Elizabeth Stein 0:00
Hi, everyone. I'm Elizabeth Stein, founder, and CEO of Purely Elizabeth. And this is Live Purely with Elizabeth, featuring candid conversations about how to thrive on your wellness journey.

This week's guest is Dr. Sanjay Juneja, a practicing triple board-certified hematologist and medical oncologist known nationally as the OncDoc, where he boasts over half a million subscribers across his social media platforms. He is also the host of Target Cancer Podcast, where he chats with distinguished guests discussing novel advancements and conceptual challenges of cancer as a whole.

Dr. Juneja has been featured on CNBC, BlueBurg, WebMD, and the Washington Post and serves as an active international keynote speaker, as well as a contributor for Entrepreneur Magazine. Dr. Juneja currently practices alongside his wife at the Mary Bird Cancer Center in Baton Rouge, Louisiana. In this episode, we talk about what everyone should be doing to detect cancer early, including the potential of some new screening methods, his top diet and lifestyle tips for preventing cancer, how our genetics only account for 15% of cancers, the future of cancer treatments, including AI, and so much more. Keep listening to get all your questions answered about cancer and me, Dr. Sanjay Juneja.

Elizabeth Stein 2:25
Dr Sanjay Juneja, welcome to the podcast. It's an absolute honor and pleasure to have you on today.

Dr. Sanjay Juneja 2:32
Thank you for having me and for everyone who listens and getting educated, it does take a village to help the healthcare system, and everyone, I think, needs to be their biggest advocate. So I very much respect people taking the initiative and it's unfortunate to have to, but I think that's the safest thing to do.

Elizabeth Stein 2:50
Absolutely, and I love that about you and your TikToks and just bringing this education and awareness. As I think back to my grandfather having cancer, it was like, oh no, we're going to talk about the C word and it was this thing we didn't want to talk about. So bringing it really into the conversation and how we can be preventative and the best things we can be doing when we do have a diagnosis. So, thank you for all the work that you're doing.

Dr. Sanjay Juneja 3:19
Oh, of course, it's an honor. I feel like the universe always has a purpose for you. And it's not for success or things in vain. It's like if you reach those things if you get a viewership on TikTok, or if you can work hard enough and get into whatever that is, it may seem like it benefits you, but I think they're all a means to an end, to benefit the world, and I think we all have it, and that's why I always use the word honor because it's a privilege to be able to help the world.

Elizabeth Stein 3:49
Yeah. Did you always feel like this was your calling? At what point did you know that this was your destiny?

Dr. Sanjay Juneja 3:57
I always wanted to be a teacher. I knew that much. A science teacher in middle school had a pretty influential one that made me appreciate what would be silly things like why the leaves change and why the speed of taking a turn on your car has to go down because of the friction. So I was like, wow, it just makes the world more, I guess, enchanting. And then I got into a bad car accident. Coincidentally, after the example I just used, it was not on a turn and I was legally blind for a while.

And I remember when people asked, “Well, weren't you scared you wouldn't see again?” I was like, “I was weirded out by the fact that I wasn't and I was wondering why.” I wasn't medical at this point, but my ophthalmologist would tell me this is what's wrong, this is what your pressure is, it's blocked up. This is why you're doing the drop, this will open it up, and then we celebrate little victories. So it was that whole process that I chalked up to what reduced the fear of the long term, and gave you micro goals and you had victories during a time you still couldn't see, and then that translated to cancer.

I was like, where else can you use that? And a doctor means a teacher. That's why the PhDs were the first doctors. So I still get to teach but I get to hopefully make something on the surface very scary, I mean still scary, but less scary is the hope, that you can still live and enjoy despite that, whether it's curative or incurable. People live for years now. But either way, even if it's curative, it can still be debilitating mentally. But I think the more you understand, I see that every day in my clinic, someone that's very meek and then all of a sudden vibrant. Four weeks in, diagnosis hasn't changed, but they're just living their best life and I think that has to do with education.

Elizabeth Stein 5:42
Yeah, I love how you use the word reducing the fear. I think that that is so powerful and something that, like you said, might not change, but it's all that mindset shift and something that, quite frankly, all of us can use, whatever it is in life of we need to be reducing fear, of so many things that come in our way.

Dr. Sanjay Juneja 6:04
I mean, if you sat down and thought about it and I do this sometimes, I did philosophy in undergrad and it's called an existential crisis. But if we all sit down, I'm sorry if this sounds graphic, but there is a natural month, day, and year of when our time is up and we forget about it. We just don't think about it. But if you were to, and things of the world going on and everything, you start to freak out. So it hasn't changed. That fact hasn't changed.

But that moment you've thought about is very scary and makes you don't want to do anything. And the next day, you stop thinking about it or you're like, yeah, I understand that. But I'm going to do XYZ and be the best dad I can. It's the same principle. It's just a matter of we're all finite, cancer, no cancer, etc. How much do you let it temper you from doing the most for your family yourself your friends or the world, whatever it is? We do it all the time and I think this is just another example of that, if that makes sense.

Elizabeth Stein 7:01
Yeah, absolutely. So you went to school, you studied, you started practicing? Certainly, not every oncologist has this type of practice and treatment of how you work with clients or patients. Was that something that did come to you right away? How did you learn your area of expertise?

Dr. Sanjay Juneja 7:24
Well, I mean what it takes to be a board-certified hematologist or oncologist. I think the quickest you can do is 14 years. So 14 years, I have all the boards and everything as anyone else. And I do practice traditionally, like with the same guidelines. And you have to because the treatments are so expensive that we approve that we’re data supported. But so I say my practice, in the sense of the treatments, is more or less the same. I am more keen on the trials before they get approved if they work well.

The sad fact is there's a whole bunch of things that are very promising right now that people are getting, that you just can't get, and I guess rightfully so until they demonstrate an actual overall benefit, either survival or recurrence, even if they look great. That's the humility of medicine. Being aware of trials and there's a bunch of stuff now that helps patients like find them themselves if their doctor is very busy and there's not a lot in town. And then, of course, consider the things that you don't learn in the traditional system when it comes to nutrition and diet. Again, this is something that's truly far more complicated than it seems.

Elizabeth Stein 8:33
That's the piece I'm curious how you learn not what you're taught in school, but other pieces are so important.

Dr. Sanjay Juneja 8:41
There's a cost there. Like I don't have much time. I work very full time and I'm back for weeks. I don't think it's right that it needs to be a medical oncologist that says they can't speak on those things and then not have your medical oncologist. That's not fair to a patient. The whole family is strung out, has a scary diagnosis, and then you're like, “Oh, but you got to go figure it out in different localities, in different places.” You also get that thrown on you on top of just the whole news. So I think there's a lot that can be done to hopefully reduce the burden of what the caregivers and the patients have to take on because I think anyone would agree that it's enough to have a cancer diagnosis and treatments.

Elizabeth Stein 9:35
Absolutely. So before we get into some of all of that, let's get into the foundation. We all know what cancer is, but let's get to the root of what happens in the body when we have cancer and some of that foundational stuff that we might think we know but have overlooked perhaps.

Dr. Sanjay Juneja 9:53
So I think even what cancer is may be challenging to understand in its root, and what it is, basically what was or were your normal cells that change, either in its environment. Your normal cells. Remember, your hand is a different hand in five years. I always thought that was silly, but what they mean is nothing you're seeing existed five years ago. These are all cells that have come since then. That happens to everything in your body. So your cells are constantly dying and replicating. If there's a place in your body where things have gone awry, things had some mutations that'll make it continue to live and not be in order, not die when it's supposed to and stuff, if they go undetected by your immune system or by your police system that's within the cell, then those continue to get fertilized. And then all of a sudden, this population of cells, otherwise known as mass, is now a cancer. But it is your cells. It still has the same DNA and things that you were born with. That's what makes it so challenging, because how do you beat something that is you but just with extra tools? If it's in one place, obviously you just hack that whole colony out, that whole rogue colony that somehow escaped over usually months or years potentially depending on the type. You just want to take that and a whole bunch of not affected stuff around it. That's why you do a lump back with breast cancer. That’s why you have to colonize with colon cancer. Might say like why don't they just cut it out? Because you want to make sure everything around it if they're even thinking about going rogue and fighting overhauling the government if they're even two steps away, we're going to cut all of it out. So the best thing you can do is remove the population.

But when it starts to spread, or what's usually a stage three, now it is developed a way to hitchhike and it learned how to put a thumb up and get a ride on your lymph nodes and start going into your lymph nodes. It learned how to jump off the highway and make a new neighborhood somewhere else in your lungs. That's what cancer is doing. It's being your normal cells that take up a lot of your energy, a lot of your calories and it's just doing what it's told to do inherently, which is live. That's why many of us are alive today. If we didn't have the inherent ability for ourselves to say, I will let all costs live, then we wouldn't have evolved. So what happens is that cell that has that inherent property I will live with doesn't know any better that it's being bad. It just says I gotta do everything I can. That's what makes cancer so hard to beat because you're trying to beat thousands of years of evolution involvement.

Elizabeth Stein 12:32
Before we get into talking about how to beat it and some of that, certainly one of the best things that we can do is prevention and early diagnosis. We'd love to hear a little bit about where we are today with early diagnosis. What should everybody know of the best things that they can do to find and diagnose cancer early?

Dr. Sanjay Juneja 12:59
Number one is the boring answer but the most important one you've got to get your screening that's approved. Health insurance companies and the healthcare system are not trying to give away money, right? They will not do something if it costs them. They will do something if it saves them. But guess what costs a lot of money? Having cancer. So if they have approved, they'll say, I'll give you something like this every five or ten years or every year. I'll pay for it. It's on me, bro. They're doing that because the data shows that if you do that, you will avoid a bad situation to some degree. So that means the mammograms at 40 or 45, sooner if you have a primary family member, depending on their age. It means colonoscopies or the cards or whatever. You talk to your doctor what’s the latest. But these things are designed at the intervals of whether it's a year, whether it's five years, ten years, those intervals are also calculated because they're like, hey, we're gonna save money if we do it in five years or a year in two years. Because if we wait too long, now we're spending a lot of money on people having stage one cancer. It sounds barbaric, but at least that's an idea of saying, okay, I get it, I get why they're paying for this. That's why the mammograms are important. The pap smears are so important. Unless I'm too old when Gardasil wasn't out. Gardasil knocks away 85%- 90% of the viruses that cause cervical cancer in females and males. But especially if you didn't get that or get more than one partner, paps are very important. That's when they say should be curable because usually that takes a long time to be truly invasive cancer. That's why it's annoying when you're like, I need a pee, I need a cone, or they gotta go back and do this. Well, because they're seeing that it wants to be cancer. It's on its way. That's why they are obsessed with it. Because you don't want it to be invasive and spread.

It's pretty challenging. So, do all your screening. Then you can google it. If you're a smoker, you need an annual low-dose CT scan. If you're over 50, that's missed 90% of the time by doctors. It's shameful. Saves one out of four people's lives. Outside of all the screening, there are all kinds of more creative ways that you could do and detect cancer. There's a lot that's happening and that's what I talk about on my podcast, Target Cancer Podcast, but they're not approved. That's the challenge. But this whole thing with grail that everyone talks about, or the cancer test is what they call it. When you get that blood test, it checks you for 50, or 60 cancers.

Elizabeth Stein 15:29
How good is that test?

Dr. Sanjay Juneja 15:31
It's pretty accurate. If you have it, it'll tell you. But it'll just tell you that you have or don't have it at that moment. It doesn't tell you about six months from now, a year from now. It just tells you do you have cancer currently? And that's the challenge with screening. You're checking to see if it's there?

The ideal thing with mammograms pap smears and colonoscopies, is you're not just checking to see if you have cancer. You're checking to see if you have a sketchy person that looks like they will become cancer. That's why you get the investigations. That's why you get the biopsies. It's like is this thing gonna cause a problem? That's the way you win because then you take out that polyp on the colonoscopy. You took out a chance of it being cancer, and we know which ones have a high likelihood. Same with the pap smears, same with the mammogram, and same with skin lesions. That's why if something looks sketchy on your skin, you gotta get it checked out because you don't want it to become a cancerous lesion. So all these tests, the Kim Kardashian one.

Elizabeth Stein 16:30
But that was to be my next question. The Prenuvo, is that what that's called?

Dr. Sanjay Juneja 16:33
Right, yes. There's a bunch that are like that. They're good in the sense that they can pick up things that are hotter or sketchy. Hotter in the sense of working harder, like a PET scan. PET scan lights up where there's activity.

Cancers have high activity. There's so many things coming out to show. We can find where in the body something is getting hotter or looking like why are they eating so much protein? Like a gym head. Usually, if you're on protein, you're jacked. It's that correlation that a lot of these tests will be able to find and hopefully see sooner because we don't have a lot of screening for it. But by far, the most important thing is, if you are losing weight and you don't know why, depression is a big reason. And other things but you're just losing weight, especially if you don't have hunger or your energy is just considerably less than it was three months ago. These are all things that say should I go see my doctor to see if I need to investigate something if there's just no reason for these things happening?

Elizabeth Stein 17:31
Do you think that some of these newer technologies, i.e., that full body scan, etc., are going to soon be covered under insurance, or do we have a ways to go for all of that

Dr. Sanjay Juneja 17:43
Yeah, we have a ways to go. If money wasn't an issue, I would get a full body MRI annually on myself if I could. I still haven't gotten one because it's just a bunch of pictures.

It just looks at every single thing and sees if something looks like it's another cancer. Maybe it's a good thing too, I don't know. But the problem is it has to be justifiable. So does doing a full body MRI every year make a difference in people dying or not dying from cancer? You might say, of course, it does. But then they look at the cost and is the cost justified. So it gets challenging in that way.

Most people won't get cancer at the end of the day. It's not like the odds are everyone will have cancer. Some tumors are out there or things that you can get born with are very rare. One of them is where your ROBOCOP just doesn't work. They have a 50% chance a year of having cancer in that year, 90% of their lifetime. So there are people like that who do qualify for every year, but most people won't. I hope nobody lives in fear of it.

But there's a bunch of things that I'm sure we'll get to that you could do to make sure that, God forbid, if you're faced with that, you can say, well, I did all these things, gave myself the best shot. The key that I try to teach is the world wills what it wills. But did you do the most without being counterproductive to say, well, I did the other thing that I'm supposed to do versus, it's so hard for me with a 40-year-old or 35-year-old that has breast cancer or whatever, so I'll say 45. That's it. Well, I'm behind on XYZ. If you take one message from here, I can undo that, and I feel so bad for the family, for the spouse, that everyone has guilt. Because I knew I needed to. So you get your screenings, you get in a couple of habits that we'll talk about. And you can say the rest is up to God, the universe, whatever you believe. But I did everything I could today that I knew, knowing would reduce my chance of this happening.

Elizabeth Stein 19:50
Okay, great takeaway. Let's talk a bit about some other preventative. We have the screenings, obviously, but if we look at a diet and lifestyle perspective, what are your top three to four things that we can all be doing I'm sure that list might be a lot longer than that, but the top things that you think are moving the needle to prevent cancer?

Dr. Sanjay Juneja 20:14
Yeah. I should preface by saying, that because I'm a full-time oncologist, like I treat cancer, I'm not like an expert on all the preventative stuff, but I can say that my podcast is that. So I can learn from the experts. There was a study that came out this summer. It was pretty awesome and it confirmed what I already knew and read and suspected and we all knew.

But if you take two people who are 45 or 50 neither of them works for the most part. They work, they keep busy, they look after kids and groceries, but they don't work out.

If you take those two people and you make one work strenuously, and by strenuous I mean that heart rate gets up to 150. So you're on that elliptical, you're doing the push-ups where you feel like you're going to die. But that happens to me now because I don't work out. And I'm just like I am so out of shape that if aliens or anything came out, I'd be like the first person gone, like I'm dying after minutes. But the point is, if you get that heart rate up, walk the stairs at your work, whatever, for four minutes, I'm talking four minutes. You can't unhear this, so you may want to get off the podcast because you're going to be burdened with the knowledge from giving you that we were saying did I do everything? Four minutes a day of strenuous activity versus that person that has a normal function of life and isn't, translates to about a 20 to 25% chance of having cancer in their lifetime. That is more than most…

Elizabeth Stein 21:41
Okay. Everybody listens to that. It's four minutes only.

Dr. Sanjay Juneja 21:44
Well, that's how they studied it. So it doesn't mean seven minutes is not great. But it means that just four minutes a day of getting that heart rate up. I'm talking about doing push-ups on your knees, doing the jumping jacks, whatever your test is. It doesn't matter what you're doing, it matters what it puts on your body. So if your heart rate is up to 140, or 150, that's the healthy stress. And that is healthy for a whole podcast. But when that revs up, when your body does that, it immobilizes your immune system. As I told you before cancers happen, they invade the immune system. Don't go take immune boosters on Amazon. It's not the same thing. The immune system is very complicated and there's a whole bunch of good things that happen with that heart rate going up. So those four minutes can make that and it helps with glucose regulation and all this stuff and we'll talk about that in a little bit. But that four minutes makes a huge difference. So if you could do 10 minutes, imagine if you could do 10 minutes two or three times a day. It's unbelievable.

When I used to be a personal trainer, I would tell people I would much prefer not in the gym three days a week for 90 minutes. I would much rather you be in the gym for 20 to 30 minutes, but seven days a week. Everything has to do with the regularity. What is over your lifetime, over your month, what does your body do in a 24-hour period, which is arbitrary, we came up with 24 hours, but throughout your life, those good things, that heart rate stuff, how often did you do it? It's the oftenness. And that's why I also promote cheating in the sense of diet and lifestyle. It's fine. Are you doing it every day or not? Everything just matters on your day-to-day shit. Excuse my language, sorry. How are you and what is your body doing day to day, week to week, month to month, year to year? And that will have humongous implications 10 years from now, five years from now, when cancer rates are going up crazy.

Cancer is a problem of older age. By far the number one factor is waking up the next morning. There's no other factor, outside of inherited, rare things, that makes you more likely to have cancer. That's why by the time you're 65, or 70, as a female, your chances of breast cancer are one in four or one in five. It goes from unlikely to 25% at that age. Why? Because things evade, the immune system wanes, et cetera.

Elizabeth Stein 24:06
I love that as the first one and I think that's very tangible. I think having it be the smaller daily things seems to be a lot easier than having some big goal that you need to do. There are a couple of other preventative lifestyle things we can be doing.

Dr. Sanjay Juneja 24:26
The other one is pretty easy to appreciate because you just have to look at other places on what their diet is. And it's very simple. You look as a scientist and say where is colorectal cancer not happening? Because everyone is talking about it in the media. Younger and younger colorectal cases. And it's just straight-up true. People are getting it in their early 40s, way more than they ever have. And then you look at places that they don't. And then, interestingly enough, they brought some of those people. They're like they have some crazy mutation that'll freeze them of colorectal cancer. We've got to discover it so we can inject it into everybody because everyone wants a shortcut. They brought them over here to study and guess what happened? They also are getting colon cancer.

Then they're like it's not the genes, it's the American diet and what the diets are. Number one, they are more active and walk around more. But number two is the indigenous people of Africa and back where the Eskimo people were before. Now it's become a disaster. When they were on their diets, depending on what's around them with fish and stuff, they were getting very low rates because of mainly two things, especially indigenous. Number one, the carbs. They had mostly low glycemic diets. I know y'all have talked about that, but that seems to be a humongous factor, not just on cancer but on heart disease, dementia, neurologic problems, strokes, all this crappy stuff. Like why are diabetes and being overweight always on the list? I wish overweight wasn't overweight. I'm overweight now and then. It is what it is. But if you look at overweight from highly processed foods, high sugar spikes, needing insulin, having glucose dysregulation, versus overweight that's not for any of those reasons but because they just like to eat but they run and they have a low glycemic diet, they will have different outcomes even though it’s the same BMI and same overweightness. So it's a little bit more. I think people are too fierce or too judgmental on the weight part as much as the diet that led to the weight. High spikes and glucose, we just know. I mean you talked about COVID. These are the people at risk. It just causes calamity and everything.

When insulin isn't enough to do the job, that's where this very sticky thing that is an energy source just has to go places. That's why we have fatty liver. We're just storing it in the liver because we've got nowhere else to go. And then they call it insulin resistance. But it's you just have so many processed spikes in your carbs and sugars that the body's like, bro, I don't know where to put it. Put it in the liver. It's not enough. Let's inject you with more insulin to put it somewhere else. Like that's what we're at and it's not necessarily our fault.

We wouldn't be around if our tongues didn't love high-calorie stuff. When we were nomadic and wearing loincloths and be like, “Dude, why don't we go to eat? I'm hungry.” “No, we'll find something. Let’s chew on some berries.” When you find that fatty kill, you eat it and you love the taste of it.

Those people who didn't love it probably died off because it was three or four days they didn't have the calories. But the ones that loved it were able to get to that next kill. Like I love mangoes, they are so sweet. So we have this almost natural selection to desire things that will keep calories. But now for 99 cents, you will have it handed to you, the bore and the mango and everything through your window in a car, so you don't have to get out. We're one step away from actually having it put to our mouth., it's like six inches away from me. So it's not our fault, because we've adapted this way over thousands of years and the convenience is just too insane. It's like you have to combat what you're primed and wired for. So I don't like the judgment on that piece. But no question having these high process, high sugar, high glycemic spikes which I love, I love a star crunch, they just cause bad problems downstream. Do I eat Star Crunch every couple of nights? Yes. I was a soccer enthusiast and that was my favorite treat in half time. So, try to eat less of that.

And the second reason that people have less cancer is because of this cruciferous vegetable thing and fiber. They all are the same thing. As Americans, we just don't like it. My kids are guilty of this and I blame this because they're American, born here. But I'm like why do kids inherently hate colored things, greens, and vegetables? Like bro, it's a color and it happens to coincidentally be the things that are good for you.

So you've got to have these legumes and nuts and diversify your diet. That's another thing we learn. Other people eat what they can eat. The oats, the legumes, and the cruciferous. They just have a very diversified diet, whereas, in America, it's very narrow. That's why we have a lot of autoimmune diseases and allergies. People are like, “Oh, I break out and rush for this”, and then you're like oh, what do you eat? I don't eat chicken