten so much easier and widely available for many people to be able to check their sugars with just a simple continuous glucose monitor that they just put on their arm, like a bandaid, and it records your sugars every five minutes.
You wanna make sure that number is well below a hundred, because if that number first thing in the morning is 100 or above, that is pre-diabetes. Now the second thing is you have to wait a certain amount of time after eating to check your sugars. If you just had dinner and 30 minutes later you check your sugar, you're gonna be shocked at what your spike is.
If you're looking at the spike. Look at it for data of, that's interesting. I didn't realize that sweet potatoes made my sugars go up so high. I thought it was a healthy thing to have.
In combining a food diary with a continuous glucose monitor, now you can start tracking what foods you're actually sensitive to and the magic number, two hours after eating it should be less than 140.
Joelle Kaufman: Body chemistry seems to work against women in perimenopause and menopause. You're hot flashing. Or you're restless. What do you say? What do you do for women who are out of whack?
Dr. Mary Ann Martin: this is where as Dr. Hormone Hacker, I really like to start with a comprehensive hormonal panel. And each woman deserves an individual conversation. There is no sweeping guideline that every woman needs to be on hormone therapy if they're having insomnia or hot flashes. It really is a nuanced conversation of how severe your symptoms are.
How much does it affect your quality of life? Let's really talk about what it looks like to be on estrogen and or progesterone and what the risks and the benefits are, and also how long do you need to be on it for. I've had conversations with women who they just get their prescriptions renewed every single year, and they've been on therapy for several years and no one has actually said.
Do you think maybe we should evaluate whether we could reduce the dose or maybe you don't need it anymore? And so I wanna encourage women that if they have moderate to severe symptoms, this is the perfect time to have a conversation with your provider and check the levels, see if you are in need of some hormonal balance, but it's not meant to be a lifelong prescription.
Joelle Kaufman: Let's dive into thyroid cancer? How is thyroid cancer treated? What's a story about someone going from terrified to thriving in your practice?
Dr. Mary Ann Martin: my patient, she was about 42 and she was Vietnamese. She had just come over to the US a few years ago and she was extremely scared because back in Vietnam, she didn't go to a lot of doctors. And that, that sometimes is the culture in Asia is we just see that healthcare is not something that they access.
In that form, they may go to an herbalist or an acupuncturist before they actually see an actual healthcare provider. And she had three children and they were young. They were all under the age of 10. Because this was their entire extended family's first experience with cancer, everybody was absolutely devastated .
She had a lot of emotion around it. She didn't even know the right questions to ask, and this is where you just sit and you hold their hand and you just let them know. In my experience with all the other females that I have treated for thyroid cancer who are around your age. This has been the outcome, and by sharing other patient stories, that's what really helped her to calm down and relax a little bit.
We talked about her being sent to the surgeon. We talked about the possibility of radiation, which she did require. I even had a meeting with her kids and her husband and her mother. And so the whole family was involved and knowledgeable. That mom is gonna be out for a while. Everyone else is gonna have to pick up the slack in terms of grocery shopping, cooking, cleaning the house, helping with homework.
I really had to make sure it was all hands on deck. The older siblings would help the younger siblings, her husband would help her mom would help the kids. After that, she felt amazing and she's been thriving ever since. No recurrence.
Joelle Kaufman: when someone's doctor finds a thyroid nodule, what's the likelihood that it is cancer?
Dr. Mary Ann Martin: the most common ways that you are going to know that you have a thyroid nodule. Either A, the scenario that you described. You see your doctor, they feel your neck, and they feel that there might be an enlargement. They order an ultrasound and it shows up on the ultrasound, but scenario B is completely unrelated.
You don't have any symptoms. For example, you came in because you've had chronic bronchitis and they do a chest x-ray or a CAT scan, and accidentally it shows there's a thyroid nodule. So in that particular case, that's what's called an incidental thyroid nodule. But no matter which scenario, whether your provider diagnoses it or it's bound by accident, your risk that nodule is cancer is less than 5%. And so I like to share with my thyroid, patients, if you are to pick a cancer, this is the one you watch because it is very effective in terms of treatment. And once we treat it, there's very little chance of recurrence. And the probability that a nodule is even cancer is also incredibly low.
Joelle Kaufman: When I had my core needle biopsy, we do the local numbing and the doctor says, Hey, don't jump. There's a sound. That particular thing. It has a sound 'cause it's like a, spring. and one of the challenges with breast cancer is we don't numb the patient enough and. Suffice to say my doctors did not, and I looked at 'em and said, so you buried the lead there. wasn't the sound. But you just have to advocate. Say, Hey, I don't wanna feel a lot of pain here.
Dr. Mary Ann Martin: I'm so glad that you shared that because what I do is after I numb the area, I will tap on the neck and I'll say, can you feel this? And based on their answer, we can always give a little bit more. And yes, I absolutely agree with you. We have to be proactive in asking what we need.
If you move, it's not gonna be the area where we're getting the best cells. So the better numbed and comfortable you are, we're going to get a better biopsy result.
Joelle Kaufman: You weren't supposed to be a doctor. You were chasing Connie Chung. tell us a little bit about how your pursuit of journalism. It actually made you a better doctor and how does that help you as you care for people?
Dr. Mary Ann Martin: I think one of the missed arts of healthcare is actually listening. We are so pressured for time to see a certain number of patients during the day, that really becomes a lost art. We have time to ask the patient, what's the one problem that you have today? And even before they answer, we're already writing a prescription for what we think is going to be the solution.
So when I actually studied journalism, it honed my ability to, first of all, ask the right questions. And then to stop and listen. Because if you ask the right questions and if you let people share their story, they're gonna tell you everything you ever wanted to know, and more importantly, the best way to help them.
Joelle Kaufman: So do you find both in journalism and in medicine, the art of really listening and being curious is in decline is the same, is on the ascent?
Dr. Mary Ann Martin: I feel that 40, 50 years ago when there was such a thing as a doctor in private practice, because that is a rare occurrence in this day and age, healthcare is now a business model. Back in the time where you could actually spend 20 to 30 minutes with your healthcare provider and you saw the same healthcare provider each time you develop a relationship.
I love when I hear doctors who are in their sixties and seventies tell me. That they've seen generations of families. So now they intimately know their family history, not from what the patient is telling them because they've actually seen these family members in the past or currently. And it just weaves this ability to have that close relationship, to feel comfortable enough to tell your healthcare provider everything and know that you are going to be heard and that.
Most importantly, the solution is going to be a partnership. I learned a long time ago that if I don't have the buy-in from the patient, it doesn't matter how much knowledge I have, it doesn't matter if I quote the latest study, the latest clinical research, if I can't figure out a way for them to be involved in their own proactive care.
Joelle Kaufman: Let's talk about what you do as a health coach and the lifestyle interventions that were never taught in medical school. And how emotion electronic medical records have forced a change in how you practice medicine and led you to make changes in what you wanted to do. And I'd love for you to also talk about the difference between prevention and treatment and how we train medical professionals and how we should.
Dr. Mary Ann Martin: Wow, if I could change the curriculum, believe me, there'd be a lot of changes because when I went through medical school. It was really, let's study the science. Let's study the disease process, and then right after that, here are the treatments, which are all prescription. I was never taught one day in medical school about anything, diet, exercise, stress, sleep, nothing.
The average healthcare provider does not have the time, nor do they know where to look for this information. And what I experienced with electronic medical records is had you seen me back in the day when we had paper charts, I can maintain my eye contact with you and have a good relationship and rapport.
I. But I can still write my note on my lap so that when you and I were done with the visit, I was done with my note. But when EMR came into play, you've probably seen doctors already who they are at a little desk hunched over on their computer and there's very little eye contact with the patient. Now, for some people that's how they operate and for me, I had such a strong background in journalism, can you imagine if I was interviewing somebody and all I did was take notes on my phone and I never looked at you, what would you tell me? You wouldn't tell me anything. And so I felt the same way with my patients. If I really wanna get the full story, I have to be fully present, which means not having distractions by typing and having full eye contact, because 80% of our communication is nonverbal, and so if I just rely on what I'm hearing, I'm not getting the whole story. So when our practice switched over to EMR, unfortunately I started having to take my work home. Because it would take me then another two to three hours to finish all of these notes at home.
At the time our kids were eight and 11. My husband was also working full-time as a physician. We started getting into conversations about you are not here, and even when you are physically here, you're not here.
You're working, you're distracted, and you're not able to have time with the family like you used to. And it was such a struggle. It was a constant argument, and my sleep was affected, my exercise was affected, everything was affected. And when I learned that there were other healthcare providers who were actually transitioning to more preventative care and coaching their patients on an individual basis on lifestyle interventions, that really got my attention.
And when I started following a mentor. And she was sharing with me what she does, and I started adopting the same model in my office with my patients and saw such incredible reverse and improvement in disease where people were able to come off multiple medications. And really, here's the thing is when you take a prescription medication, the only person you're helping is yourself.
When you adopt a lifestyle, for example, a mom who is doing the grocery shopping and cooking for her family, if she starts adopting better lifestyle habits, she now is that point of inspiration and the ripple effect for the rest of her family. So you're influencing multiple people that you care about when you adopt these lifestyle changes.
And really when my personal story happened, which was as an endocrinologist, I was supposed to be the expert at helping people with diabetes. It was an utter failure and I had the worst imposter syndrome when my grandmother, my aunt, and my mom developed type two diabetes and I couldn't do anything about it.
Now, you could also say they were not ready to change their lifestyle. So after my mom was diagnosed with type two diabetes. And I realized I was at risk myself. And when I got tested, I was this close to being pre-diabetic. So an A1C, which is your average two to three month sugar level. If it's 5.7, it's pre-diabetes.
Mine was 5.6, about as close as you can get, and I don't like to be that close to the edge. So that's when I went on my personal journey. Of figuring out what can I start doing because I did not wanna take medication. And so some of the lifestyle changes that I adopted, I never cut out carbs completely because that's not sustainable.
But what I did do was I was more in tune with which carbs spiked up my sugars. I had them earlier in the day. I had them in a smaller portion. I had them less often. I focused more on protein and vegetables. I changed from just cardio to more strength training. I made sure I was in bed by 11 as much as possible, and I really found that just by doing all those things, my stress level went down automatically.
And then because I was now coaching a lot of clients outside of the office and earning an income from that, I was able to reduce my office hours and improve my quality of life, which reduced my stress, which allowed me to put more effort into this total lifestyle change. And so that's really what happened for me,
that was the culminating point where I said.
I don't wanna be part of the problem anymore. I really wanna be part of the solution. And so Dr. Hormone hacker was born and from that was a focus now on prevention and lifestyle medicine.
I'm about to be a first time author and my first debut book, which is the blueprint on how to reverse diabetes naturally without medication is soon to come out.
This is the intriguing part we all know right now there's type one diabetes, which people are born with and diagnosed very young. Type two diabetes, which tends to be lifestyle driven. Alzheimer's is known to be a type three diabetes.
Joelle Kaufman: What's the name of your book?
Dr. Mary Ann Martin: my book is called The Type Zero Diabetic Returning to Zero, where if you already have it, we're going to reverse it, and if you don't already have it, we're gonna make sure you never get it.
Joelle Kaufman: Okay I wanna do a quick rapid fire and we'll close it out with those.
If you could add one test to every annual physical, what would it be?
Dr. Mary Ann Martin: Fasting Insulin
Joelle Kaufman: What's the biggest inflammatory food people think is healthy?
Dr. Mary Ann Martin: Smoothies.
Joelle Kaufman: smoothies. Why are smoothies inflammatory?
Dr. Mary Ann Martin: Here's a problem when you go to a place that makes smoothies. If you were to line up all the amount of fruit that is required to make that smoothie. I promise you, you cannot eat that amount of fruit and even fruit, which is healthy, if it's in excess, becomes inflammatory because it causes a glucose spike.
So people don't realize some smoothies contain 60 to 70 grams of sugar. That is like eating five pieces of bread.
Joelle Kaufman: Okay, so Jamba Juice is on the cutting board
someone. Who a thyroid lump and is waiting for biopsy results, what should they know?
Dr. Mary Ann Martin: three days prior and three days after the biopsy do not take any blood thinners. Okay? That means aspirin, ibuprofen, Advil, et cetera.
Joelle Kaufman: Okay. If you could get one thing across to everybody listening, one thing they need to remember, what would it be?
Dr. Mary Ann Martin: Your lifestyle is more important than your DNA.