June 11, 2024 • 29 mins
On this show, Karolyn talks with leading integrative and naturopathic oncologist Daniel Rubin, ND, FABNO, about prostate cancer, which is the most common cancer among men in the United States. Dr. Rubin will describe his evidence-based approach to treating prostate cancer and talk about new research looking at the natural substance, modified citrus pectin. Dr. Rubin is Co-Founder (along with his wife, Debi Smolinski, ND) and Medical Director of Naturopathic Specialists, LLC, in Scottsdale, AZ.
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(00:00):
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Hello everyone, andwelcome to Five to Thrive Live. I'm
(00:43):
Carolyn Gazzella and I co host thisshow with my good friend, doctor Lise
Alschuler. So, prostate cancer isthe most common cancer among men, and
it's been in the news a lotlately, and that's the topic of our
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And finally, doctor Oheeres Probiotics.It's a best selling probiotic for more than
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probiotic. Learn more at Doctorohira Probioticsdot com. With me today is one
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of the pioneers of naturopathic oncology,Doctor Daniel Rubin. Doctor Rubin is the
medical director of Naturopathics Specialists in Scottsdale, Arizona, which has been an integral
part of the Phoenix Metropolitan medical communityfor the past twenty years. Doctor Rubin,
thanks for joining me well, thankyou very much. It's so good
to talk to you again. Iknow it's been a while, doctor Rubin.
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I'm so excited that I was ableto host you on this show.
So let's just dive right in.So, with prostate cancer being the leading
cause of cancer death among men,I'm assuming early detection is key. So
how is prostate cancer detected and diagnosed? It's a great question because there is
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a lot of work that's gone intothis, especially because of the statistics that
you just gave, and of coursethere's a lot of men on the planet
and prostate cancer can be lurking andsometimes it's just in the background. I
mean, we know that a highdegree of men that die of other causes
upon post mortem autopsy will be shownto have a low grade prostate cancer that
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was never diagnosed and never became clinicallyrelevant. But for those that have potentially
about to be clinically relevant disease orearly detection is key. Now I don't
spend time in the early detection spacebecause I'm in the diagnosis space and in
terms of oncology treatment, but theactual diagnosis still depends on the gold standard,
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which is a biopsy. But howdo you get to the biopsy?
So how do you actually know ifsomebody needs a biopsy. So usually we
had relied on just regular old pstesting, which really just isn't that great.
And sometimes, unfortunately, even thoughPSA screening is done, sometimes it
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doesn't get the attention of the physicianuntil it really gets too elevated. And
I see this a decent amount inmy practice. Unfortunately, the PSA has
been up, they've been following,it keeps going up, but it doesn't
get the attention until it's a littletoo high. Then they get diagnosed and
sometimes unfortunately the men of metastatic disease. So there's some new tools out there
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there. There's actually one called xoDX, which is a prostate test.
This one actually is in the realmof helping to decide whether or not a
biopsy. You should really go forwardwith the biopsy, because, like I
said, sometimes the doctors will seean elevated PSA meaning above four point zero,
which is usually a cut score,and be like, ah, this
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doesn't seem to be too much.Maybe we don't necessarily need to get a
biopsy, but the EXODX and MEany cases can be useful to detect whether
or not there's a higher probability ofdetecting an aggressive type prostate cancer versus one
that's not as aggressive, and ithelps with basically compliance with physicians recommendation to
either defer the prostate biopsy or toproceed with biopsy. So that's one to
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take a look at. There's alsothis sort of subset of PSA which is
called percent free PSA, which isa good hint, and the lower the
fraction of PSA that's freely floating insteadof bound up by like a protein,
the higher the probability there may bea prostate cancer. So just adding the
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percent free PSA fraction to a regularps A screening could lead someone in the
direction of getting a biopsy. There'salso some tools. There's the EPI switch
tool which is out there, andthe EPI switch personalized. It's called the
ps Report report. It is atrue prostate screening test and it can show
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whether or not there's a low versusa high likelihood of someone harboring a prostate
cancer. It's a blood test andthe confirmation data I believe is in nine
out of ten, so there's aboutninety three percent rate that if somebody tests
in the high likelihood range that abiopsy will show prostate cancer, and I
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think the data on PSA screening isin the thirty two percent, meaning thirty
two out of one hundred men whohave a positive cup score for PSA are
going to be diagnosed per biopsy withprostate cancer. And then lastly, I
think one of the ones that's popularizedout there, and I really don't know
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how it does with prostate detection,but it's the it's the Gallery test by
a company called Grail, which andit's not just prostate specific. I think
it looks for about thirty different typesof cancer. It's very popularized about thoul
dollars out of pockets, not insurancereimburse but it's a screening test done by
a lot of nature pathic physicians,a lot of functional medicine integrated vectors,
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and family practice physicians, and thoseare ways besides you know, a digital
rectal exam, which means men shouldbe going to the doctor regular deleite to
get their checkups, because you stillhave a physical exam that can help detect
a mass or a suspicion if thereis maybe a hard prostate or something like
that. Great, well that's that'sgood clarification. So once we have a
diagnosis of prostate cancer, how isit typically treated. Well, some well
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it's going to depend on the stage. So if you get a biopsy and
if it's diagnosed and you have aprostate cancer, you're going to get a
stage in a grade. And thegrade is generally called the Gleason score.
That's a score meaning how aggressive doesthat prostate cancer look? Aggressive? Meaning
is likely aggressive? You know,just like if you were anything that's aggressive.
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Those that are less aggressive tend tobe less voracious on the body.
Those that are more aggressive could havemore impact like metastatic disease and cause havoc
can eventually be lethal to the tothe human that has the prostate cancer.
So gleas in grades that are likearound six, because it's basically six to
ten is where you're going to seeyour gleas in grades, ten being the
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highest, six being on that lowend and depending on the person's age,
vitality level, life expectance, seekgleas in grade and then staging, which
looks at a scan to see ifmaybe some lymph nodes may be suspected or
if there's any skeletal lesions. Somemay actually just fall unto the observation role
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watch PSA, you know, doprostate exams, watch how they feel,
maybe watch a scan here, andthere are some other labs, and these
people may may not never have progressivedisease, especially if they go see a
nature pathic oncologist or somebody skilled inthat realm or similarly trained to a nature
pathic oncologists or rather similarly skilled whocan manage that disease. We're not just
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talking about a general practice nature pathicphysician or integrative doctor. This is somebody
who is skilled in oncology and alsoknows when to proceed and when you need
to proceed with conventional because as youget into the higher gleas in grades,
now you're going to start maybe havingthese people at initial diagnosis get diagnosed with
metastatic disease. So somebody with aneight, nine or ten, which is
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a more aggressive gleas in grade,may actually diagnosis on scan. And there's
various new scans out Some are fancierthan others. Some may be just a
pelvic MRI, and some may goall the way to do a PSMA PET
scan, which is a polarify scan. It's a gallium scan basically, and
they can detect metastatic disease, evenif it's local disease, like the sort
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of nodes in the pelvis look suspiciousor uptake. The contrast on the scan
that could upstage somebody. Or ifthey see a bony lesion in the pelvis
or in the hip or in thearm, that's going to put somebody in
advanced stage disease. And then that'sgoing to depend on how it's treated.
So really making sure that you geta clear diagnosis because some people, some
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doctors may say, hey, wegot prostate cancer, we need to move
to a prostatectomy, we need prostateremoval. But sometimes you need to put
the brakes on that because some peoplemay not be the best candidates for surgery
because they may have what they callextra prostatic disease, meaning that even if
it's spread metastasis wise to the localnodes, it also could be leaking out
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of the prostate capsule. And somy suggestion is to really go with a
physician who is going to do agood diagnostic workup after the diagnosis of prostate
cancer, no matter what the gleasinggrid is, before deciding what to do.
Because this is cancer, and eventhough there's some rules, rules are
meant to be broken in oncology,and that's a rule. This is meant
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to be broken. So we haveto make sure that the diagnosis is right
so you can approach. Some primarytreatments are going to be the prostatectomy,
and some men may be cured.Some may not be as good of a
prostatectomic candidate, and they may gothrough a conventional treatment with primary radiation therapy
and that may have curative intent.Also, some may have a combination of
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prostatectomy followed by radiation. Some mayeven require androgen deprivation therapy in the conventional
realm. And that's for the youknow, that's more a diagnosis in the
upfront approach. Once you get intothe later stages, in the more advanced
disease or recurrent disease, you know, depending on where you have lesions versus
what's called biochemical recurrence, which issomething you and I are going to get
into later, I believe. Thenyou start looking at small molecules, sometimes
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chemotherapeutics, radiation outside of the prostate, and other you know, sometimes clinical
trials and it gets treated more likeyou would think a typical ad nocarcinoma would
get treated. But those are thegeneral conventional approaches perfect. I'm glad that
you brought up natropathic oncology because youhave advanced training in naturopathic oncology, just
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like after all Showers. So fromyour perspective, from that naturopathic standpoint,
how do you generally approach prostate cancertreatment? Well, I look at data.
And when I say data, I'mnot necessarily looking at studies. I'm
looking at the individualized patient data,which means I'm narrating the pathology report to
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them. I think it's really importantto start there, know that pathology report,
know the case before you have yourfirst visit with the patient. So
we always ask for records to besent ahead of time so we can be
familiar if we have to review somethingor we have enough time. You know
there that we're not just looking atthe data. First off, when the
patient comes in and whatever scams theyhave and watching their PSA trend as they
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you know, we're watching PSA andwhat led up to biopsy and really,
like I said, dissecting and narratingthat report so they understand it. And
you've got to look for some ofthe really small things like is there Harry
neural invasion was their lymphovascular invasion,what's the gleasing grade? And in what
order was the gleasing grade? Wasthere extra prosthetic extension? And then looking
at the scans and once we havea complete workup, then we got to
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see is are they questioning conventional treatment? Was conventional treatment already done as this
person had a prost technic if theyhad radiation? Where are they coming to
me at? And then we runour set of labs. I got to
look at somebody's biophysiological individuality before Iknow exactly what to do, before I
can actually create a more comprehensive treatmentplan. And so we'll start somewhere,
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and we oftentimes will start with lifestylechanges. Now nowadays, here we are
in mid twenty twenty four, there'sa lot of info and there's a lot
of stuff out there on lifestyle change. So more than ever, patients are
coming to me already having made atleast some type of dietary change, and
if not having made a dietary change, maybe they're actually aware that a dietary
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or lifestyle change is going to needto happen because that information islay been given
to them by family or friends,their kids, or maybe they're consumers of
social media, or maybe they're listeningto excellent podcasts like five to Thrive and
they understand about this stuff, sothey at least approach up, but they're
not sure exactly what they need todo. Whether they need they need to
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cut out or cut down on alcohol. Do they need to go to a
plant four to a plant based diet. Do they need to get out of
their chair and out of their bedand start exercise? Like what does it
take? Or maybe this isn't somethingthat needs a lifestyle change. Maybe we
need to jump right to supplementation,some specific supplementation. And again that's going
to depend on the data that Ihave in front of me, and it
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may be that somebody is in likea holding pattern. It's like, Okay,
I've got a glease in seven.I don't have any suspicious nodes.
I do have a little extra prostaticextension. My doctor said that I'm a
candidate for surgery, but I don'thave to. I don't exactly, you
know, have to jump to surgeryright now. He wants to give me
another MRI in three and a halfmonths. What can we do now we
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have three and a half months andI'm going to put this person on what
I would consider more of a trueanti prostate cancer slash blocking protocol to either
make them a better surgical candidate maybeto bring down that extra prostatic extension so
we don't have what's called a positivemargin on surgery. And a positive margin
is when there's a margin that stillshowed cancer at the cutting line the surgical
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excision, and so there may ormay not be cancer left in the body,
which may then if there is,make them a candidate for radiotherapy.
And so I'm going to try andimprove their ability to have a curative type
surgery. I'm going to check themfor circulating tumor cells. I'm going to
do a biophysiological assessment. I'm goingto do an immune assessment. I'm really
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going to work them up to seewhat needs to be done, because again,
if somebody already has what I wouldconsider a lifestyle that befits that we
would use for the diagnosis, thenmaybe that's not the issue and I have
to look further. And for me, there's a lot of there's a lot
of press partianers out there who don'trely on labs and they practice a different
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way than I do. I havea lot of reliance on labs, not
because I think that's where my skilllies, but because I don't want to
make certain assumptions about a person,and if I can look for something,
I want to make sure that I'mchecking it, So I am doing the
job for them because it's not mylife in front of me. Yeah,
that makes a lot of sense.And you mentioned dietary supplements, and I
want to talk about a new studythat was published in the journal Nutrients that
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looked at the natural substance modified citruspectin. What is modified citrus pectin?
Yeah, so this looked at avery specific modified citrus pectin, and me
as the guest, I need toactually be very clear that this was the
pectosol version by econugenics. This wasnot just any modified citrus pectin, because
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there are differences, and the differenceslie in the manufacturing process and the size
of the molecule. The smaller thesize, the better it works. Is
what's called the galectin three inhibitor andone used in this study and the earlier
phase study that preceded it. Becausethis is a twelve month study you're talking
about, and they had an initialsix month study. The product that was
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used was pectisol or pectisol. Seeit wasn't another modified citrus pectant. We
need extreme clarity and you can't justswitch one out from the other. That
said it was a landmark study.It was amazing because this is a nutrient,
a nutritional supplement derived from the pithof citrus fruits. And what we're
talking about is the white, breadyinner part of the citrus peel. That's
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where the pectin is. And thecompany modifies the citrus pectin into a really
tiny size and it gets into thebloodstream and it can neutralize a molecule called
galectin three. Galectin three, we'veheard the word lectin. There's a prefix
on there called gal It's a certaintype of lectin. It's the third one
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that I think was discovered in thegalectin series, and it happens to be
an inflammatory molecule. I mean,look, molecules in the body serve a
purpose. So there's a custodial levelof galectin three that's acceptable, but high
pathologic levels or disease based collecting threeare things we don't want a lot of
people don't know this, but galectinthree was really famous. Well, I
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guess I wouldn't say it was instrumentalin the response, the inflammatory response and
the sickness that was caused by theSARS CoV two or the coronavirus which was
called COVID nineteen. Galectin three didn'tget a lot of airtime for that,
but it is absolutely a huge playerin that whole inflammatory pathway, in that
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systemic inflammatory response syndrome, which wasquote new but when you look at people
at high galectin three, so weused it there. Well, the same
can be true in the inflammatory anclemetabolic milieu of a prostate cancer. And
so the study that you're talking aboutwas preceded by an initial six months where
there were patients who were entered intothe study and who took four point eight
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grams of the modified citrus pact andcalled pectisol three times a day for six
months, and it was taken bymouth. It's easy to take. Look,
I take it from time to time. For me, it tastes great,
it's a beautiful lime flavor mixes andwater gives me superpowers. I really
like it. As long as theydid not have any disease progression, they
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were allowed to continue for an additionaltwelve months, and this is the story
that was just the paper that wasjust published in Nutrients. So forty six
people were eligible for the continuation oftwelve months. Seven of them said,
you know what, I don't wantto travel to the study site. I
love this stuff. I'm going tocontinue taking it. Thirty nine people continued
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and were on trial, and theytook it three times a day. Now,
what's interesting is of those forty sixpeople, there was an eighty five
percent response rate. That's a bigdeal. Eighty five percent overall response rate,
which is a huge number of responses. Now, what's interesting is that
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it wasn't just it was not acherry pick study, meaning they weren't just
selecting people who had you know,we're going to be predicted to respond.
Actually, twenty one percent of thepatients in the study had the advanced glease
in grade either eight, nine orten. Thirty eight percent of these patients
had actually prior hormone therapy, andall of these patients had either the prostate
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removed, the prostate radiated, ora combination of both. And all of
these patients who have been primarily treatedthen had what's called biochemically relapsed prostate cancer.
That's when you had either radiation,surgery or the combination of both,
and your PSA over time began togo up again, which means there's still
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prostate cancer cells in your body.So to qualify you had to have gone
through primary treatment and you also hadto have this biochemically relapsed prostate cancer.
So again, what did they do. They took They took this substance,
the pectasol. They took it threetimes a day. And what was really
interesting is that at the end ofthe study, at the end of twelve
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months, ninety percent of these peoplestill had negative scans. Now ten percent
of them had disease progression. Diseaseprogression means either they found something on scan,
which could be a single lymph node. And when you get a single
lymph node in prostate cancer, andreally that's the only one lighting up,
especially on these advanced testings, youcould either have that remove surgically or you
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can have that rate that node radiatedand you could be back to no evidence
of disease. So really important pointso, and modified citrus pect in this
pecasol can actually hold you. Soeven if they progressed, it doesn't mean
that they had necessarily serious disease.But there's this whole other grouping called PSA
doubling time, and that's the lengthof time it takes from your PSA to
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double. So let's say you startedat point one and then six months later
it was point two, so yourPSA doubling time was like six months.
Well, then it goes from pointtwo to point four. That could take
another eighteen months. And so there'sdifferent risk stratifications or groupings, and so
you could be in a not soserious PSA doubling time group, or you
could be in a PSA doubling timemore serious group, which is somebody that's
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doubling more quickly. Well with inthat disease progression. Ten percent of the
people, like I said, hadprogression, which means either their doubling time
became worse, like more quickly,or they had positive SCAN. Ninety percent
of people either had stayed in thesame risk or stratification for doubling time or
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went into a better doubling time category. What that means is it actually took
longer for their PSA doubling time todouble or their PSA to double, and
they continue to have negative SCAM.So that's a year and again this is
built on another six months is andthey basically a phase one phase two and
not your typical phase one phase twowhere they look for toxicity just a we'll
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call it rather a two part studywhere they looked for patients progressing and they
didn't. And that's why it's aphenomenal study. Yeah, and ninety percent,
that's a huge percentage. So howsafe is modified citrus pectin? I
would well, incredibly safe. Imean from a physician's perspective. You know,
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it's out on the open market.There are some people who have some
bottel sensitivity because it's a fiber likesubstance. And so if somebody's taking like
a full dose, which we callone scoop, which is basically five grams
or four point eight grams of theactual substance and they mix it in water
and chug it down. If you'reon an empty stomach, that's probably going
to cruise past your you know,stomach and interi your intestines, and that
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might cause you know, a prettyquick transit time and may give you a
little bit diarrhea and you may sufferfor a day, which means you might
want to you might want to takeit more slowly. You could divide your
dosages up. I've had some patientsactually mix up a dose, keep it
in a glass on the counter,and it seems to the longer it's in
(24:17):
room temperature water, because in myopinion, it mixes best in room temperature
water. The longer it's in roomtemperature water sort of, the the better
it mixes, and kind of thethicker it gets. And I think it's
a little easier on the GI SoI'm like, you know, if you're
going to take it two times aday or three times a day, keep
the glass out there and when youwalk by sip it, or if you're
at work, keep it on yourdesk just kind of sick on it and
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you're getting it in your body.It also comes in capsules. It also
comes in tablets, and so thoseare other ways to get it. In
capsules, you have to take apretty hefty dose. I think you're looking
at fifteen capsules a day for ifyou take in the three dosages a day,
and that's a lot of extra stuffand a lot of you know,
capsules, and then the tablets youcan some people take those as a one
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dose because I believe four point eightgrams is going to equal for pretty big
chewable tablets, and some people kindof get sick of eating those after a
while, so the powder still rainsas the most popular version of the product.
Okay, perfect, So I dowant to we have several minutes left,
and I do want to talk aboutdiet because I've been reading some research
(25:21):
on plant based diets, specifically formen with prostate cancer. So what are
your dietary recommendations. Well, it'splant based or plant forward. A lot
of people just can't handle the plantbased. My experiences that about ninety two
percent of the time a man withA type blood is going to really be
(25:41):
able to handle a true vegan dietA grid fifty percent of those people are
going to go for a while andthen they're going to need a fish add
back. They're going to they needsomething a little bit more heavy on the
protein. You can supplement their protein. When people come to me and they're
(26:02):
O type blood or their A Btype blood, they tend to need more
protein and they just don't do aswell on the true plant based So we
call it more of a plant forwarddiet. Book of what you're eating is
plant but tofus. Look, wehave our patients eed soy based foods.
We believe we're advocates. I don'tlike the word believe we're advocates for that.
(26:23):
So I have some great anti prostatecancer activity. I even use some
soy isoflavone, you know, baseddirect supplementation. But sometimes they just need
that more dense protein, and soI tend to favor grass fed, high
quality beef products from cows that arewalking around in grass fed and are happy
(26:45):
versus poultry products. Most people sortof drift towards poultry, but it's really
I mean, if you look atwhat chickens and turkeys and what they eat,
they eat omega six and enriched grainsversus a cow that walks around and
is happy as eating leafy greens,and so the tendency is further to be
less inflammatory products from and after eatingthat meat. So I push people in
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that direction, and usually they're prettyhappy about that recommendation. But the one
thing to watch out for, andthis is a clinical warning from somebody who's
been in the trenches for about twentyseven years treating people, is if you
go plant based or plant forward,and after a good six to eight weeks.
Usually it takes that long to getthere. If you're feeling fatigued,
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it's usually that you don't have enoughprotein and you need to mix it up.
And that might mean that you goneed a burger and you're doing it
once a month and that satisfies you, or once every two weeks something like
that, or you're grilling something ormaybe eat the chicken, and that really
in the scheme of things, itmakes so much of a difference to give
your body what it's calling for versuswhat your head thinks it needs, which
is another reason that you want tobe under the care of a nature pathic
(27:52):
oncologists because these are the subjects.Is our experience. We know how to
manage these things. We can watchlabs. This is not a do it
yourself, Yes, are listening.You know this is serious stuff. A
lot of people don't want to putout the money for this, they don't
want to put out the time.But if you've got prosty cancing, you're
going at it alone. We wishyou best, but there's a lot of
nature pathic oncologists around and we're hereto help. This is what we do
(28:17):
all day. Yeah, absolutely,so, where can our listeners find out
more about you and your clinic.Do you have a website that you can
share with us? We do,and if you're listening, it's a really
great website to remember because it's Listenand Care dot com. Listen and Care
dot com, perfect listening care dotCom. I highly recommend that you check
that out. So Doctor Rubin,thank you again for joining me and talking
(28:41):
about this important subject. Well,thank you so much for having me on.
This was a lot of fun andlooking forward to our next chat Caron.
Absolutely, you are a wealth ofinformation. So that wraps up this
episode of five to Thrive Live onceagain. I'd like to thank our sponsors
pro Thrivers Wellness, Sleep Design specificallyfor Thrivers, immused post biotic to give
(29:02):
your immune system that extra boost,cognizance, it colling to help enhance memory,
focus and attention, and of coursedoctor o'heas award winning shelf Stable probiotic.
All right, everyone, may youexperience joy, laughter, in love.
It's time to thrive everyone. The
Any health related information on the followingshow provides general information only. Content presented
on any show by any host orguest should not be substituted for a doctor's
advice. Always consult your physician beforebeginning any new diet, exercise, or
treatment program. Hello everyone, andwelcome to Five to Thrive Live. I'm
(00:43):
Carolyn Gazzella and I co host thisshow with my good friend, doctor Lise
Alschuler. So, prostate cancer isthe most common cancer among men, and
it's been in the news a lotlately, and that's the topic of our
show. But first I'd like tothank our sponsors, Beginning with Prothrivers Wellness
Sleep. It's a product that campaigncombines higher dose melatonin and other sleep supporting
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And finally, doctor Oheeres Probiotics.It's a best selling probiotic for more than
thirty years and it contains twelve prostrains that our shelf stable so no refrigeration
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probiotic. Learn more at Doctorohira Probioticsdot com. With me today is one
(02:14):
of the pioneers of naturopathic oncology,Doctor Daniel Rubin. Doctor Rubin is the
medical director of Naturopathics Specialists in Scottsdale, Arizona, which has been an integral
part of the Phoenix Metropolitan medical communityfor the past twenty years. Doctor Rubin,
thanks for joining me well, thankyou very much. It's so good
to talk to you again. Iknow it's been a while, doctor Rubin.
(02:37):
I'm so excited that I was ableto host you on this show.
So let's just dive right in.So, with prostate cancer being the leading
cause of cancer death among men,I'm assuming early detection is key. So
how is prostate cancer detected and diagnosed? It's a great question because there is
(02:59):
a lot of work that's gone intothis, especially because of the statistics that
you just gave, and of coursethere's a lot of men on the planet
and prostate cancer can be lurking andsometimes it's just in the background. I
mean, we know that a highdegree of men that die of other causes
upon post mortem autopsy will be shownto have a low grade prostate cancer that
(03:21):
was never diagnosed and never became clinicallyrelevant. But for those that have potentially
about to be clinically relevant disease orearly detection is key. Now I don't
spend time in the early detection spacebecause I'm in the diagnosis space and in
terms of oncology treatment, but theactual diagnosis still depends on the gold standard,
(03:46):
which is a biopsy. But howdo you get to the biopsy?
So how do you actually know ifsomebody needs a biopsy. So usually we
had relied on just regular old pstesting, which really just isn't that great.
And sometimes, unfortunately, even thoughPSA screening is done, sometimes it
(04:09):
doesn't get the attention of the physicianuntil it really gets too elevated. And
I see this a decent amount inmy practice. Unfortunately, the PSA has
been up, they've been following,it keeps going up, but it doesn't
get the attention until it's a littletoo high. Then they get diagnosed and
sometimes unfortunately the men of metastatic disease. So there's some new tools out there
(04:30):
there. There's actually one called xoDX, which is a prostate test.
This one actually is in the realmof helping to decide whether or not a
biopsy. You should really go forwardwith the biopsy, because, like I
said, sometimes the doctors will seean elevated PSA meaning above four point zero,
which is usually a cut score,and be like, ah, this
(04:54):
doesn't seem to be too much.Maybe we don't necessarily need to get a
biopsy, but the EXODX and MEany cases can be useful to detect whether
or not there's a higher probability ofdetecting an aggressive type prostate cancer versus one
that's not as aggressive, and ithelps with basically compliance with physicians recommendation to
either defer the prostate biopsy or toproceed with biopsy. So that's one to
(05:17):
take a look at. There's alsothis sort of subset of PSA which is
called percent free PSA, which isa good hint, and the lower the
fraction of PSA that's freely floating insteadof bound up by like a protein,
the higher the probability there may bea prostate cancer. So just adding the
(05:40):
percent free PSA fraction to a regularps A screening could lead someone in the
direction of getting a biopsy. There'salso some tools. There's the EPI switch
tool which is out there, andthe EPI switch personalized. It's called the
ps Report report. It is atrue prostate screening test and it can show
(06:01):
whether or not there's a low versusa high likelihood of someone harboring a prostate
cancer. It's a blood test andthe confirmation data I believe is in nine
out of ten, so there's aboutninety three percent rate that if somebody tests
in the high likelihood range that abiopsy will show prostate cancer, and I
(06:25):
think the data on PSA screening isin the thirty two percent, meaning thirty
two out of one hundred men whohave a positive cup score for PSA are
going to be diagnosed per biopsy withprostate cancer. And then lastly, I
think one of the ones that's popularizedout there, and I really don't know
(06:45):
how it does with prostate detection,but it's the it's the Gallery test by
a company called Grail, which andit's not just prostate specific. I think
it looks for about thirty different typesof cancer. It's very popularized about thoul
dollars out of pockets, not insurancereimburse but it's a screening test done by
a lot of nature pathic physicians,a lot of functional medicine integrated vectors,
(07:09):
and family practice physicians, and thoseare ways besides you know, a digital
rectal exam, which means men shouldbe going to the doctor regular deleite to
get their checkups, because you stillhave a physical exam that can help detect
a mass or a suspicion if thereis maybe a hard prostate or something like
that. Great, well that's that'sgood clarification. So once we have a
diagnosis of prostate cancer, how isit typically treated. Well, some well
(07:33):
it's going to depend on the stage. So if you get a biopsy and
if it's diagnosed and you have aprostate cancer, you're going to get a
stage in a grade. And thegrade is generally called the Gleason score.
That's a score meaning how aggressive doesthat prostate cancer look? Aggressive? Meaning
is likely aggressive? You know,just like if you were anything that's aggressive.
(07:58):
Those that are less aggressive tend tobe less voracious on the body.
Those that are more aggressive could havemore impact like metastatic disease and cause havoc
can eventually be lethal to the tothe human that has the prostate cancer.
So gleas in grades that are likearound six, because it's basically six to
ten is where you're going to seeyour gleas in grades, ten being the
(08:18):
highest, six being on that lowend and depending on the person's age,
vitality level, life expectance, seekgleas in grade and then staging, which
looks at a scan to see ifmaybe some lymph nodes may be suspected or
if there's any skeletal lesions. Somemay actually just fall unto the observation role
(08:39):
watch PSA, you know, doprostate exams, watch how they feel,
maybe watch a scan here, andthere are some other labs, and these
people may may not never have progressivedisease, especially if they go see a
nature pathic oncologist or somebody skilled inthat realm or similarly trained to a nature
pathic oncologists or rather similarly skilled whocan manage that disease. We're not just
(09:00):
talking about a general practice nature pathicphysician or integrative doctor. This is somebody
who is skilled in oncology and alsoknows when to proceed and when you need
to proceed with conventional because as youget into the higher gleas in grades,
now you're going to start maybe havingthese people at initial diagnosis get diagnosed with
metastatic disease. So somebody with aneight, nine or ten, which is
(09:24):
a more aggressive gleas in grade,may actually diagnosis on scan. And there's
various new scans out Some are fancierthan others. Some may be just a
pelvic MRI, and some may goall the way to do a PSMA PET
scan, which is a polarify scan. It's a gallium scan basically, and
they can detect metastatic disease, evenif it's local disease, like the sort
(09:46):
of nodes in the pelvis look suspiciousor uptake. The contrast on the scan
that could upstage somebody. Or ifthey see a bony lesion in the pelvis
or in the hip or in thearm, that's going to put somebody in
advanced stage disease. And then that'sgoing to depend on how it's treated.
So really making sure that you geta clear diagnosis because some people, some
(10:07):
doctors may say, hey, wegot prostate cancer, we need to move
to a prostatectomy, we need prostateremoval. But sometimes you need to put
the brakes on that because some peoplemay not be the best candidates for surgery
because they may have what they callextra prostatic disease, meaning that even if
it's spread metastasis wise to the localnodes, it also could be leaking out
(10:31):
of the prostate capsule. And somy suggestion is to really go with a
physician who is going to do agood diagnostic workup after the diagnosis of prostate
cancer, no matter what the gleasinggrid is, before deciding what to do.
Because this is cancer, and eventhough there's some rules, rules are
meant to be broken in oncology,and that's a rule. This is meant
(10:54):
to be broken. So we haveto make sure that the diagnosis is right
so you can approach. Some primarytreatments are going to be the prostatectomy,
and some men may be cured.Some may not be as good of a
prostatectomic candidate, and they may gothrough a conventional treatment with primary radiation therapy
and that may have curative intent.Also, some may have a combination of
(11:15):
prostatectomy followed by radiation. Some mayeven require androgen deprivation therapy in the conventional
realm. And that's for the youknow, that's more a diagnosis in the
upfront approach. Once you get intothe later stages, in the more advanced
disease or recurrent disease, you know, depending on where you have lesions versus
what's called biochemical recurrence, which issomething you and I are going to get
into later, I believe. Thenyou start looking at small molecules, sometimes
(11:39):
chemotherapeutics, radiation outside of the prostate, and other you know, sometimes clinical
trials and it gets treated more likeyou would think a typical ad nocarcinoma would
get treated. But those are thegeneral conventional approaches perfect. I'm glad that
you brought up natropathic oncology because youhave advanced training in naturopathic oncology, just
(12:01):
like after all Showers. So fromyour perspective, from that naturopathic standpoint,
how do you generally approach prostate cancertreatment? Well, I look at data.
And when I say data, I'mnot necessarily looking at studies. I'm
looking at the individualized patient data,which means I'm narrating the pathology report to
(12:24):
them. I think it's really importantto start there, know that pathology report,
know the case before you have yourfirst visit with the patient. So
we always ask for records to besent ahead of time so we can be
familiar if we have to review somethingor we have enough time. You know
there that we're not just looking atthe data. First off, when the
patient comes in and whatever scams theyhave and watching their PSA trend as they
(12:48):
you know, we're watching PSA andwhat led up to biopsy and really,
like I said, dissecting and narratingthat report so they understand it. And
you've got to look for some ofthe really small things like is there Harry
neural invasion was their lymphovascular invasion,what's the gleasing grade? And in what
order was the gleasing grade? Wasthere extra prosthetic extension? And then looking
at the scans and once we havea complete workup, then we got to
(13:11):
see is are they questioning conventional treatment? Was conventional treatment already done as this
person had a prost technic if theyhad radiation? Where are they coming to
me at? And then we runour set of labs. I got to
look at somebody's biophysiological individuality before Iknow exactly what to do, before I
can actually create a more comprehensive treatmentplan. And so we'll start somewhere,
(13:33):
and we oftentimes will start with lifestylechanges. Now nowadays, here we are
in mid twenty twenty four, there'sa lot of info and there's a lot
of stuff out there on lifestyle change. So more than ever, patients are
coming to me already having made atleast some type of dietary change, and
if not having made a dietary change, maybe they're actually aware that a dietary
(13:56):
or lifestyle change is going to needto happen because that information islay been given
to them by family or friends,their kids, or maybe they're consumers of
social media, or maybe they're listeningto excellent podcasts like five to Thrive and
they understand about this stuff, sothey at least approach up, but they're
not sure exactly what they need todo. Whether they need they need to
(14:16):
cut out or cut down on alcohol. Do they need to go to a
plant four to a plant based diet. Do they need to get out of
their chair and out of their bedand start exercise? Like what does it
take? Or maybe this isn't somethingthat needs a lifestyle change. Maybe we
need to jump right to supplementation,some specific supplementation. And again that's going
to depend on the data that Ihave in front of me, and it
(14:37):
may be that somebody is in likea holding pattern. It's like, Okay,
I've got a glease in seven.I don't have any suspicious nodes.
I do have a little extra prostaticextension. My doctor said that I'm a
candidate for surgery, but I don'thave to. I don't exactly, you
know, have to jump to surgeryright now. He wants to give me
another MRI in three and a halfmonths. What can we do now we
(15:00):
have three and a half months andI'm going to put this person on what
I would consider more of a trueanti prostate cancer slash blocking protocol to either
make them a better surgical candidate maybeto bring down that extra prostatic extension so
we don't have what's called a positivemargin on surgery. And a positive margin
is when there's a margin that stillshowed cancer at the cutting line the surgical
(15:20):
excision, and so there may ormay not be cancer left in the body,
which may then if there is,make them a candidate for radiotherapy.
And so I'm going to try andimprove their ability to have a curative type
surgery. I'm going to check themfor circulating tumor cells. I'm going to
do a biophysiological assessment. I'm goingto do an immune assessment. I'm really
(15:41):
going to work them up to seewhat needs to be done, because again,
if somebody already has what I wouldconsider a lifestyle that befits that we
would use for the diagnosis, thenmaybe that's not the issue and I have
to look further. And for me, there's a lot of there's a lot
of press partianers out there who don'trely on labs and they practice a different
(16:03):
way than I do. I havea lot of reliance on labs, not
because I think that's where my skilllies, but because I don't want to
make certain assumptions about a person,and if I can look for something,
I want to make sure that I'mchecking it, So I am doing the
job for them because it's not mylife in front of me. Yeah,
that makes a lot of sense.And you mentioned dietary supplements, and I
want to talk about a new studythat was published in the journal Nutrients that
(16:26):
looked at the natural substance modified citruspectin. What is modified citrus pectin?
Yeah, so this looked at avery specific modified citrus pectin, and me
as the guest, I need toactually be very clear that this was the
pectosol version by econugenics. This wasnot just any modified citrus pectin, because
(16:47):
there are differences, and the differenceslie in the manufacturing process and the size
of the molecule. The smaller thesize, the better it works. Is
what's called the galectin three inhibitor andone used in this study and the earlier
phase study that preceded it. Becausethis is a twelve month study you're talking
about, and they had an initialsix month study. The product that was
(17:10):
used was pectisol or pectisol. Seeit wasn't another modified citrus pectant. We
need extreme clarity and you can't justswitch one out from the other. That
said it was a landmark study.It was amazing because this is a nutrient,
a nutritional supplement derived from the pithof citrus fruits. And what we're
talking about is the white, breadyinner part of the citrus peel. That's
(17:33):
where the pectin is. And thecompany modifies the citrus pectin into a really
tiny size and it gets into thebloodstream and it can neutralize a molecule called
galectin three. Galectin three, we'veheard the word lectin. There's a prefix
on there called gal It's a certaintype of lectin. It's the third one
(17:55):
that I think was discovered in thegalectin series, and it happens to be
an inflammatory molecule. I mean,look, molecules in the body serve a
purpose. So there's a custodial levelof galectin three that's acceptable, but high
pathologic levels or disease based collecting threeare things we don't want a lot of
people don't know this, but galectinthree was really famous. Well, I
(18:17):
guess I wouldn't say it was instrumentalin the response, the inflammatory response and
the sickness that was caused by theSARS CoV two or the coronavirus which was
called COVID nineteen. Galectin three didn'tget a lot of airtime for that,
but it is absolutely a huge playerin that whole inflammatory pathway, in that
(18:40):
systemic inflammatory response syndrome, which wasquote new but when you look at people
at high galectin three, so weused it there. Well, the same
can be true in the inflammatory anclemetabolic milieu of a prostate cancer. And
so the study that you're talking aboutwas preceded by an initial six months where
there were patients who were entered intothe study and who took four point eight
(19:03):
grams of the modified citrus pact andcalled pectisol three times a day for six
months, and it was taken bymouth. It's easy to take. Look,
I take it from time to time. For me, it tastes great,
it's a beautiful lime flavor mixes andwater gives me superpowers. I really
like it. As long as theydid not have any disease progression, they
(19:25):
were allowed to continue for an additionaltwelve months, and this is the story
that was just the paper that wasjust published in Nutrients. So forty six
people were eligible for the continuation oftwelve months. Seven of them said,
you know what, I don't wantto travel to the study site. I
love this stuff. I'm going tocontinue taking it. Thirty nine people continued
(19:47):
and were on trial, and theytook it three times a day. Now,
what's interesting is of those forty sixpeople, there was an eighty five
percent response rate. That's a bigdeal. Eighty five percent overall response rate,
which is a huge number of responses. Now, what's interesting is that
(20:07):
it wasn't just it was not acherry pick study, meaning they weren't just
selecting people who had you know,we're going to be predicted to respond.
Actually, twenty one percent of thepatients in the study had the advanced glease
in grade either eight, nine orten. Thirty eight percent of these patients
had actually prior hormone therapy, andall of these patients had either the prostate
(20:30):
removed, the prostate radiated, ora combination of both. And all of
these patients who have been primarily treatedthen had what's called biochemically relapsed prostate cancer.
That's when you had either radiation,surgery or the combination of both,
and your PSA over time began togo up again, which means there's still
(20:52):
prostate cancer cells in your body.So to qualify you had to have gone
through primary treatment and you also hadto have this biochemically relapsed prostate cancer.
So again, what did they do. They took They took this substance,
the pectasol. They took it threetimes a day. And what was really
interesting is that at the end ofthe study, at the end of twelve
(21:15):
months, ninety percent of these peoplestill had negative scans. Now ten percent
of them had disease progression. Diseaseprogression means either they found something on scan,
which could be a single lymph node. And when you get a single
lymph node in prostate cancer, andreally that's the only one lighting up,
especially on these advanced testings, youcould either have that remove surgically or you
(21:38):
can have that rate that node radiatedand you could be back to no evidence
of disease. So really important pointso, and modified citrus pect in this
pecasol can actually hold you. Soeven if they progressed, it doesn't mean
that they had necessarily serious disease.But there's this whole other grouping called PSA
doubling time, and that's the lengthof time it takes from your PSA to
(22:02):
double. So let's say you startedat point one and then six months later
it was point two, so yourPSA doubling time was like six months.
Well, then it goes from pointtwo to point four. That could take
another eighteen months. And so there'sdifferent risk stratifications or groupings, and so
you could be in a not soserious PSA doubling time group, or you
could be in a PSA doubling timemore serious group, which is somebody that's
(22:26):
doubling more quickly. Well with inthat disease progression. Ten percent of the
people, like I said, hadprogression, which means either their doubling time
became worse, like more quickly,or they had positive SCAN. Ninety percent
of people either had stayed in thesame risk or stratification for doubling time or
(22:48):
went into a better doubling time category. What that means is it actually took
longer for their PSA doubling time todouble or their PSA to double, and
they continue to have negative SCAM.So that's a year and again this is
built on another six months is andthey basically a phase one phase two and
not your typical phase one phase twowhere they look for toxicity just a we'll
(23:10):
call it rather a two part studywhere they looked for patients progressing and they
didn't. And that's why it's aphenomenal study. Yeah, and ninety percent,
that's a huge percentage. So howsafe is modified citrus pectin? I
would well, incredibly safe. Imean from a physician's perspective. You know,
(23:33):
it's out on the open market.There are some people who have some
bottel sensitivity because it's a fiber likesubstance. And so if somebody's taking like
a full dose, which we callone scoop, which is basically five grams
or four point eight grams of theactual substance and they mix it in water
and chug it down. If you'reon an empty stomach, that's probably going
to cruise past your you know,stomach and interi your intestines, and that
(23:55):
might cause you know, a prettyquick transit time and may give you a
little bit diarrhea and you may sufferfor a day, which means you might
want to you might want to takeit more slowly. You could divide your
dosages up. I've had some patientsactually mix up a dose, keep it
in a glass on the counter,and it seems to the longer it's in
(24:17):
room temperature water, because in myopinion, it mixes best in room temperature
water. The longer it's in roomtemperature water sort of, the the better
it mixes, and kind of thethicker it gets. And I think it's
a little easier on the GI SoI'm like, you know, if you're
going to take it two times aday or three times a day, keep
the glass out there and when youwalk by sip it, or if you're
at work, keep it on yourdesk just kind of sick on it and
(24:37):
you're getting it in your body.It also comes in capsules. It also
comes in tablets, and so thoseare other ways to get it. In
capsules, you have to take apretty hefty dose. I think you're looking
at fifteen capsules a day for ifyou take in the three dosages a day,
and that's a lot of extra stuffand a lot of you know,
capsules, and then the tablets youcan some people take those as a one
(24:59):
dose because I believe four point eightgrams is going to equal for pretty big
chewable tablets, and some people kindof get sick of eating those after a
while, so the powder still rainsas the most popular version of the product.
Okay, perfect, So I dowant to we have several minutes left,
and I do want to talk aboutdiet because I've been reading some research
(25:21):
on plant based diets, specifically formen with prostate cancer. So what are
your dietary recommendations. Well, it'splant based or plant forward. A lot
of people just can't handle the plantbased. My experiences that about ninety two
percent of the time a man withA type blood is going to really be
(25:41):
able to handle a true vegan dietA grid fifty percent of those people are
going to go for a while andthen they're going to need a fish add
back. They're going to they needsomething a little bit more heavy on the
protein. You can supplement their protein. When people come to me and they're
(26:02):
O type blood or their A Btype blood, they tend to need more
protein and they just don't do aswell on the true plant based So we
call it more of a plant forwarddiet. Book of what you're eating is
plant but tofus. Look, wehave our patients eed soy based foods.
We believe we're advocates. I don'tlike the word believe we're advocates for that.
(26:23):
So I have some great anti prostatecancer activity. I even use some
soy isoflavone, you know, baseddirect supplementation. But sometimes they just need
that more dense protein, and soI tend to favor grass fed, high
quality beef products from cows that arewalking around in grass fed and are happy
(26:45):
versus poultry products. Most people sortof drift towards poultry, but it's really
I mean, if you look atwhat chickens and turkeys and what they eat,
they eat omega six and enriched grainsversus a cow that walks around and
is happy as eating leafy greens,and so the tendency is further to be
less inflammatory products from and after eatingthat meat. So I push people in
(27:07):
that direction, and usually they're prettyhappy about that recommendation. But the one
thing to watch out for, andthis is a clinical warning from somebody who's
been in the trenches for about twentyseven years treating people, is if you
go plant based or plant forward,and after a good six to eight weeks.
Usually it takes that long to getthere. If you're feeling fatigued,
(27:29):
it's usually that you don't have enoughprotein and you need to mix it up.
And that might mean that you goneed a burger and you're doing it
once a month and that satisfies you, or once every two weeks something like
that, or you're grilling something ormaybe eat the chicken, and that really
in the scheme of things, itmakes so much of a difference to give
your body what it's calling for versuswhat your head thinks it needs, which
is another reason that you want tobe under the care of a nature pathic
(27:52):
oncologists because these are the subjects.Is our experience. We know how to
manage these things. We can watchlabs. This is not a do it
yourself, Yes, are listening.You know this is serious stuff. A
lot of people don't want to putout the money for this, they don't
want to put out the time.But if you've got prosty cancing, you're
going at it alone. We wishyou best, but there's a lot of
nature pathic oncologists around and we're hereto help. This is what we do
(28:17):
all day. Yeah, absolutely,so, where can our listeners find out
more about you and your clinic.Do you have a website that you can
share with us? We do,and if you're listening, it's a really
great website to remember because it's Listenand Care dot com. Listen and Care
dot com, perfect listening care dotCom. I highly recommend that you check
that out. So Doctor Rubin,thank you again for joining me and talking
(28:41):
about this important subject. Well,thank you so much for having me on.
This was a lot of fun andlooking forward to our next chat Caron.
Absolutely, you are a wealth ofinformation. So that wraps up this
episode of five to Thrive Live onceagain. I'd like to thank our sponsors
pro Thrivers Wellness, Sleep Design specificallyfor Thrivers, immused post biotic to give
(29:02):
your immune system that extra boost,cognizance, it colling to help enhance memory,
focus and attention, and of coursedoctor o'heas award winning shelf Stable probiotic.
All right, everyone, may youexperience joy, laughter, in love.
It's time to thrive everyone. The
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