- The document discusses an integrated approach to cancer prevention and treatment through lifestyle changes. - It presents a model showing how lifestyle factors like nutrition, exercise, stress, and social support can affect cancer development over many years and influence whether cancer progresses or not. - Evidence from studies on nutrition, exercise, stress management, and social support suggest that adopting a healthy lifestyle may reduce cancer risk and slow cancer progression. The Prostate Cancer Lifestyle Trial found significant benefits of lifestyle changes for men with early-stage prostate cancer.

1. Lifestyle Matters:
An Integrated Approach to
Cancer Prevention
Lisa Nelson, MD
Family Practice Associates
Medical Director, The
Nutrition Center
Director of Medical
Education, Kripalu School of
Yoga & Health

2. Changing the paradigm
The doctor of the future will give
no medicine, but will interest his
patients in the care of the human
frame, in a proper diet, and in
the cause and prevention of
disease.
—Thomas Edison

3. Normal Cancer
This model assumes that cancer comes out of the
blue. While the diagnosis may feel like that, in
actuality it takes years for most cancers to develop.
How we think about cancer

4. Normal Cancer
 Surgery
 Chemotherapy
 Radiation
How we treat cancer

5. But what role does lifestyle play in the
development and treatment of cancer?
By changing what we eat and how we move,
can we reduce our likelihood of developing
cancer?
Could changing our diet & exercise patterns
help us even if we do get diagnosed with
cancer?

6. Here is a different model for cancer
development & progression
Healthy cells
Dysplasia
Cancer in situ Dissemination
Distant
metastases
Local
disease
• Notice the arrows go in both directions
• This model shows that what we do– in terms of
lifestyle, screening and treatment– can affect
which direction we move on the spectrum

7. Here is a different model for cancer
development & progression
Healthy cells
Dysplasia
Cancer in situ Dissemination
Distant
metastases
Local
disease
• The truth is, most cancers take years to develop
• By changing our lifestyle and adopting prevention
strategies, we can affect our likelihood of
developing cancer, and slow its progression

8. What affects how we move along
this spectrum?
• Genetics & family history
• Exposures: tobacco, carcinogens, infections
• Nutrition & body weight
• Exercise
• Stress & social connectedness

9. The role of genes
Deterministic…?
Or predictive?

10. Maybe it depends
Genes may put us at increased risk, but lifestyle and
environment play a huge role as well

11. The science of genetics vs
epigenetics
 Only 5-10% of cancers are caused by inherited genetic
defects
 That means that most cancers are due to changes that occur
during our lifetime
 The science of epigenetics shows us that it’s not just the DNA
sequence (or gene) that determine our health, but how and if
these genes are expressed
 Our lifestyle & our environment can change gene expression

12. Food and gene expression and cellular
function

13. Food synergy: an operational concept for understanding nutrition. David R.J acobs Jr., Myron
D. Gross, and Linda C. Tapsell. AJCN 2009;89 (S)S-6S.
Courtesy Annie Kay MS, RYT, RD

14. When we eat this…

15. 2000
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2010
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
We get this

16. And this: Diabetes in pandemic
proportions
0 - 6.3
6.4 - 7.5
7.6 - 8.8
8.9 - 10.5
> 10.6
Source: www.cdc.gov/diabetes 2009 BRFSS Data

17. And this…
Death rates from cancer by state, 2011
Source: www.cdc.gov:

18. Obesity is associated with increased
risk of the following cancer types:
• Esophagus
• Pancreas
• Colon and rectum
• Breast (after menopause)
• Endometrium (lining of the uterus)
• Kidney
• Thyroid
• Gallbladder
Source: National Cancer Institute www.cancer.gov:

19. One study estimated that in 2007 in
the United States, about 34,000
new cases of cancer in men (4
percent) and 50,500 in women (7
percent) were due to obesity alone.
Source: National Cancer Institute www.cancer.gov:

20. But obesity might be more of a symptom
of the underlying conditions that cause
cancer, rather than the cause itself.
One study that looked at markers for
metabolic syndrome (a condition that
includes abdominal obesity, high blood
pressure, high triglycerides and insulin
resistance) is a better indicator of
cancer risk than obesity alone.
Source: International Journal of Epidemiology, 2015, 1–11
:

21. In that study, metabolic risk score was
associated with increased risk of the
following cancers in men and women:
• Esophagus
• Pancreas
• Colon and rectum
• Breast (after menopause)
• Endometrium
• Kidney
• Thyroid
• Gallbladder
• Liver
• Cervical
• Oral
Source: International Journal of Epidemiology, 2015, 1–11
:

22. But here’s the good news: metabolic
syndrome is highly depending on the
foods we eat and whether or not we
exercise.
By changing our lifestyle, we can
reduce our risk of cancer, just like we
can reduce our risk of developing heart
disease or Type 2 diabetes
Source: International Journal of Epidemiology, 2015, 1–11
:

23. CV disease and cancer: common cause?
Incidence Rate of Cardiovascular Disease According to the Number of Ideal Health Behaviors and Health Factors
Age-, sex-, and race-adjusted incidence rate of cardiovascular disease according to the number of ideal cardiovascular health
behaviors (nonsmoking, body mass index, physical activity, healthy diet score) and health factors (total cholesterol, blood pressure,
glucose), ARIC (Atherosclerosis Risk in Communities), 1987 to 2007.
Figure Legend:
Source: J Am Coll Cardiol. 2011;57(16):1690-1696. doi:10.1016/j.jacc.2010.11.041
Community Prevalence of Ideal Cardiovascular Health, by the American Heart
Association Definition, and Relationship With Cardiovascular Disease
Incidence

24. It showed that healthy behaviors lower risk
of both cardiovascular disease and cancer
There was an inverse association between the
number of ideal cardiovascular health metrics
and cancer incidence.
Participants meeting goals for 6-7 ideal health
metrics (weight, blood pressure, diet) had
51% lower risk of cancer than those meeting
goals for 0 ideal health metrics.

25. Nutritional recommendations to prevent
cancer:
It’s actually not complicated:
 Whole foods (not processed)
 Mostly plants
 Not too much
(Thank you, Michael Pollan!)
Source Michael Pollan In Defense of Food

26. Like this:
Yum!!

27. Exercise

28. Exercise can reduce your risk of the
following cancers:
 Colon
 Breast
 Endometrial
 Prostate
 Lung
Excellent data on secondary
prevention (recurrence) for
breast and colon as well
http://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivity

29. Yoga helps too!
 Yoga improves mood in women
undergoing radiation and chemo and for
fatigued in breast cancer patients
 Yoga also reduces anxiety in breast
cancer patients undergoing radiation and
chemo
 Gentle yoga can be considered for the
treatment of sleep disruption that many
cancer patients experience
Source: SIO Clinical Practice Guidelines on the Use of Integrative Therapies
as Supportive Care in Patients Treated for Breast Cancer

30. Meditation as adjunct therapy
 Meditation, particularly mindfulness
based stress reduction, is
recommended for treating mood
disturbance and depressive
symptoms in breast cancer patients
 Meditation can also improve quality of
life and reduce anxiety in breast
cancer patients
Source: SIO Clinical Practice Guidelines on the Use of Integrative Therapies
as Supportive Care in Patients Treated for Breast Cancer

31. Social connectedness

32. Social support and overall mortality
Strong relationships are good for us!
 A meta-analysis of 148 studies and over 300,000 people
showed
 A 50% increased likelihood of survival from all causes
for participants with stronger social relationships
Source: Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk:
A Meta-analytic Review. PLoS Med 7(7): e1000316. doi:10.1371/journal.pmed.1000316

33. Stress does the opposite
 Study of over 4000 men with prostate cancer in Sweden
 Mean follow up 51 months
 Men in the highest tertile of stress (self-reported) had a 66%
increased risk of mortality than those in the lowest tertile

34. Women with breast cancer need support
 Women who went through their breast cancer diagnosis
and treatment alone were 4 times more likely to die of
their disease than women who were supported by 10 or
more friends or family members
Source: Journal of Clinical Oncology 24 no 7 (2006): 1105-11

35. Integrated cancer prevention:
putting it all together

36. Prostate Cancer Lifestyle Trial
This landmark study followed 93 patients with early
stage prostate cancer over 2 years. The control
group went about life as usual. The intervention
group:
 Followed a plant based diet
 Got regular exercise
 Did yoga (gentle asanas)
 Learned mindfulness stress reduction
 Attended weekly group support

37. After one year:
 PSA scores had decreased by 4% in intervention
group, but increased by 6% in control group
 6 patients in the control group needed radical
prostatectomy, radiotherapy, or androgen deprivation
but none in the lifestyle intervention required
treatment
 Changes in serum PSA and LNCaP cell growth were
significantly associated with the degree of change in
diet and lifestyle.
Prostate Cancer Lifestyle Trial
Sources:Urology. 2008 Dec;72(6):1319-23. doi: 10.1016/j.urology.2008.04.050.
Epub 2008 Jul 7; J Urol. 2005 Sep;174(3):1065-9; discussion 1069-70

38. After 2 years:
 13 of the 49 control patients (27%) vs only 2 of the
43 intervention group (5%) had undergone
conventional prostate cancer treatment
 Three of the treated control patients but none of
the treated experimental patients had a PSA level
of >or=10 ng/mL
Prostate Cancer Lifestyle Trial
Sources:Urology. 2008 Dec;72(6):1319-23. doi: 10.1016/j.urology.2008.04.050.
Epub 2008 Jul 7; J Urol. 2005 Sep;174(3):1065-9; discussion 1069-70

39. Bottom line:
Lifestyle changes can actually slow down the
progression of prostate cancer. This is big
news!
Imagine how these same measures could help
improve prevent cancer from developing in the first
place?
What other cancers might this type of intervention be
helpful for?
Prostate Cancer Lifestyle Trial

40. Integrated prevention and treatment
of cancer
 Lifestyle matters!
 Eat a whole foods, plant based diet
 Exercise most days of the week
(150 min/week)
 Reduce stress and increase social
connection
 “Be kind to yourself and others 

41. Other resources
 National Cancer Institute www.cancer.gov
 www.cdc.gov
 Institute for Responsible Nutrition
http://www.responsiblefoods.org
 Physicians Committee for Responsible
Medicine http://www.pcrm.org/health
 The Nutrition Center
www.thenutritioncenter.org

42. Thank you!