Tuesday, June 17, 2008

Tipping the scales on cancer

Is cancer "in your genes"? Are you convinced there is nothing you can do to change how the cancer-forming genes will behave that you may have inherited or developed? A study published today in the Proceedings of the National Academy of Sciences shows otherwise.

A very small group of 30 men with low-risk prostate cancer chose to forgo surgery, chemotherapy, or radiation therapy for various reasons. These men instead chose intensive diet and nutrition changes plus participated in daily moderate exercise and stress reduction therapies as part of a research study led by Dr. Dean Ornish, a physician-researcher who has long studied the effects of diet and lifestyle changes on health promotion.

After 3 months of the diet and lifestyle intervention, the men had their prostates re-biopsied and re-evaluated for gene expression of more than 500 different genes, many involved directly in various pathways of cancer promotion or inhibition. Gene activity levels were both increased (48) and decreased (453) at a level of statistical significance. However, it is always very difficult to interpret the clinical significance related to the change in the genes' expression on balance. In this case, these changes could potentially lead to an anti-cancer effect, as the activity of cancer-preventing genes increased while a number of cancer-promoting genes, including those involved in both prostate cancer and breast cancer, decreased or even shut down.

These men were not evaluated during this short time frame for how these diet and lifestyle changes may affect their overall long-term cancer survival. Larger and longer clinical trials are clearly (and, I would add, urgently) called for to do that important work based on the results from this pilot study.

It is very difficult to quantify these results in terms of estimating how much of a beneficial effect these lifestyle changes might bring to any one individual. I certainly understand the limitations of the study thus far.

In fact, several years ago, I had an oncologist ask me publicly after one of my speaking presentations if I thought everything I undertook for my own cancer recovery (which is essentially a comprehensive "cancer rehab" lifestyle program very similar to that which Dr. Ornish has been studying with prostate cancer patients) would really be worth it if all that work only brought about a 2% increase in my odds for long-term survival.

I still remember that you could hear a pin drop in that huge auditorium during the moment I thought how to best respond to this oncologist in front of ~500 cancer survivors. Here is what I said: "Yes, I would do everything again, even knowing it only increased my odds 2%. Perhaps it increased my odds from 1% to 3%, which doesn't sound like much, but it is an increase that is still above 0%. Perhaps it would increase my odds from 49% to 51%, an increase that would tip me over into the majority instead of the minority, a group where I would clearly prefer to be."

I don't know the intent of this man's question or if my answer was what he was looking for. He did not come up to continue the dialog afterward. However, at least 100 people who were sitting in the audience did come up after the Q&A session ended to tell me that they appreciated my response.

In addition, here is what I wish I would have also said in my response to that oncologist plus the hundreds of cancer survivors, their loved ones, and any other oncology health care team members in attendance during that Q&A session so many years ago:

"Having undergone, endured, and recovered from several episodes of surgery, chemotherapy, and radiation therapy plus having experienced multiple very unpleasant and even frightening side effects from these therapies, some of which have compromised many aspects of my quality of life on a long-term and daily basis, I would like to add some comments about the word "work" as used by the questioner in regards to the efforts involved with my diet and lifestyle changes. I cannot imagine that anyone would choose to "work" through all the unpleasantness of the cancer therapies I have undergone if one could choose to "work" at enjoying and also improving diet, exercise, and stress reduction while significantly reducing risk for both cancer prevention and long-term cancer survivorship while also improving overall health and quality of life."

Are nutrition and lifestyle changes part of comprehensive cancer care at your cancer treatment facility or part of your daily plan for cancer prevention? If it is, you're fortunate (and in the minority). If it is not, I encourage you to start asking "Why not?" Don't let yourself get caught up with the nay-sayers in quibbling about how large or small the benefit will be. I encourage you to identify your own obstacles to a healthy life-style and start enjoying the changes you make and the benefits you see! :-)

Research regarding the benefits gained from diet and lifestyle change for cancer prevention and cancer survivorship is not complete, but don't wait for that to happen before you take the opportunity to "work" at improving your own diet and lifestyle that can contribute to overall improved health. Genes may influence, but it is very clear that genes do not completely rule the day. You are what you eat (and do) and apparently so are many of your genes!

The diet used by the men participating in Dr. Ornish's research is a plant-based diet, based on a wide diversity of fruits, vegetables, whole grains, nuts, seeds, and beans or legumes. The following blessing honors that diversity of edible, and health-promoting, plants:

The garden is rich with diversity
With plants of a hundred families
In the space between the trees
With all the colors and fragrances
Basil, mint, and lavender,
God keep my remembrance pure,
Raspberry, Apple, Rose
God fill my heart with love,
Dill, anise, tansy,
Holy winds blow in me.
Rhododendron, zinnia,
May my prayer be beautiful
May my remembrance O God
be an incense to thee
In the sacred grove of eternity
As I smell and remember
The ancient forest of earth.

~~Chinook Psalter (1891-1904)

Diana Dyer, MS, RD

1 comment:

Anonymous said...


I SO agree with you. I keep a "contract" that I made up a long time ago as to keeping my nutrition and exercise "in check". The VERY FIRST LINE of it is " Dr. Mark Pegram was a co-investigator on landmark research that led to the development of Herceptin (I had this for a year after chemo), the first molecularly targeted therapy for breast cancer.
(This is from a second opinion visit a patient/friend of mine had with him and the notes she took) "Regarding the importance of diet/exercise/weight control in preventing recurrence? Avoid sugar?"

"It works! It lowers the risk of recurrence in a major way. You don't have to avoid sugar, you just have to have a low fat, low cholesterol, low calorie diet with lots of fresh fruits and vegetables."

I also have on my list:

Is THAT food (that food being "junk" food) worth going through surgery, chemotherapy & radiation again for?

Is THAT food worth feeling tired for?

Is THAT food worth aching for?

Is THAT food worth eating the "chemicals" in it?

Have you HAD your "weekly" treat?

and several more...then I signed it and dated it and keep it in my purse. Like you said, I would MUCH rather "work" at STAYING healthy than "work" at GETTING healthy...have a GREAT day.