When a woman sits across from me after a breast cancer diagnosis, I ask her one question.
"What did your oncologist say caused it?"
Almost every time, I get a blank stare.
Nobody asked. Nobody explained. The conversation went straight to treatment, which matters, and nobody talked about the body the cancer grew in.
That is exactly the conversation I wanted to have with my guest, Dr. Nasha Winters. At 19 she was told she had months to live. Thirty-five years later, she has spent her whole career asking the question nobody asked her.
Key takeaways from this episode
- Dr. Nasha Winters is a naturopathic doctor and author of The Metabolic Approach to Cancer. She was given a terminal ovarian cancer diagnosis at 19, in 1991.
- She views cancer through the lens of "terrain," the whole ecosystem of your body, and looks at ten areas, starting with mental and emotional health.
She watches a few everyday blood markers closely, including the neutrophil-to-lymphocyte ratio from a standard CBC, plus CRP, sed rate, and LDH.
In her view, finishing treatment is the start of rebuilding healthy cells, not the finish line.
Her "four S's" for breast health are sugar, stress, sleep, and sex.
In this article
Key Timestamps
00:00 The question most women are never asked
05:45 A terminal ovarian cancer diagnosis at 19
12:15 The three "accidents" she credits
17:00 Dr. Anna on the 13-hour overnight fast
19:00 The ACE score and psychoneuroimmunology
37:45 The 10 areas of terrain
44:40 The neutrophil to lymphocyte ratio
48:15 CRP, sed rate, and LDH
53:30 Why ringing the bell is the beginning
56:00 The microbiome and immunotherapy
Meet Dr. Nasha Winters
Dr. Nasha Winters is a naturopathic doctor who also holds a doctorate in Oriental medicine and spent 13 years studying Ayurveda. She is the author of The Metabolic Approach to Cancer (2017) and Mistletoe and the Emerging Future of Integrative Oncology, and she has worked with tens of thousands of patients directly.
She and I met on a break at an integrative mental health conference, talking about how even the guides are always tending their own gardens. I knew then I wanted her on the show.
A terminal diagnosis at 19
Dr. Nasha was pre-med, headed for a conventional medical career. She was also collecting diagnoses. By 19, she had been labeled with PCOS, endometriosis, IBS, juvenile rheumatoid arthritis, anxiety, and a thyroid problem that would later turn out to be Hashimoto's.
Then the symptoms picked up speed. She thought her swollen belly was weight gain or endometriosis flaring.
She landed in the ER barely conscious. Doctors found a tumor the size of a grapefruit on her right ovary, lesions in her liver, fluid filling her abdomen, and a complete bowel blockage. On October 21, 1991, about three weeks after her 20th birthday, she received a terminal diagnosis of ovarian cancer. She was told she was too sick for treatment and had months.
What struck me most is how she describes those earlier labels now. Every one of them, she says, was her body trying to get someone's attention. A decade of signposts. Cancer was the wake-up call nobody could ignore.
She kept her diagnosis almost completely private until 2012. She did not want to be treated like "the cancer patient" in what she believed were her last months. And she is very clear on one thing. She never had surgery, chemo, or radiation, because none was offered, and she does not suggest that path for anyone else.
The three "accidents" she credits
Dr. Nasha calls these accidents because she stumbled into all three before she understood any of the science.
1. A forced fast. With a complete bowel blockage, she could not eat for weeks, only sips of water, then herbal tea, then broth. Looking back, she believes that stretch lowered inflammation in her body. Over the following years, her tumor shrank.
This is her personal story, not a protocol. Please do not attempt an extended fast during any illness without your care team.
Fasting is part of my world too, so I shared what I teach. My general rule of thumb is 13 to 16 hours between dinner and breakfast, breaking your fast by around 10 a.m. and eating earlier in the evening. A 2016 study in JAMA Oncology of women with a history of early-stage breast cancer found that those who fasted less than 13 hours overnight had a higher risk of recurrence than those who fasted longer.
That should have been front-page news. If you have diabetes, take medication, or are in active treatment, talk with your doctor before changing when you eat.
2. A "family fast." This one is about trauma, and it is where I will spend the next section.
3. A mindset shift. Dr. Nasha shares a personal experience with psilocybin mushrooms the week of her diagnosis, and how it changed the way she saw her own future. She describes it as lighting a pilot light, the first moment she believed she might survive. Psilocybin is still being studied in clinical trials and remains illegal in most places. Listen to the full episode for her story in her own words.
Why your childhood still talks to your cells
You may have heard of the ACE score. It stands for Adverse Childhood Experiences, a ten-question survey about hard things that happened before age 18.
Research going back decades links higher ACE scores with more chronic illness later in life. Dr. Nasha explains it this way. Early trauma can rewire the immune system, nervous system, gut, and metabolism toward illness instead of wellness.
Her score is ten out of ten.
That realization changed her major from pre-med chemistry to psychology and biology, and it led her to psychoneuroimmunology. That is a big word for a simple idea. Your thoughts, your stress, your hormones, and your immune system are all in constant conversation.
It also led to her "family fast." She took two years of distance from her family of origin so she could heal without slipping back into her people-pleasing role. As I told her, you can't heal in the same environment you got sick in.
I see this connection with my own patients. Women with a history of trauma often have a harder time moving through menopause. Chronic stress keeps cortisol, your stress-and-storage hormone, running high, and it pushes down oxytocin, your bonding hormone, which supports resilience. Dr. Nasha also sees a common thread of going silent, of not feeling safe to speak up, in so many women with breast and ovarian cancers.
If that lands for you, Gorgeous, it is not a sentence. It is information. And information is something you can work with.
Cancer as terrain, and the 10 areas she looks at
Conventional cancer care often uses battle language. Fight it. Beat it. The trouble is that a battle can take out healthy cells along with cancer cells, and it does not always ask what kind of body let the cancer grow.
Dr. Nasha talks about terrain instead. Think of your body as a garden. Seeds scattered on hard, rocky ground rarely take root. Rich, well-tended soil grows something beautiful. Terrain is the whole ecosystem, and no single plant, pathway, or bacteria tells the full story.
In The Metabolic Approach to Cancer, she outlines ten areas of terrain. This year she reordered them, moving mental and emotional health to the top and the epigenome to the end.
Mental and emotional health. Where her own healing started.
Metabolism. The fuel you give your cells, which changes as you age. More protein, less of the constant carb grazing.
Environmental toxins. In her words, it is no longer a question of whether you have exposure, only how much.
Microbiome. The bacteria in your gut, which help you absorb nutrients and respond to medications.
Immune function. Your immune system should recognize, respond, and remember.
Inflammation.
Circulation and oxygenation.
Hormone balance. How your body uses, processes, and clears hormones, not only how much you have.
Circadian rhythm and stress response. Your body clock and how you handle pressure.
The epigenome. The switches that turn your genes up or down. She now sees it as the place where the other nine pour in. Your family history is a vulnerability, not a verdict, because those switches respond to everything you put in, on, and around your body.
Test, assess, address, don't guess
That is Dr. Nasha's motto, and I love it. Testing can start with questionnaires, like her terrain questionnaire and the ACE survey, plus an honest audit of the people, places, and things in your life. Then come labs, many of which you may already have.
The neutrophil to lymphocyte ratio
Neutrophils and lymphocytes are two types of white blood cells, and both show up on a standard CBC (complete blood count). The ratio between them is not printed on your report, so you have to divide one percentage by the other.
Dr. Nasha points to research linking this ratio to overall health outcomes. Standard ranges flag a ratio above about 3 to 1. She prefers to see something closer to 2 to 1, because lab "normal" is based on the average population, and the average population is not thriving. She also watches for a ratio that drops too low, especially after heavy treatment.
I am going back through my own patients' labs because of this conversation.
Her inflammation "trifecta"
Dr. Nasha tracks three markers together.
CRP (C-reactive protein). A general marker of inflammation in the body. She likes it below 1.
ESR (sed rate). How quickly red blood cells settle in a tube. A high number suggests "thick, sticky" blood. She likes it below 10.
LDH (lactate dehydrogenase). An enzyme linked to how your cells make energy. She notes it was dropped from many routine panels years ago, along with magnesium and uric acid. Target ranges vary by lab, so ask your doctor how yours reads.
Here is the part that stopped me. When scans look clear but all three of these are out of range, she keeps watching closely. When a patient still has activity on a scan but her trifecta looks great, Dr. Nasha feels reassured that the body's terrain is in the driver's seat. These are her clinical observations, and your own care team should always interpret your results.
Why ringing the bell is the beginning
So many women ring the bell after their last round of chemo or radiation, or finish five years of tamoxifen, and feel like they have crossed the finish line.
Dr. Nasha tells them it is the starting line. Conventional therapies can save lives, and they also clear out healthy cells. After treatment, her focus is helping the body rebuild a bounty of healthy cells as quickly as possible.
If you are a survivor, this is your invitation to keep tending your garden long after the last appointment.
Your gut and your immune system
Most of your immune system lives in and around your gut. Dr. Nasha cites research showing that a balanced microbiome is linked to a better response to immunotherapy, and that antibiotics shortly before starting treatment may reduce that response. She would not start an immunotherapy without looking at the gut first.
Her low-cost first look comes from the same CBC. When monocytes, eosinophils, and basophils are all elevated, she considers that a clue the gut may be out of balance. If you are heading into immunotherapy, ask your oncologist whether gut health and recent antibiotic use should be part of your plan.
Reading your body's capacity
I have many of my patients check their urine pH as a simple biomarker of overall health. Dr. Nasha offered a fascinating twist.
She sees acidity as a signal that the body is already under metabolic strain. So she compares saliva pH and urine pH. When they are close together, she reads that as a body with more capacity to handle intense therapy. When they are far apart, she pulls back and chooses gentler support. She adds a simple skin scratch test and a urine specific gravity check, then helps her patients learn to read their own capacity day by day.
The lesson here is simple. Listen before you push harder.
The four S's of breast health
Since October is Breast Cancer Awareness Month, I asked Dr. Nasha what matters most for breast health. Her answer is the four S's. Sugar, stress, sleep, and sex.
Sugar. She sees elevated insulin in nearly every breast cancer patient she works with. She looks at hemoglobin A1C (your average blood sugar over about three months), fasting insulin, and C-peptide, a marker of how much insulin your body makes.
Stress. When your body thinks it is running from a saber-toothed tiger, it does not rest, digest, or repair. Dr. Nasha believes even inherited risk, like a BRCA mutation, is influenced by the environment around the gene. This does not replace genetic counseling, and it is a reason to give your stress response real attention.
Sleep and sex. Deep sleep is when your body does so much of its nightly repair. And intimacy, in whatever form feels good to you, supports oxytocin, the bonding hormone that helps you stay resilient under stress. Both deserve a place on your list.
Questions to bring to your next appointment
Whether you have a diagnosis, are a survivor, or simply want to tend your terrain, these questions can open a better conversation with your care team.
What do you think may have contributed to this diagnosis, and what can I work on?
Can we look at my neutrophil to lymphocyte ratio from my CBC?
Would CRP, sed rate, and LDH be helpful to track for me?
How are my fasting insulin and A1C, and what would you like them to be?
Should my gut health or recent antibiotics factor into my treatment plan?
Who can support me with stress, sleep, and past trauma alongside my medical care?
Your body is always speaking to you. Sometimes it whispers. Sometimes it throws boulders in your path. Listen, and trust that little voice. And please share this episode with a woman who needs to hear it. Women heal in community.
Frequently asked questions
Who is Dr. Nasha Winters?
Dr. Nasha Winters is a naturopathic doctor and author of The Metabolic Approach to Cancer and Mistletoe and the Emerging Future of Integrative Oncology. She received a terminal ovarian cancer diagnosis at 19 in 1991 and has since worked with tens of thousands of patients using a terrain-based, integrative approach.
What does "cancer terrain" mean?
Terrain refers to the whole internal environment of your body, including metabolism, immune function, inflammation, hormones, the microbiome, stress, sleep, toxin exposure, and emotional health. Dr. Winters compares it to soil in a garden. The focus is on supporting a healthy body alongside, not instead of, appropriate medical care.
What is the neutrophil to lymphocyte ratio?
It compares two types of white blood cells found on a standard complete blood count. You calculate it by dividing the neutrophil percentage by the lymphocyte percentage. Standard ranges often flag a ratio above about 3 to 1, and Dr. Winters prefers closer to 2 to 1. Ask your doctor what your number means for you.
What are the four S's of breast health?
Dr. Winters' four S's are sugar, stress, sleep, and sex. She sees these as common threads across breast health, treatment, and survivorship.
Is overnight fasting safe for breast cancer survivors?
A 2016 study in JAMA Oncology found that women with early-stage breast cancer who fasted less than 13 hours overnight had a higher risk of recurrence. Overnight fasting is not right for everyone, especially if you have diabetes, take medication, or are in active treatment, so talk with your care team first.
Did Dr. Nasha Winters avoid conventional cancer treatment?
She was told she was too ill for treatment in 1991, so conventional therapy was never offered to her. She is clear that her path is not a recommendation for anyone else. Always make treatment decisions with a qualified oncology team.
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This article is for educational purposes only and is not medical advice. It reflects a conversation between Dr. Anna Cabeca and Dr. Nasha Winters and their clinical perspectives. It is not intended to diagnose, treat, cure, or prevent any disease. Please talk with your own healthcare provider before making changes to your care, diet, or treatment plan.
