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Live the Anticancer way of life

Professor to speak about his research

Lorenzo Cohen, professor and director of the integrative medicine program at the University of Texas MD Anderson Cancer Center, will be in Concord on Thursday to discuss his research into the connections between lifestyle choices and cancer occurrences.

His presentation will discuss how to lower the risk of cancer as well as improve outcomes for those touched by cancer, through choices in diet, exercise and stress management. His work, and the work of other researchers at MD Anderson, has been influenced by David Servan-Schreiber, a doctor who wrote extensively on the connections between lifestyle choice and cancer occurrences, before succumbing to a brain tumor. His work also influenced Concord Hospital officials in their creation of an Anticancer lifestyles class for cancer survivors.

Cohen spoke with the Monitor about his work, his experiences and the world-wide cancer epidemic. His presentation, Living the Anticancer Life, will begin at 7 p.m., at the Concord City Auditorium.

Your talk is advertised as an opportunity to hear the evidence behind the role that lifestyle can play in risk of developing cancer and then influence outcomes of those diagnosed with cancer. What is that evidence?

It varies by cancer, but the overall estimate from the American Cancer Society shows that taking into account diet, nutrition, an individual's weight and physical activity, upwards to 30 percent or more incidents of cancer can be attributed to aspects of lifestyle. If you take into account smoking and tobacco related behaviors. . . there's no question at least 50 percent of cancer could be prevented if individuals were making appropriate lifestyle choices.

A lot of what I'll be sharing with the audience is the evidence behind that: why different types of foods relate to your risk of cancer, why physical activity will decrease your risk of cancer, why obesity is a key promoter of cancer.

Then I'll talk also about what we are doing at MD Anderson in what we call integrative medicine - working with patients in terms of diet and physical activity and lifestyle, and in particular looking at some of the evidence of the role that stress has in our physiology and biology, how stress can literally speed on the aging process and literally have a deleterious effect on every cell in our body.

Your own training is as a research psychologist, particularly focused on stress and stress biology. How did you come to be delivering lectures on the effect of nutrition on cancer?

When I started off, most of my research was focusing more on conventional forms of stress management and coping and adapting to difficult life circumstances like a diagnosis of cancer.

I was really focusing on mental health processes and how stress in particular impacts biology and then can influence health outcomes. In the world of cancer, that meant I was particularly interested in stress and the immune system, stress and stress hormones and their effect on the body.

Shortly after starting out at MD Anderson, I started getting interested in things like yoga, meditation, expressive writing and other types of forms of stress management we could look at for patients.

From there it just seemed to be this natural evolution from looking at the benefits of acupuncture, to looking at the benefits of other lifestyle changes like diet and physical activity, and the world of integrative medicine.

Has there been any part of it that seemed strange or like a departure from what you always thought you would be doing?

What was a little initially out of my comfort zone was helping to design and oversee clinical trials of natural products, for example. We've been working with colleagues in Shanghai, China, now for close to nine years looking at both mind body kinds of interventions like tai chi and chi gong and also looking at traditional Chinese medicines, herbs they use to treat cancer and helping to oversee and design more formal clinical trials of what could potentially be cyto-toxic agents, like chemotherapy but in a natural product.

But in some sense, a clinical trial is a clinical trial. If the outcome is did the tumor shrink, or did the patients mental health get better, in a well designed clinical trial, regardless of the substances that you're using, all of the processes and the research design and methodology is very similar.

How is David Servan-Schreiber's book Anticancer: A New Way of Life connected to your work at MD Anderson?

He was actually an advisor/adjunct faculty member here. And we've jointly embarked on doing a formal clinical trial of some of the tenets that are part of integrative medicine that he reviews in his book, whether comprehensive lifestyle changes would improve outcomes for those diagnosed with cancer.

The primary area that we are focusing on is trying to provide the necessary support so people can make appropriate changes in their diet, incorporate appropriate activity and come up with a daily stress management program and ensuring that people are well-integrated within their social network, with the ultimate goal of improving physical outcomes.

How long before we might see headlines about the results of that study?

It's going to be quite some time, actually. It's a probably a five-year study that we just started. We started programming the computer because a lot of what we will be doing is online support for the patients through a secure website where they'll be able to register information of what they're doing and connect with their lifestyle coach, and other participants, and have access to useful information to encourage the behavior change.

Did you find it difficult to convince oncologists to work with you on a study of lifestyle choices?

Actually, our experience was the exact opposite. The challenge was to choose the right population when we had all the different departments lobbying us to choose them.

So, we had gynecological oncologists saying, "Oh you need to pick ovarian cancer for this reason or that reason." . . . Our GI colleagues - gastrointestinal oncology colleagues - wanted us to pick colon cancer patients. . . . Our prostate cancer colleagues wanted us to pick their patients. And then of course the breast. . . .

I believe lifestyle factors can influence outcomes in all of those cancer populations, but in particular, both breast and prostate are hormonally-driven cancers for the most part, and we know that diet, stress and physical activity influence hormonal regulation. So that's some sense why we chose that.

If the oncologists supported your study, saying they believed healthier lifestyle choices would help their patients, why don't all doctors prescribe an anti-cancer lifestyle already?

That question often comes up when we speak to audiences. It's because to date most of the evidence we have is epidemiological in nature, meaning that we look at cohort of patients who have undergone treatment and try and look at individual difference factors that predict who does better or worse, who has a recurrence of disease.

We see people who are active have a lower recurrence of disease. People who eat more fruits and vegetables have a lower recurrence of disease. But those are observational studies and finding an association doesn't necessarily mean causation. If you manipulate the risk factor do you manipulate the outcome? Not necessarily.

That's what we need to do. Take people who fall into certain risk categories and modify their risk factors and see whether we really can change the outcome.

Since becoming involved in this research, have your own personal diet and mental health habits and physical health habits changed?

Definitely they have. Just seeing the evidence and of course speaking to the evidence on a regular basis. Initially I wasn't making dramatic changes in my life, but now I've really modified and try and live the tenets of the Anticancer lifestyle as much as I can.

You say "try." Has it been a difficult transition? Which of the tenets of the lifestyle do you find the most challenging?

Absolutely. The meditation component is one I find the most challenging.

It's not part of our culture to engage in stress management. Eating healthfully and exercising regularly is just something that is just more accepted. . . . You need to eat every day and so you can make a choice of if you are going to eat food that is unhealthy or healthy. But you have to eat to live.

You don't have to exercise to live, however it is something that again is culturally accepted and is part of our culture. There's gyms all over the place. And you can do lots of different things while you are exercising. You can have conversations with people, you can watch television, listen to the radio and read a book all at the same time. You see the people on the treadmills reading a book and listening to music and scanning the tickers on CNN all at once.

When you are doing stress management and meditation, you can't do anything else. You have to set aside that time, where we often view that as indulgent and a waste of time.

Why is this so hard for Western cultures?

We just gave a talk in Houston, on meditation as medicine for the mind. Somebody asked "how do I know when I'm doing it, when I'm being successful?"

With food and exercise, there's much more feedback you can get, either from the machine that tells you how much calories you burn, or the scale after you've changed your diet for a month will give you feedback.

With meditation, it's not as tangible, and it may take a while of regular meditation before you start to feel some of the benefits in how your body's functioning, your brain's functioning, and your interactions with others.

It also goes against our culture. The person who gets the pat on the back Monday morning is the one who says I worked all weekend, I wrote these articles, I submitted a manuscript, I balanced the budget, I did whatever that particular job is.

If you come in on Monday and say, I went for a long walk with my wife and I played baseball with my kids and I went to a yoga class, people roll their eyes and don't view that as the stellar employee. This is, I believe, a challenge of our society.

Historically, cancer rates in Asia are much lower than in Western society and you mentioned studying traditional remedies that may hold hope for natural medicine. But is there any concern, any conversation happening among your Chinese colleagues about the possible dangers to Chinese people from the rapid move they are making to a Western lifestyle?

The conversation is happening, because it's not that it's possibly changing. It has changed.

The increase in incidence of colon cancer in Japan is in line with the United States when it used to be in line with India. The number one cancer in Shanghai is breast cancer, it never used to be.

I was so surprised to hear that, and immediate response from a Western trained doctor was Western lifestyle. The people are adopting the Western lifestyle, they've changed their diet, they've taken on more sedentary jobs, they're gaining weight, getting exposed to environmental toxins that they had never been exposed to before and all of this together - it's not just any one thing in particular - it's led to this increasing incidence of breast cancer.

But still in rural China, breast cancer is relatively low and rare, and in rural China they are still eating a high plant-based diet, getting much more physical activity and much less incidence of obesity.

Will you address environmental toxins and their suspected role in incidences of cancer?

The talk will not be so much about that. I think it's important and we'll talk about simple things that you can avoid as best as possible. . . . But some things are just hard to control. The water we drink and the air we breathe is much harder to control.

Yes, indeed. I was struck several times in auditing the Anticancer class by an intense fear of all those factors that are beyond my control. Do you address this fear, the feeling of being at the mercy of larger forces, in your work on stress and anxiety management?

It's all about a balance at the end of the day, and doing everything you can to decrease your exposure to the traditional Western lifestyle, which leads to a tremendous inflammatory load on the body and is responsible for many chronic diseases of the West: cancer, diabetes, cardiovascular disease.

But you don't want to have this knowledge of things that are out there that are potentially dangerous for our health to result in fear, and we don't want to engage in healthy behaviors out of fear.

Fear of recurrence of disease - "if I don't do this, I'm going to have a recurrence" - that may get you started but fear as an inducer of change is not sustainable.

If not fear of disease, then what can help cancer patients, survivors and the rest of us stick to the Anticancer tenets?

What I think can make change more sustainable is that it makes you feel better when you are engaged in all aspects of the anticancer "prescription." You will have more energy, you sleep better, you will lose weight, your mood will be improved, your interactions with others are better and your overall outlook on life is better.

Providing people with a sense of control over their lives, especially when you are trying to control cancer, is empowering and in and of itself can help to sustain the lifestyle changes.

However, being mindful of how you are feeling and paying attention to the changes in your life is an important aspect that needs to permeate all the areas of change. People who do not pay attention to the beneficial changes will not likely keep up the new found healthy behaviors. So mindfulness, in the truest sense of the word, needs to be fostered.

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com.)

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