As part of Breast Cancer Awareness month, one of our clinic’s nutritionists, Melissa Parker, MS CNS CDN, bravely and graciously shares her own story, highlighting the differing options she was offered for breast cancer treatment and why she chose to include the functional medicine (FM) path. Her experience shows just how powerful the levers of diet, lifestyle and environment can be. And illustrates how a carefully-constructed plan that targets epigenetic expression is a key consideration for individuals with BRCA gene mutations. Wishing every reader the best of health. – Dr. KF
I love Autumn. As a lifelong Northeasterner, seeing summer’s green leaves darken to earthy russet and goldenrod shades is a seasonal rite of passage that I relished. Coming from a long line of nature enthusiasts, I was taught from an early age to appreciate and respect the natural world in all of its stages. My family had lots of seasonal traditions, but one of my childhood favorites was our annual pumpkin picking trip. Our relatively short drive to a nearby farm felt like an eternity as I envisioned my route to the Perfect Pumpkin. Before the car fully stopped, I would burst out and sprint towards the rambling paths leading up to the pumpkin patch. Once there, I would carefully comb through the haze of orange globes and twisted stems to find the Perfect Pumpkin. This could be a lengthy process, one that I savored and did not want rushed. Those feelings were not the norm for me, I was in motion much of the time and knew two speeds: fast and faster. In truth, I despised downtime and failed to see its merits. With so much to see, learn, and do why would anyone willingly choose to slow down or, heaven forbid, rest?
Sometimes when we resist certain choices, they are made for us.
It was October 1998, and although I lived in New York City, it still looked and felt like Autumn. The smell of cinnamon permeated coffee shops and pumpkins were on display next to piles of Halloween candy. Even as I rushed through the crowded streets, these seasonal signs were not lost on me.
Each day was fully packed by design with only a smattering of hours to wind down, let alone sleep. I was proud that I could power through meetings, Transatlantic jet lag, 90-minute advanced yoga classes and more with ease and precision. In my mind, this wasn’t simply luck, but the result of a self-designed healthy lifestyle. I had always been very active, played virtually every sport, danced competitively since the age of 7, ran in 2 marathons, and worked out for at least an hour every day. I was a vegetarian, and at times vegan, who never smoked or did drugs, and rarely drank anything besides water. While others grappled with seasonal colds and common ailments, I rarely had even the slightest sniffle. My 12-hour workdays in the fashion industry were hectic and demanding, but I loved it. I had amazing friends and family, an endless hobby list, and was newly engaged to my now husband. My life could not have been better.
And then one morning, everything changed.
Through jet-lagged vision after an overnight flight from Paris Fashion Week, I saw the homecoming gift my fiancée left – a bright orange pumpkin with a note that said “Welcome Home! Love, the Perfect Pumpkin”. He loved my pumpkin patch stories and would find ways to surprise me with a pumpkin every year. I felt like a kid again as my fingers instinctively traced each section of the smooth gourd before I started to shower. A rush of happy memories nudged me towards daydreaming as I began one of my daily routines, breast self-examination.
This daily ritual began when I was 18 and recommended due to my family history. Most women on the maternal side of my family had breast cancer at some point in their lives. The majority were diagnosed over 50, in early stages, and had no reoccurrence; however, there were exceptions. My mother was 36 when a small “shadow” showed up on a mammogram (her second ever), she was ultimately diagnosed with stage 1 breast cancer. Although it was fully contained and had not spread, she chose to have a bilateral mastectomy for what she still describes as “peace of mind”. She was otherwise healthy, and other than family history, had no risk factors. I am infinitely grateful that she is healthy today and had no reoccurrence. Unfortunately, her mother was not as fortunate; she was diagnosed with breast cancer at age 29 and passed away due to ovarian cancer shortly before her 40th birthday. As a result, I took what was then considered a proactive stance by seeing a breast surgeon twice a year for thorough exams and learning to do my own. I passed on oral contraceptives due to the potential risk of early onset associated with a familial history of breast cancer. With these actions and lifestyle choices, I believed I could delay the onset of this disease or avoid it altogether.
Still daydreaming, I forfeited my usual, doctor-prescribed visualization of a flower’s petals as I started my daily exam. Instead, I pictured my new Perfect Pumpkin and made each smooth section a “petal”. Between the sleep deprivation and sudden nostalgia, it would have been so easy to miss the tiny bump, but I didn’t miss it. That day, I went to my trusted gynecologist. With confidence, she told me that I was too young to have breast cancer regardless of my family history. She said it was a cyst, and although I never had one before, felt that the “tiny pebble” would go away on its own. Trust me, I really wanted to believe her, but could not shake the feeling that something was wrong.
By sheer luck, I secured an appointment with one of the foremost breast specialists in the U.S. The best-selling books, awards, and pictures with celebrities lining her office walls reassured me of her expertise. “Whatever she thinks it is, she’s right because she is the best” was my mantra that day. So, when she said that the pebble had no tumor-like characteristics, that there was a 1% chance it was cancerous, and I was too young and healthy to have breast cancer I believed her. To confirm what she already knew to be a correct diagnosis, she did a needle biopsy and told me return in a year for a baseline mammogram. I left feeling relieved and confident in her assessment. About a week later, I got the call that everyone dreads, the call that no one can truly prepare for, the tiny pebble was malignant.
I was 28 years old and I had cancer.
The days that followed were a blur of appointments with breast surgeons and oncologists along with gut-wrenching conversations with friends and family as news traveled. I got my one and only mammogram to assess the pebble’s dimensions, but it was undetectable due to the density of breast tissue in women under 40. Eventually, via ultrasound, the pebble was determined to be 1 cm in size and was tentatively categorized as stage 1. The initial cluster of professional opinions were eerily similar, and within the course of a week, I was repeatedly told the following:
The young onset age meant that my cancer was highly aggressive and reoccurrence was likely
A bilateral mastectomy was unnecessary for survival
Rounds of radiation therapy in the chest area were necessary for survival
A highly aggressive chemotherapy regimen was also necessary for survival
I would lose all of my hair and need biweekly shots to encourage healthy white blood cell production during chemotherapy
My radiated skin would harden making any reconstruction extremely difficult
One or both of my arms could swell indefinitely due to chronic lymphedema
There was a 75% chance of infertility due to chemotherapy-driven loss of menstruation
I would experience post-treatment menopause and all of the associated symptoms
I should undergo genetic testing, and if I had the BRCA 1 or 2 gene, an elective oophorectomy (removal of my ovaries) before I turned 40 was ultimately necessary for survival
I was overwhelmed, scared, and, for the first time, did not trust my ability to make good decisions. I no longer trusted myself. Every set of options came with a daunting list of potentially permanent consequences. Temporary setbacks and symptoms I could handle, but the permanency of some felt insurmountable to me. The idea that every bullet point above was inevitable or necessary was difficult to accept, so I sought out answers from other, less conventional practitioners.
It turns out that I had options.
I contacted a previous work colleague that was diagnosed with breast cancer in her mid 30s. For the first time, I heard the specifics of her treatment and ongoing care. She discussed her surgery and staggered chemotherapy protocol layered with IV therapy, dietary interventions, supplement regimens, and yoga with a glaringly positive tone. She shared just one piece of advice – do whatever is necessary to get an appointment with my oncologist, it will literally change your life.
Her oncologist was a highly regarded, Harvard educated, medical doctor with a laundry list of accomplishments. She did not take on new patients unless something in their medical story piqued her interest, I was genuinely surprised that she agreed to see me. We sat down in her office and she asked if I knew why she chose to meet with me. When I said my age was the reason, she partially agreed. She shared that she was intrigued by the fact that my only visible risk factor was genetic predisposition. That despite all of the good lifestyle choices I made and proactive screening, I still got cancer. She wanted to identify factors that tipped the scales towards cancer instead of the opposite and uncover the root cause(s) in order to “rewire” my future responses. She described a treatment plan that included surgery and an open-ended chemotherapy course that we would develop collaboratively. I would work with a nutritionist to create dietary plans focused on detoxification, immune support, genetic expression, and cell regeneration; each one of these processes is particularly important for premenopausal women and reducing cancer risk in women with the BRCA mutation.
Detoxification, in the context of my treatment, was the ability to differentiate pro-cancer cells from healthy cells and ultimately discard pro-cancer cells via detoxification pathways. The ability to reduce drug therapy resistance is also supported by detoxification processes. Carefully monitored nutrient-adjusted diets with periods of fasting have been associated with increased detoxification capacity expressed in a positive ratio of healthy cells to cancer cells (Valter Longo’s work, which you can read more about, or listen to here as he discusses it with DrKF). This was an infrequent, yet important part of my dietary plan.
My regular diet would consist of 9-10 cups of colorful, low glycemic fruits and vegetables each day. The antioxidant-rich micronutrients such as vitamins A, C and E, folate, dietary fiber, phytochemicals in these foodsencourage the activity of cancer-fighting immune cells,. Regular intake of bioactive food components such as genistein, curcumin, theanine, choline, and sulforaphane found in cruciferous vegetables were prioritized due to their healthy cell regenerative capabilities and inhibitory effects on cancer stem cell regeneration. Here at DrKF’s clinic we also recognize these as DNA methylation supportive foods, most of which are known to modify gene expression (along with many other key lifestyle factors) – an important consideration for our BRCA patients.
I would have a daily sleep journal to not only record sleep, but periods of rest. There was no mention of percentages or things that would be permanently damaged, instead, she emphasized the concept of bio-individuality and how together we could likely reset my future genetic expression via these specific treatments and lifestyle modifications. Cancer is known to be a disease of altered gene expression. Some cancer drugs attempt to target this mechanism although their blunt activity is nowhere near as nuanced and refined as phytochemicals appear to be, and their side effects can be severe. My short and long-term treatment included natural protocols to positively affect this genetic expression for my breast cancer.
I chose to give my instincts one more to chance to get it right and they did.
After four rounds of strong, but staggered chemotherapy, an elective bilateral mastectomy, new daily routines that included fresh green juices, a plant-based diet with small amounts of organic animal protein, an emphasis on intestinal health and stress reduction, at least 8 hours of daily sleep, meditation, and acupressure, I no longer had signs of any health issues and was pronounced cancer-free. However, there were a number of things I did have:
Menstrual regularity throughout the entire course of treatment without a single sign of menopause
An absence of swelling, discomfort or physical restriction in both arms
Enough energy and immune-resilience to continue working full time without restriction and remain active
A head of hair that grew back quickly and surgical scars that were now barely detectable
The opportunity to plan a wedding without fear or trepidation
And last, but certainly not least, a renewed trust in myself
You can see the clear contrast from what I experienced versus what I was told to expect because of the different approach I took.
It should come as no surprise that our wedding was in October, October 30, 1999 to be exact. By the Spring of 2000 I was pregnant with my son and three years later had a daughter. I tested positive for the BRCA 1 gene, and at the age of 35, chose to have an elective oophorectomy. During that time, I followed a new career path and became a certified Pilates instructor. Shortly thereafter I obtained a Masters’ degree in Clinical Nutrition and now have the privilege of being a Functional Nutrition Resident at the Sandy Hook Clinic in Connecticut. I am grateful to be part of such a collaborative and diverse community of healthcare professionals. I am continually inspired by their wisdom, generosity, and patient-centric practices. Without functional medicine I truly believe I would not be here today, sharing my experiences as my own children and I head towards the grassy patch that holds the Perfect Pumpkin.
If you’re interested in learning more from the Sandy Hook Clinic about modifying genetic expression, cancer and the BRCA mutation, check out these articles:
This Connecticut native’s interest in health began in childhood, as a competitive athlete and dancer, Melissa Parker strived to perform and feel her best. After earning undergraduate degrees in Health Sciences and Literature at Syracuse University, she embarked on a decade-long career in the fashion industry. She concurrently completed a comprehensive certification program in the Pilates Method. After a diagnosis of breast cancer at 28, Melissa compiled an integrative team of healthcare professionals to oversee her care. As she followed recommended and self-created nutrition therapies, she experienced enumerable health benefits. Inspired by continued health through future surgeries and two pregnancies, she earned a Master of Science degree in Nutrition at the University of Bridgeport and received the highest academic honor of Summa cum Laude. She feels incredibly privileged to help her clients achieve their health goals and be a current Functional Nutrition resident at the Sandy Hook Clinic in Newtown, CT.
Kara Fitzgerald, ND, received her doctor of naturopathic medicine degree from the National University of Natural Medicine in Portland, Oregon. She completed the first Counsel on Naturopathic Medicine-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord, PhD. Her residency was completed at Progressive Medical Center, a large, integrative medical practice in Atlanta, Georgia.
Dr. Fitzgerald is the lead author and editor of Case Studies in Integrative and Functional Medicine and is a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine (IFM)’s Textbook for Functional Medicine. With the Helfgott Research Institute, Dr. Fitzgerald is actively engaged in clinical research on the DNA methylome using a diet and lifestyle intervention developed in her practice. The first publication from the study focuses on reversal of biological aging and was published 04-12-2021 in the journal Aging. She has published a consumer book titled Younger You as well as a companion cookbook, Better Broths and Healing Tonics and has an application-based Younger You Program, based on the study.
Dr. Fitzgerald is on the faculty at IFM, is an IFM Certified Practitioner and lectures globally on functional medicine. She runs a Functional Nutrition Residency program, and maintains a podcast series, New Frontiers in Functional Medicine and an active blog on her website, www.drkarafitzgerald.com. Her clinical practice is in Sandy Hook, Connecticut.
Additional publications
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