Examining ‘Anticancer: A New Way of Life’
Whenever there’s a program on nutrition at the Wellness Community’s West L.A. cancer support center, Michael States knows to expect a full house.
Nutrition is one thing that cancer patients or survivors “can go home and take control of,” says the director of clinical programs.
People with a cancer diagnosis crave tangible advice on how to help their treatment or improve their long-term odds. A recently published book, “Anticancer: A New Way of Life,” aims to fill that void -- and it is resonating with cancer support communities.
The author, physician-scientist and two-time brain cancer survivor David Servan-Schreiber, lays out the evidence for complementary treatments or preventive measures for cancer -- diet, exercise and more. And he condemns the reluctance of most conventional physicians to recommend these approaches.
A copy of the book donated to the Wellness Community’s library has been checked out continually over the last few months. The book is recommended nationwide on Internet message boards. “It’s the hot read right now,” says chef Elisa Hunziker of L.A., a breast cancer survivor.
Beyond checkups
Servan-Schreiber was first diagnosed with brain cancer at age 31. After a relapse seven years later and a second round of surgery and chemotherapy, he said he was shocked when his oncologist’s only recommendation for further prevention was surveillance. Was there nothing else he could do?
The moment spurred him to study what science had revealed about the power of lifestyle changes to fight cancer.
Studies, he found, suggest all of the following may reduce the risk of getting cancer: eating fruits and vegetables, staying away from sugar and bad fats, exercising, fostering a positive mental outlook and practicing relaxation techniques such as yoga and meditation.
And, he read, a few preliminary studies suggests these facets of healthy living may also improve the outcome for people with cancer diagnoses.
Servan-Schreiber turns these general guidelines into much more specific advice -- drink green tea not soda, air out dry-cleaned clothes before wearing them, choose grass-fed beef if you must eat meat.
He focuses on four areas where he feels the evidence for a cancer-protective effect is strong: detoxifying your internal and external environments, eating “anti-cancer” foods, increasing physical activity, and pursuing emotional peace.
The section on anti-cancer foods has some of the strongest evidence. For example, a component found in the spice turmeric has been shown to inhibit a key chemical pathway in cancer cells. That pathway is important to a cancer cell’s ability to keep dividing.
Polyphenols in green tea, including one called EGCG, reduce growth of new blood vessels in animal studies (a process tumors need to grow) and suppress the growth of several cancer cell lines in the lab.
Garlic, leeks and onions strongly inhibit growth of colon, brain, lung, prostate and breast cancer cells in the lab.
Omega-3 fats in fish oil reduce inflammation, a culprit in cancer and heart disease.
“I had always separated food from drugs,” says Servan-Schreiber, who admits to eating lunches of a refined-flour bagel, a sugar-loaded Coke and fatty, salty chili before his diagnosis. “But food is a low-grade pharmacological intervention, three times a day every day, that can profoundly influence your biology.”
The book’s clear explanations and practical summaries, plus Servan-Schreiber’s triple dose of street cred, as a doctor, scientist and cancer survivor, are responsible for the book’s popularity, Hunziker says.
“It’s a complete education in cancer prevention for $25.95,” she says.
Some evidence
Much of the food advice is based on the work of Richard Beliveau, a biochemist at University of Quebec at Montreal whose laboratory has tested many plant-based compounds on cancer cells in culture and in animal models of cancer.
The gold standard scientific test, of course, would be large, controlled clinical trials -- but these are rare. Studies with thousands of patients are hard to design properly and must run a long time to test for cancer prevention. Finally, such trials are expensive, and because there’s no way to patent yoga or green tea, there is no corporate money to fund them.
In the absence of the gold standard, Beliveau and Servan-Schreiber say that a food must have three types of evidence to be considered a strong cancer-prevention candidate:
* Studies that show eating a food is linked to lowered cancer incidence in a large population.
* Studies showing a food compound can prevent cancer cell growth in the lab dish.
* Studies that show the food component can block cancer’s progression in an animal.
Foods with all three types of evidence include ones rich in omega-3 fatty acids (such as fish and fish oil), leafy green vegetables (from the broccoli and onion families), the berry family, the citrus family, spices such as turmeric and ginger, and polyphenols such as resveratrol (found in red wine) and catechins (in green tea).
Beliveau recommends these items only for preventing a first occurrence of cancer. “The primary prevention evidence is really strong,” he says. “There is very little evidence yet for treatment of cancer and secondary prevention.”
This is generally true for all of the book’s advice. Studies that look at whether an intervention -- be it diet, exercise or meditation -- can reduce the risk of a relapse or alter a treatment outcome are rare.
But Servan-Schreiber goes further, recommending them also for after a cancer diagnosis, as a follow-up to conventional treatment and prevention of a relapse.
Still, the dearth of hard data does not stop some doctors from recommending Servan-Schreiber’s approaches for cancer survivors.
“None of his recommendations fit that model of randomized, placebo-controlled trials,” says Dr. Larry Bergstrom, director of complementary and integrative medicine at the Mayo Clinic Arizona, in Scottsdale. “But everything he advocates in the book, it’s what I tell my patients to do every day.”
Bergstrom sees the book as empowering for patients: “There are some things you can do for yourself no matter what is going on with your health.”
Dr. Richard Schilsky, president of the American Society for Clinical Oncology and an oncologist at the University of Chicago, says that none of the advice would harm a patient.
But the lack of definitive data is why many mainstream oncologists do not hand out specific recommendations (10 servings of blueberries per week, say, or 30 minutes of swimming three times per week) when patients ask about lifestyle changes, Schilsky says.
Adds Dr. Lowell Schnipper, chief of oncology at Beth Israel Deaconess Medical Center in Boston, “just because something makes sense is not a good enough reason to cause a patient to act on it, when you are in a position of authority, advising them. . . . There are so many examples of promising medications that fell apart when looked at under the magnifying glass of the randomized-controlled study.”
But Servan-Schreiber thinks waiting for elusive and far-off absolute answers from large clinical trials is institutional resistance at its worst.
“I think it’s medical negligence not to give this information to patients, because people will die without this advice and they will not hurt themselves with it,” he says.
Certainly, there is soundness to much of his advice. The American Cancer Society, World Cancer Research Fund and American Society of Clinical Oncology all have guidelines encouraging us to eat more produce and less meat, lower our intake of sugar and fat, exercise more, maintain a lean body mass and not smoke.
It’s when Servan-Schreiber departs from these generalities that he gets into debatable science.
For example, the only environmental toxins that the American Cancer Society flags for the public to avoid are cigarette smoke and UV radiation from the sun. But Servan-Schreiber, among other things, urges readers to avoid antiperspirants containing aluminum and limit exposure to the electromagnetic radiation emitted by cellphones. Links between these exposures and cancer have been deemed inconclusive so far by the scientific community.
Still, cancer survivors say his advice isn’t hard to swallow.
“Whether or not there’s a randomized, controlled trial of these things, I’m going to do them anyway,” says Diana Chingos, a three-time cancer survivor and head of USC’s Norris Cancer Center Survivorship Advisory Council. The cost is minimal, she says -- slightly higher grocery bills, perhaps paying for acupuncture treatment or a yoga class.
“It doesn’t hurt, it makes you feel better, and it will help with other things too,” Chingos says. “In my mind, there isn’t a downside.”
