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Nutritional and Mind-body Interventions in Cancer and Chronic Illness Paul B. Schlosberg 2 Copyright© 2008 By Paul B. Schlosberg And MagPro Publishing http://www.MagPro.org All rights reserved under International Copyright Conventions. Published in the United States by MagPro Publishing ISBN: TBD Layout: Paul B. Schlosberg Publisher: MagPro Publishing Text Editing: John de Cuevas First Edition: May 2008 3 Contents Preface 5 Chapter One Introduction 6 1.1 Building a Foundation of Health 6 1.2 Personal Connections to the Study 7 1.3 The Mind, Optimism, and Cancer 8 1.4 How This Book is Organized 11 Chapter Two Literature Review 2.1 The Mind and Cancer 13 2.1.1 Emotional Stress and Cancer 13 2.1.2 Is There A Cancer-Prone Personality Type? 16 2.1.3 The “Will To Live” and Cancer 17 2.1.4 Mindfulness And Cancer 18 2.1.5 Holistic Approaches 20 2.1.6 Kabat-Zinn: Mindfulness Meditation 20 2.1.7 Simonton: A Holistic, Psychosocial Approach 23 Benson: The Relaxation Response 25 2.1.8 2.2 13 Nutrition and Cancer 26 2.2.1 Overview of Cancer and Physiology 28 2.2.2 What causes cancer? 29 2.2.3 Nutrition, Immunity, and Balanced Health Systems 30 Inflammation and Cancer 32 2.2.4 4 Chapter Three Conclusions and Future Considerations 38 Endnotes 44 Appendix A: Key Terms 49 5 “When life has meaning, you can bear almost anything; without it, nothing is bearable...the greatest tragedy is not death, but life without purpose." Rick Warren Preface Although I have firm views on the use of both conventional and holistic medicine in cancer, in this book, it is not my aim to attempt to persuade readers to make choices based solely on these. It is my hope that readers make informed, intelligent decisions true to their spirit, by weighing all of the best possible options, with the use of sound judgment. With the exception of specific aspects that may be subjective in nature, the following is based upon factual, research-based information. Although a disclaimer is appropriate, the health solutions herein are preventive, researched, and generally regarded as safe (GRAS); and, extensive references are provided for follow-up research. I do not endorse particular treatments, conventional or alternative; however, unless contra-indicated, I believe what is outlined can at least be used as a supplement to almost any type of treatment. These evidence-based practices can not only enhance recovery but also enhance one’s quality of life. Of course, it is imperative that one discuss any possible changes in a health program with their chosen health professional. 6 Chapter One: Introduction “God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, and the wisdom to know the difference” Rheinhold Niebuhr 1.1 Building A Foundation of Health To be clear about the main perspective I take in this book, my view is similar to that of the Chopra Center for Well Being in California, run by the renowned holistic pioneer Dr. Deepak Chopra ― it is not my intention to treat cancer, rather to help a person build a foundation of health. Dr. David Simon of the Chopra Center says, "We do not believe our programs treat people with cancer. By this I mean that we are dedicated to improving a person's quality of life by reconnecting body, mind, and spirit." 1 Although cancer is complex, many healthcare experts believe cancer is the result of the modern "toxic" lifestyle: mismanaged stress, poor nutritional habits, overexposure to toxic chemicals, and a sedentary lifestyle. The toxic lifestyle I refer to is unquestionably one of stress: social and emotional stress, ecological stress, and physiological stress, with much of the physiological stress resulting from poor diet. Additionally, I feel that cancer represents, from an extreme standpoint, the problems we currently face in American culture due to an erroneous overemphasis on acute healthcare solutions such as dangerous pharmaceuticals and invasive surgeries (which, I admit, are often necessary), rather than on more forward thinking, preventive, client-centered, self-healthcare practices. This book is an exploration of mind and body coping skills in cancer, of how embracing holistic practices such as nutrition, exercise, and mind-body modalities like positive mental imagery, stress-reduction, emotional interventions, faith and spirituality – 7 along with the use of either conventional or non-conventional treatments, can cultivate greater patient empowerment and attentiveness to self-care. These practices also help enhance one’s overall wellness and sense of dignity and integrity in the face of lifethreatening illness. 1.2 Personal Connections to the Study There are significant reasons for my interest in mind-body health in the prevention and treatment of cancer. I have lost two fathers to cancer: my natural father died of oral cancer at age 34 when I was three, and my step-father died of esophageal cancer at age 54, when I was 31; additionally, my mother is a survivor of breast cancer. Moreover, it is likely that just about all Americans are affected by cancer either directly or indirectly ― cancer is truly a major epidemic of the Western world. Cancer is in process of, or has taken over heart disease as, our nation's number one killer. At least one in three people we know throughout our lifetimes will develop cancer.2 My interest in holistic treatments is due in part to my own experiences in traditional healthcare: I have had debilitating health conditions, including numerous experiences with both conventional and holistic medicine. From these experiences, I have come to believe that the soul of our conventional healthcare system ― for example, authentic client-centered care that elementally connects helpers and clients from a heart level ― if not already damaged, is in jeopardy of becoming so due mainly to financial influences and to corporatization, though there are other factors too. Thus, I feel we need a profound change in our practice of healthcare to one that is far more mind-body-spirit oriented. Below, I outline the experiences of prominent cancer educator, naturopathic doctor and author Verne Varona, which I hope can help vividly illustrate my own 8 experiences with cancer, and my reasons for researching and writing. In his recent book, Varona poignantly reveals his experiences as a thirteen-year-old boy, watching his mother dying from cancer. He writes, "his mother, at the age of thirty-five years lay on her deathbed . . .” and seeing her lying comatose in the hospital. "Her vivacity and shapely figure . . . had become lean and frail. She lay quietly still. The bright hazel eyes which once had gleamed now darkened orbits of torment. The silence of her presence felt deafening. Thirteen years of memories flooded his mind; she was a gifted dancer, painter and poet and had struggled through a devastating divorce with a graceful resiliency sustained by a faith as constant as the sunrise. . . ." 3 I cite the above to illustrate the devastating physical and emotional effects of cancer, and of severe conventional cancer treatments. In his book, Varona also writes about deaths of other family members from cancer, and then explains underlying reasons for his research, "Helplessly, I watched their weight and appetite decrease as life gradually slipped away. Deep beneath the exterior pretense of a tough and hardened adult, I still carried my boyhood fear of the same fate. I reasoned that as most of my family became sick, surely my turn was inevitable. Repeatedly I asked myself the same questions: What factors caused them to become sick? What, if anything could prevent me from becoming sick? Are we all just victims of some mysterious master plan, or do we really have some choice in creating healthy, vital lives for ourselves?" 4 1.3 The Mind, Optimism, and Cancer My concerns are similar to Varona’s: Do we have clear choices in creating our own health? Do we have choices about how we are involved in our healthcare treatments, and about whether we can face serious illness and even death with dignity and 9 freedom from suffering? Like Varona’s mother, my step-father was a physically vital man at age fifty-four, and within months he lost sixty pounds, his back and body charred black, like a burn victim, from excessive radiation treatments. I witnessed his eventual death from pneumonia because of a compromised immune system from treatments. Certainly, I understand that his conventional treatment team did their best to help, but I have to wonder, like Varona, particularly when I learn about success stories using holistic treatments: Are there better ways for treating life-threatening illness? Is it possible to optimize health through preventive practices, and in doing so perhaps live disease-free lives, and avoid serious health problems like cancer? An important related question, is why does one person with cancer live and yet another with a similar diagnosis and treatment die? Dr. Carl Simonton, founder of The Simonton Cancer Center in Malibu, California, argues that many causes of cancer are well known, such as exposure to carcinogenic substances in the environment, genetic predisposition, radiation, and dietary influences, among others. Simonton points out, however, perhaps the basis of his work, that although all these factors are important and play real roles in why people contract cancer, it is also true that large numbers of people with these risk factors nevertheless do not contract cancer.5 Simonton writes: “A great deal of time, energy, and resource have been poured into the search for the cause of cancer, but one important fact is often overlooked: When exposed to known cancer producing substances, most people still remain healthy.” 6 The heart of Simonton’s work concerns intrinsic factors that have to do with the ways patients respond to major lifestressors that may have preceded their illness, as well as how they respond to the stress particularly from life-threatening illness, also their general coping styles, and their overall 10 emotional condition. Simonton believes these factors usually can be changed through practice, and he has helped patients do so with much success at the Simonton center.7 A growing body of research shows it is clear that the way we think directly affects our immune system, which directly fights cancer. The National Cancer Institute states that immune system functions like natural killer (NK) cell counts and lymphokine-activated killer (LAK) cell activity destroy cancer cells.8 A mind-body study conducted by Dr. Barry Bittman of the Mind-Body Institute with researchers from Loma Linda University, (as well as other similar studies) shows that one’s mental state directly affects the levels of NK cells and LAK cells in the blood.9 Thus, not only is this book a study of physical health, but also an exploration of the human mind and spirit. Throughout the study, I hope to better understand the extremes of illness, and perhaps most importantly, understand the human potential for triumph over catastrophic illness. Rather than succumb to demoralization, perhaps people can learn to explore illness the way Henry Thoreau explored reality, desiring to "live deeply and suck the marrow out of life," 10 that is, to embrace human existence by exploring how life-threatening illness helps one not only triumph emotionally, but also build a more meaningful relationship with oneself, one's loved ones, and one's peers. Paradoxically, though it may be difficult to conceptualize, experiencing and understanding illness (and healing) can help one who suffers from cancer create a more meaningful and empowered existence. I certainly agree with Simonton that the mind and particularly an optimistic attitude is one of, if not the, most important keys to fighting cancer. I think Simonton would probably agree that attitude and optimism alone do not fight cancer; that optimism 11 put into practice is key. And, this I believe, in part, is where overall health practices, and nutritional practices specifically, are of particular importance. 1.4 How This Book is Organized In the first half of the book, I explore the mind and cancer, including possible reasons for roadblocks to optimism and their origins, ways to stimulate positive outlook, and constructive actions toward emotional wellness that can be taken in a cancer diagnosis. From the standpoint of both integrative mind and body health, it means strengthening the body's defenses. From a psychological and emotional perspective, it means exploring the roots of stress, emotional conflict, and gaining greater selfawareness. This includes cultivating a positive attitude, improving one’s emotional resiliency, and becoming open to new ideas for developing self-help skills. Of great importance also is gaining insights to the tendency to succumb to the demoralization and fear that often occurs during cancer. When I refer to cultivating the mind and an optimistic attitude, I am not referring to a pollyanna mentality. For example, prominent mind-body researcher Lisa Aspinwall at the University of Maryland studied cancer patients and found that optimists spent more time than pessimists studying severe risk, health education materials. What it likely means is that optimists do not have their heads in the clouds or in denial, but rather are concerned, well-organized, and mobilized to take action. To me, this is exactly the perspective one needs to be able to modify health practices to fight cancer.11 The second half of the book covers the practice of nutrition and its importance in preventing and fighting cancer. Nutrition and its relationship to cancer cannot be overstated. In fact, the American Cancer Society, as cited in Brown and Trivieri, “now 12 states that as many as a third of all cases of cancer in the United States could be avoided if we as a nation adopted healthier eating habits.” 12 Sound nutrition strengthens the body’s defenses, specifically immunological function. Even though western conventional medicine has created a separation between mind and body, the two in fact are not separate: in conjunction with a positive mental attitude, attention to nutrition is a critical for enhancing and building the body's immunological response. In my view nutrition is, or should be, considered a mind-body discipline. The reason is that integrating nutrition into one's lifestyle and reaping the known physiological benefits of good diet are dependent upon an initial change in mental perspective and corresponding change in health practices. In other words, one needs to relearn habits and reframe ways of looking at healthcare in order to make crucial changes to diet and develop new ways of managing stress. From my research and experience, I have concluded that holistic approaches to cancer are useful, important, perhaps even critical. Cancer is unquestionably a complex problem with dozens if not hundreds of biological, psychological, social, and spiritual influences. At times cancer's onset may seem inexplicable; however, I know from personal experience that people will continue to be healed with mind-body selfhealthcare practices. And if this is so, why are not more Americans willing to attempt, and at least be made more aware of, such practices as nutrition or positive mental imagery, particularly when their implementation is harmless, and research shows their extremely beneficial impact on overall health? 13 I will explore this dilemma. This is an introduction to prevention of cancer, and an introduction to the holistic support of cancer treatment, nutrition, and mind-body health; an orientation for anyone 13 with cancer, or for one with a loved one with cancer, or for those who would like to learn more. Although the topics are targeted at cancer, they are applicable for generally improving overall health and wellness. The information is useful for people who would like to become better educated about what may be one of our most important social health problems, and about their own health and wellness in general. Chapter Two: Literature Review 2.1 The Mind and Cancer “Cancer is a curious thing. Childless women get it, And men when they retire. It’s as though they needed an outlet For that foiled creative fire.” W.H. Auden 2.1.1 Emotional Stress and Cancer In this section, I identify important questions to initiate research and further exploration into cancer, stress, and the mind; then, provide some underlying theory, and finally, offer discussion of practical mind-body practices that may be useful in the holistic support and prevention of cancer. Important questions, though certainly not exhaustive are first, does stress ― or perhaps more prosaically, the way one copes with stress ― contribute to cancer development? Do particular personality characteristics cause, or contribute to, the development of cancer? What is mindfulness, and do mindfulness and self-awareness play roles in coping with cancer? Additionally, how large a role does the mind play in cancer prevention? And how large a role do the physical practices and actions, for example, health habits and health behaviors, play? The answers are not simple, because 14 an overlap exists, and the mind and thoughts guide one’s actions and behaviors. Currently, a growing body of research seems to indicate that the physical aspects of preventive health, such as nutrition, exercise, and the avoidance of toxic environmental substances, do contribute to cancer prevention.14 However, we probably know more about, or are at least currently better able to draw relationships concerning, the physical aspects of cancer than we know about the psychological or “mind” aspects of cancer. According to Cassileth, "the fact is that there are no data that show that [using mind-body interventions, such as meditation and emotion management] has any direct effect on disease." She adds, however, that there are measurable physiological effects, including the reduction of heart rate and blood pressure, and relaxation of the musculoskeletal system.15 For the purposes of this writing, I take the view – admittedly, a leap of faith – that being emotionally healthy at least plays a role in fending off or avoiding cancer; and thus, the converse: that an emotional problem or pathology may contribute to cancer’s development. Cancer is an extreme condition, and it would seem to require an extreme measure of non-wellness to cause it. This concept has been the driving force of behavioral health researchers aiming to prove that the mind is influential in cancer. I focus on preventive health and promoting the viewpoint that relatively simple and basic but powerful mind-body skills such as self-awareness, cognitive behavioral self-dialogue, meditation, breathwork, and optimism are influential in cancer prevention. Changing one’s thoughts, and as an effect, also one’s self-care and wellness practices, are powerful steps, and in some cases may prevent or even reverse cancer.16 In one example, a study by Ornish revealed preliminary findings that holistic lifestyle changes including 15 emotional support, relaxation, diet, and exercise can prevent, slow, or perhaps even reverse prostate cancer in some men. 17 18 Overall, the practitioners I discuss believe firmly in holistic practices, or would not be devoting their lives to promoting and teaching them. My views are similar to theirs, even though current research may not necessarily substantiate the practices’ overall validity. Mind-body medicine has been practiced for thousands of years, and whole-person care has always been recognized intuitively and empirically. Anecdotal stories of successes and triumphs over cancer have existed from time immemorial. Moving toward the future, modern health science will be able to corroborate the usefulness of mind-body practices. Thus far, though, there is a lack of "meta" holistic research available. Large-scale funding is limited in preventive health, unlike the abundance of pharmaceutical-based research funding available. Even though integrative healthcare is growing at a dramatic pace, there is still a tremendous amount of resistance from the conventional system as a whole, from the insurance and pharmaceuticals industries, to doctors and psychiatrists, as each is threatened by the growth of holistic medicine. Northrup, an innovator merging traditional medicine with holistic medicine (including nutrition, homeopathy, and energy medicine), cited in a recent writing an example of the medical community’s overall apathetic stance toward holistic research and treatment in cancer. Taxol, an expensive drug costing around $5000 per course of treatment, received much publicity because it lengthened the life of ovarian cancer patients by several months. Interestingly, according to Northrup, a holistic medicine study published in the prestigious medical journal Lancet revealed that women going to a 16 support group lived eighteen months longer than those who did not. However, for reasons I have mentioned, the study was not given much attention. Northrup concluded that if holistic cancer support were a drug, it would be unethical not to use it in every instance of the disease. 19 2.1.2 Is There A Cancer-Prone Personality Type? Controversy surrounding holistic mind-body approaches to cancer centers on whether or not particular personality characteristics contribute to cancer’s development. The debate goes far back historically, at least as far as the second century when the Greek physician Galen attributed cancer to a melancholy disposition. Similarly, in contemporary times, people who support and practice the holistic therapies concurrently often support the notion of a cancer personality type, believing the development of cancer is in fact influenced by certain personality traits and characteristics. However, again, the theory is difficult to prove. Temoshok attempted to prove the cancer personality theory in the 1990’s at the University of California at San Francisco, positing a Type C personality, indicating that a cancer-prone person suppresses emotions, is often hostile, is a people pleaser, and has poor self-concept. Temoshok’s research followed along with others attempting similar work that linked health conditions to various stress-prone personality types. For example, Friedman and Rosenman's hard-driving hostile Type A personality is correlated with cardiovascular problems, and its opposite, the Type B personality, alternately, is one who is relaxed and handles stress well.20 The “helpless-hopeless” type identified by Seligman is one in which repeated failures become a learned response, which Seligman called "learned helplessness." Seligman’s work was expanded to cancer research by 17 Schmale, and a study by Schmale and Iker of sixty-eight women predisposed to cervical cancer showed that, based upon either their hopefulness or hopelessness potential, they could predict which ones would or would not contract cancer. 21 Temoshok and the others mentioned have developed significant followings; yet, unfortunately, recent findings show conflicting results making things less clear. 2.1.3 The “Will To Live” and Cancer The idea of a cancer personality type raises the notion of the influence of an individual’s "will to live" in cancer. Most of us recognize intuitively that when people have a strong will to live they have better chances for survival. For example it is common practice in my experience for doctors to say to the loved ones of patients who are holding on to life, "Oh, he has a tremendous will to live," or the converse, "well, it was her time, she simply lost her will to live." Simonton has found that valuable indications of the will to live are peoples’ health habits, practices, and behaviors in response to their illness. Many of the cancer patients Simonton studied were given decent prognoses to live a number of additional good years of life, but Simonton still found, for example, “lung cancer patients who refused to stop smoking, liver cancer patients who wouldn’t cut down on alcohol, and others who wouldn’t show up for treatment regularly.” 22 He also found that many cancer patients that did live a long time against odds would frequently make comments such as “I can’t die until my son graduates from college,” or “They need me too much at work,” or “I won’t die until I’ve solved the problem with my daughter.”23 Developed through years of research and practice, Simonton’s work today includes motivation, education, mind-body, and psychosocial interventions to encourage patients’ attitudes, and to 18 improve their health behaviors. He claims his successful research outcomes support his thesis. 24 2.1.4 Mindfulness and Cancer An important intervention for preventive, holistic approaches to cancer is the use of mindfulness. Mindfulness meditation is a way of being present to one’s body, thoughts, and feelings without judging, criticizing, or rejecting what one discovers.25 At times mindfulness is practiced as a sitting meditation; at others a daily living meditation, and form of self-therapy; or, a combination of both. A better description may be that it is a holistic, integrated way of living. Somewhat humorously, it has also been stated that mindfulness can perhaps be viewed as the opposite of mindlessness. Mindfulness meditation expert Kabat-Zinn explains that mindfulness meditation, in general or in the treatment of cancer, is not a pie-in-the-sky, strange, or exotic ideology. He believes that mindfulness meditation is about learning to be well regardless of one’s physical situation. “You can be unbelievably healthy no matter what is wrong with you,” says Kabat-Zinn. “It’s not like you have cancer and have to be done with that before you can be well. And one way of being well is through meditation. . . . Meditation is about knowing what’s on your mind. . . . The real meditation is how you live your life, not how you sit in a chair. It is about how intimate you are with yourself in the moment.”26 Though often more broad in scope, the use of mindfulness meditation in cancer support typically involves four aspects: emotion management, reducing symptoms from cancer, the reduction of the symptoms associated with the treatments, and pain management. As Kabat-Zinn describes it, mindfulness is parallel in certain respects 19 to self-awareness. In the art of preventive cancer care, self-awareness and mindfulness are significant to help gain better awareness of emotions, and for influencing the mind, thoughts, and feelings. Mindfulness meditation increases awareness of inner emotional, psychological, and sensory experiences, and is similar to taking an inner psychological and spiritual inventory. It can help one learn to develop a better perspective and more realistic expectations about one’s daily life. For example, an important sign of a toxic lifestyle, including the poor health practices (codependent and addictive health behaviors) that typically spur lifestyle-related health problems, is the inability to maintain realistic boundaries, limits, and sense of capabilities. The following example illustrates the above point concerning the relationship of mindfulness to overall health. A substantial number of Americans suffer from bloodsugar and metabolic imbalances, including pre or type II diabetes, which are suggested to be linked to cancer. A type II diabetic with sugar metabolism problems needs to moderate sugar consumption. Yet people with this condition unfortunately go beyond limits due to compulsivity; they typically may deny, either privately or outwardly, how many carbohydrates are being consumed. In another scenario, an overstressed workaholic believes he or she can work compulsively, perhaps sixty or seventy hours per week or more, though clearly ignoring good health practices and not paying sufficient attention to other important life priorities. Though these individuals likely have good intentions, one aspect of the problem, perhaps, is they are not mindful enough about the consequences, or unrealistic about how their actions contribute to their toxic lifestyle. These examples succinctly illustrate possible lifestyle factors connected to the development of cancer and other chronic illnesses. In 20 part, the answer has to do with a cultural need for improved health education, and for greater attentiveness to mindfulness and self-awareness, in general. In the various phases of cancer, mindfulness meditation can be utilized in unique ways. For example, in the initial phase of cancer, immediately following diagnosis, mindfulness and self-awareness can be a useful tool, because learning to calm the mind is extremely difficult with the emotional upheaval typically occurring during this phase. As Byers explains, when first diagnosed, patients' initial reaction is often shock, frequently causing what Byers describes as “a systemic [emotional] breakdown.” She says there is an initial shock because cancer and the treatments cause both medical and psychological trauma. Byers says the cancer patient’s perspective is, “your body feels like it has betrayed you . . . all these years you have been living and doing all these wonderful things, and you feel like, now, how could it betray you?” 27 Seng says, "For some people, finding out they have cancer and [or] going through very difficult cancer treatment can lead to post-traumatic stress disorder symptoms. . . . Other cancer patients may have had post-traumatic stress from earlier traumatic events, and aspects of having cancer makes them experience symptoms again.”28 The use of mindfulness meditation, and expressive techniques such as writing about the trauma, and other self-awareness techniques, are shown to be effective for dealing with trauma associated with cancer. 29 2.1.5 Holistic Approaches In the following sections, 2.1.6 through 2.1.8, I overview the work of successful mind-body cancer practitioners. Each involves the practice of mindfulness and selfawareness in holistic cancer support and prevention, in similar, yet unique ways. 2.1.6 Kabat-Zinn: Mindfulness Meditation 21 The Mindfulness Based Stress Reduction program (MBSR) ― emanating from ancient eastern Buddhist traditions and developed by Jon Kabat-Zinn, Professor of Medicine Emeritus at the University of Massachusetts Medical School ― originated in the U. S. at the University’s medical center in Worcester, where it is currently practiced.30 Kabat-Zinn also spearheads research on mindfulness at the center, in conjunction with the MBSR program. Currently, MBSR is offered in over 200 U. S. hospitals, and is the focus of a number of research studies at the National Center for Complementary and Alternative Medicine (NCCAM). Through MBSR, Kabat-Zinn has put forth an exceptional effort to spread the ancient East’s message to the modern West of mindfulness and its connections to physical health and life-threatening illnesses including cancer. Kabat-Zinn’s work blends science, health, and spirit. Rooted in Eastern health and spiritual practices, Kabat-Zinn’s use of mindfulness meditation fundamentally involves directing one’s attention to the here and now. I am fascinated to learn that the purposes of modern psychotherapeutic interventions in part have similar aims to those of mindfulness; it is inspiring and enlightening to find that the standard goals of modern psychotherapy have correlations with Kabat-Zinn’s wisdom, which comes from the ancient study of meditation and healing.31 Two examples, Gestalt Therapy, a form of therapy developed by Fritz Perls, and Dialectical Behavior Therapy (DBT), a cognitive therapy developed by Marsha Linehan, are Western psychotherapeutic practices extensively implementing the use of mindfulness.32 33 However, these are merely two among others. In fact, the preeminent psychological theorists of the twentieth century particularly theorists of humanistic 22 psychology ― for example, Carl Jung, Abraham Maslow, Carl Rodgers, and Alfred Adler ― are influenced deeply by mindfulness and Eastern thought, of learning to focus on the present.34 The practice of mindfulness and awareness take numerous forms, including: attentiveness to thoughts in meditation; to a higher power in prayer; to feelings, emotions, desires, in self-awareness and self-analysis; to other's actions and feelings during acts of interpersonal communication; to one’s own actions; and, attentiveness to self-care. But, to simplify, the essence is what Kabat-Zinn teaches as learning a fundamental change of how to "be" rather than "do" as a way of centering the mind. Also, at times, learning how to be while doing, because one must take action in daily life – for example, create, connect, work, and construct. Cancer patients come to Kabat-Zinn’s MBSR Program along with others suffering from severe conditions like heart disease, arthritis, diabetes, kidney disease, or chronic pain. During daily MBSR sessions, patients are taught to use meditation to cope with the psychological and physical effects of stress. They learn how to become mindful of their emotional states, primarily the emotions fear and anger which, in excess, are particularly destructive to health. During the program, through the daily practice of hours of meditation, patients begin to shift their awareness away from lingering negative, destructive mental patterns to a more relaxed state of being. Kabat-Zinn says that although meditation is sometimes difficult to put into words because the mind is so vast and can seem “mysterious and vague,” the practice of meditation really is quite simple. 35 In MBSR three basic types of meditation are implemented: sitting meditation, either in a straight-backed chair or on the floor; a body scan meditation lying on a mat on the floor; and standard hatha yoga postures, similar to those found at any neighborhood yoga class. 23 Group discussion and one-on-one counseling are also integral to the program. MBSR patients find that mindfulness and self-awareness are about learning to live life, whether sitting in mindfulness meditation, or performing one’s normal daily activities, from an internalized perspective with intention rather than being motivated mainly by external cues, desires, needs, and wants. It is the imbalanced over-focus on externalization that creates a hyper-stressed physiology. MBSR is founded upon the concept that encouraging internalization, reflection, and self-awareness promotes greater relaxation, and mental and physical wellness. Csikszentmihalyi in part sums up the mental and psychological aspects of this more internalized lifestyle: There are two main strategies we can adopt to improve the quality of life. The first is to try making external conditions match our goals. The second is to change how we experience external conditions to make them fit our goals better. . . . The solution is to gradually become free of societal rewards and learn how to substitute for them rewards that are under one's own powers. This is not to say that we should abandon every goal endorsed by society; rather, it means that, in addition to or instead of the goals others use to bribe us with, we develop a set of our own. 36 2.1.7 Simonton: A Holistic, Psychosocial Approach Simonton implements a holistic cancer program incorporating lifestyle management, emotional support, and a specific form of meditation and imagery for cancer patients, which, according to his own research, is quite successful. Simonton outlines and discusses this research and practice in Getting Well Again.37 In Simonton's practice, the cancer patient in meditation envisions his or her cancer cells, and 24 next imagines pac-men gobbling them up. Simonton believes that part of the strength of his techniques stems from the concept of empowerment (a foundational tenet of each of the practitioners mentioned in this book). When a patient feels empowered, beautiful things can occur at every human level: physical, emotional, and spiritual. When a cancer patient begins to find hope, energy, vitality, and self-confidence blossom, and the immune system becomes mobilized for action, halting cancer cell proliferation. It seems a testament to the success of Simonton’s work that he is one of the biggest influences upon the use of imagery and holistic, psychosocial treatment in cancer. His work has spurred the use of imagery, and its study, in many major cancer centers and universities across the U. S., and a review of forty-six studies conducted from 1966 to 1998 by the American Cancer Society found that guided imagery was highly effective in managing stress, anxiety, depression, pain, and the side effects of chemotherapy. There have been few studies evaluating programs such as Simonton’s, or the use of holistic and psychosocial interventions in cancer. According to a report issued by the United States Congress Office of Technology Assessment (OTA), with an advisory panel including notables such as Andrew Weil, C. Norman Shealy, and Jeanne Achterberg 38, among others, three studies have been performed to assess survival rates using imagery and psychosocial interventions. One study was done on Siegel’s ECaP program, a program influenced by Simonton’s.39 According to the report, “the study found a small, but not statistically significant increase in survival time among ECaP participants compared to nonparticipants.” 40 Another study was done on Spiegel’s psychosocial cancer program at Stanford University, using psychotherapy, group support, and self-hypnosis for women with breast 25 cancer.41 According to the OTA report, There was a significant difference in survival time between the two groups: women who underwent psychotherapy lived an average of 36.6 months after randomization to the intervention, while women in the control group lived an average of 18.9 months following randomization. . . . Spiegel and his colleagues also found that psychotherapy significantly reduced anxiety, depression, and pain among participants. The investigators suggested that involvement in the support group may have allowed patients to better mobilize their resources, to improve compliance with conventional treatment, or to improve their appetite and diet through reduced depression. They also suggested that patients who learned selfhypnosis for pain control may have been better able to remain physically active. 42 2.1.8 Benson: The Relaxation Response Benson is well known for promoting a technique called “the relaxation response,” a phrase he coined in the 1970's. The relaxation response is mantra meditation, or the repetition of a word, phrase, or thought, to encourage a deep, mind-body-spirit healing state of relaxation. Benson acknowledges that repetition is not the only way to elicit physiological benefits of the relaxation response. Benson says, "The relaxation response can be elicited by a number of meditative techniques, such as diaphragmatic breathing, repetitive prayer, qi gong, yoga, progressive muscle relaxation, jogging—even knitting."43 Benson claims that mind-body medicine, which consists of stressmanagement, diet, and exercise, is the third leg holding up the other two legs of a threelegged stool of healthcare. The other two legs are surgery and medicine, the more conventional, acute forms of care. The relaxation response is holistically integrated with 26 psychosocial interventions for cancer patients at the Benson-Henry Institute at the Massachusetts General Hospital. 2.2 Nutrition and Cancer "Let food be thy medicine and medicine be thy food” Hippocrates As mentioned in the introduction, one of the most important goals of this book is to help cancer patients and all seekers of wellness learn to develop a foundation of health. This foundation will optimize the chances for preventing cancer, or perhaps slow or reverse it. I follow Quillen’s suggestion, urging those dealing with cancer to “focus on the parts of [the] body that are working properly, not on the cancer.” 44 The scientific links between physiological health and diet are becoming clearer as we continue to develop scientific research in the relatively new area of human nutrition. One of the most important threads for health-building is learning ways to enhance immunity. In my view, proper diet and nutrition, though only one aspect of a comprehensive approach, is perhaps the most direct one because we must eat regularly for survival, in normal circumstances three to six times per day; thus, the importance of food choices cannot be overstated. I do not think it is a stretch to say that in certain respects, nutrition is black and white ― meaning that just about every food we put into our body affects us in either an enhancing or depleting way. Research shows links between immunity and cancer, as well as links between immunity and diet. Yet it is somewhat more difficult to show a direct relationship between cancer and diet, though we see evidence from existing studies, and scores of additional ones in progress. It is generally accepted that various components of the immune system such as T Cells, and NK cells, cytokines, prostaglandins, good 27 eicosanoids, and other physiological sub-structures are involved in the elimination of malignant cell proliferation; and we do know that specific aspects of nutrition influence these components of the immune system (explored below). It has become widely accepted that a strong immune response offers better chances to ward off cancer, and nutrition improves this factor. According to Quillen, the average person has cancer six times in the body within a lifespan, but roughly sixty percent of the time it is warded off by a healthy immunological response. Quillen explains that a number of nutritional supplements are known to bolster immunity including colostrum, whey extracts, aloe extracts, Essiac tea, and others.45 The conventional approach, treatment, and overall philosophy for cancer originates in part from Pasteur, one of the forerunners of conventional medicine in the early twentieth century. 46 Pasteur concluded that many of the diseases we experience are caused by exogenous pathogens. In other words, Pasteur put forth that, "the state of health or disease was not a measure of the integrity of the immune system, but rather of the strength of the invading microbe." 47 Pasteur developed the "germ theory" of medicine, which according to Seaward is now the leveraging idea for modern medicine's use of antibiotics, immunizations, and use of pharmaceuticals in general to treat disease. 48 Pasteur influenced the development and use of vaccines. Today a number of top pharmaceutical companies are using vaccines for cancer treatments, including drug vaccinations as treatments for cervical cancer, and melanoma, among others. Major pharmaceutical corporations are now implementing cancer vaccination programs, including a leading one of Pasteur’s name: The Sanofi-Pasteur Corp. According to Seaward, in the early 1900s Pasteur was challenged by the French 28 scientist and philosopher, Claude Bernard. Bernard argued it was not, as Pasteur believed, the strength of invading microbes that determined disease, though that was certainly a factor. Perhaps more importantly, the strength of an individual's interior milieu, or, internal system, determines whether or not one can fend off invading pathogens, and ultimately fend off diseases such as cancer. Bernard’s views represent those of holistic, integrative, and alternative medicine, and those promoted in this book. 2.2.1 Overview of Cancer and Physiology Following, I provide a brief overview of what cancer is, and how cancer develops at the cellular level. Cancer, in fact, is not one, but a group of over 100 conditions. In various forms, cancer is defined, basically, as uncontrolled cellular growth. When human cells divide and grow they form tumors, though some tumors are benign and do not cause major threats to health. However, dangerous tumors which grow unchecked are considered to be malignant. Malignant tumors are dangerous because they attack and injure healthy cells, tissues, and organs; and when they spread from their initial tumor site, they are metastatic. The body has internal mechanisms to control rapid cell division and growth; however, for various reasons, if metastasis is uncontrolled, it will invariably lead to serious disease and death. Though there are many types of cancers, all cancers generally fit into one of the four following main categories: Carcinomas – cancers of the soft tissues, organs, and the tissues that surround the organs Sarcomas – cancers of the hard tissue such as bone, also cartilage, muscle, and fat Leukemias – cancers of the blood Lymphomas – cancers of the lymphatic system, over twenty different forms of lymphoma 29 exist 49 2.2.2 What Causes Cancer? Most theories about the origin of cancer point to its being either a genetic mutation or a virus ― correlating with Pasteur’s theories. However, it is now recognized that the cancer process is also advanced by “genetic, immune, behavioral, and/or psychosocial factors.” 50 By psychosocial, this likely includes environmental and preventive factors, including nutritional. 51 It is recognized that only a small number of the known forms of human cancers are caused by viruses. Most forms of cancer are caused by genetic mutations. Codes in the genes of cellular DNA of individual cells provide instruction for healthy cells to grow and divide at just the right times for positive physiological advancement, tissue repair, and development ― or, wellness. To me, an important question is: Are these genetic mutations inherent, or are they affected by external cues such as diet, environmental, and psychological factors? I wonder, if cancer is typically caused by genetic mutations, does it also mean that genes are necessarily preprogrammed, or unalterable? Interestingly, many researchers believe that genes, in fact, are also alterable by lifestyle behaviors. Perhaps more importantly, however, it is commonly accepted among preventive health researchers and practitioners that people typically do not need to change their genes, but instead need to optimize the expression of those genes. The field of nutrigenomics is devoted to this study and practice of understanding genetic patterns, and creating nutritional solutions to optimize genes’ expression.52 The breakdown of wellness in cancer occurs for various reasons, some which are known and some not. It is recognized that damaged DNA provides incorrect instructions 30 for cellular division and excessive growth, resulting in the development of tumors. The normal system of checks and balances at the cellular level are the oncogenes, giving instructions for cell growth, and suppressor genes, which give instructions to halt cell growth. Both of these genes usually work effectively for maintaining homeostasis; however, in cancer, suppressor genes are faulty. When they become faulty and cancer develops, the next line of defense is the immune system. As mentioned, it is known that cancerous cells frequently exist in the body but in a healthy individual the healthy immune system is able to control them. As mentioned, NK cells are one of the body's main fighters in this internal battle. Others include T Cells, and cytokines (chemical messengers). The overall conceptualization of the seek and destroy system is called immune surveillance theory. 53, 54 2.2.3 Nutrition, Immunity, and Balanced Health Systems Next, I look at important considerations for improving the immune system through nutrition, and through the use of balanced health systems. Human physiology is complex, and thus an extensive list of nutritional suggestions exist to improve immunity. Seaward outlines many of them.55 I do not provide his complete list here, but among the most important are: consuming a good supply of antioxidants including beta-carotene, vitamins C and E, and selenium; getting a sufficient supply of fiber for colon health and suppression of appetite; drinking plenty of clean water for cellular and tissue hydration; decreasing ingestion of pesticides, fungicides, herbicides, and fertilizers from foods or other sources; consuming an adequate supply of complete proteins for cell, hormone, and tissue building; eliminating, if not entirely, as much as possible the consumption of junk and highly processed foods, and eating foods in their natural forms; decreasing the 31 consumption of antibiotics and hormones; consuming substantial amounts Omega-3 fish oils which are recognized to decrease cellular inflammation (which, along with inflammation’s role in cancer, will be discussed in more detail below); decreasing the intake of saturated fats; decreasing trans fatty acids; being sure to vary the color of produce, eating sufficient yellow, green, and orange vegetables and fruits, or, mixed carotenoids which are known to possess different functions. 56 Without question, an important concept concerning nutrition and cancer is the paradigm of balance. Balance may seem simple in definition, though is hardly so in conceptualization and practice. The roots of the study of balance and health emanate from ancient cultures, for example, the ancient Greeks had a deep respect for the need for balance and harmony with natural laws, a primary consideration being food and herbs and their effects on health. Hippocrates, the father of medicine, initiated a field of medicine called humorism. Humoristic medicine is the theory that health depends upon balance among the four humors: blood, black bile, yellow bile, and phlegm. Today, Hippocrates’s humor theory is recognized as incorrect. Nonetheless, his idea of balanced health systems is still respected, particularly in integrative medicine. Around the same time, in the Eastern part of the world, Traditional Chinese Medicine (TCM) sprang from the concept of balance. TCM was founded upon an elemental conceptualization of balance the Chinese called Yin and Yang. Yang symbolizes active, expansive forces of nature, and Yin symbolizes the passive, and contractive. 57 However, in TCM nothing is either totally Yin or Yang, as they are relative, interdependent, and dynamic. Today, TCM is thousand of years old, is still thriving and in wide use. 32 Though not necessarily highly valued by modern, conventional practitioners, it is quite clear that the body works in the amazing synergistic balance, or, homeostasis, which was supremely valued by the ancient Greeks and Chinese. These ancients recognized intuitively that the body possessed its own wisdom for healing. Many internal systems (and perhaps an argument can be made that most physiological systems) are based upon a delicate homeostasis, which the ancients knew was effected by food and nutrition. Through modern science, we have come to realize that one particular system is extremely important: the balance between glucose (sugar) and insulin in the blood. Blood sugar is the cells’ primary source of fuel for creating ATP which powers every cell of the body. The development of ATP occurs in the mitochondria, the powerhouse of the cell. Blood sugar must constantly be maintained within a certain range ―- normal fasting levels are approximately 70 mg/dl to 100 mg/dl ― for maintaining proper energy levels, and for human survival. The body has its own built-in mechanism for this: the pancreas releases the hormone insulin for the purpose of maintaining even blood-sugar, and to shuttle glucose into the cells. Imbalances in the glucose-insulin system are thought to play a role in inflammation, and cancer. Below I explore how maintaining balance in the diet can help maintain glucose-insulin homeostasis, and strengthen one’s resistance to cancer. 2.2.4 Inflammation and Cancer Generally, it is important to study underlying, fundamental systems in order to find solutions to problems; health is no exception. One of these receiving much attention recently is the concept of inflammation and its relationship to disease; also, 33 inflammation’s connections to diet and obesity. Inflammation and obesity’s connection to lifestyle related conditions including cancer, heart disease, diabetes, arthritis, among others, are well-documented. According to Sears, when specific bodily systems are out of balance (such as the glucose-insulin system), cellular inflammation is a result and lifestyle-related health conditions including cancer, diabetes, hypertension, arthritis, among others, are the long-term result.58 Sears has devoted his life to researching inflammation, and created a system for treating cellular inflammation with food and nutrition, urging that food’s effect upon the body and the cells is as powerful as drugs. His nutritional system, "The Zone Diet", is about reducing “silent inflammation” through blood sugar stabilization created by balanced nutrition. Silent inflammation is exactly the same as we typically know inflammation ― as in pain, swelling, or rheumatoid arthritis ― but less severe, though perhaps more dangerous because it is below the threshold of detection, at a cellular level. Silent inflammation can remain undetected for many years until it eventually causes the lifestyle conditions mentioned, including cancer. Nutritional prescriptions are superior to the current medical approaches to cancer because these methods target the problem before it appears. Sears states: "After spending some 30 billion on the war against cancer, our government hasn't made any headway into finding a reliable cure for the disease or a surefire way to prevent it. With all the hype, the primary treatments for cancer still remain the big three: burn, cut, or poison. Although these rather barbaric approaches can potentially extend a patient's life span, they're not an ideal prescription for a good quality of life." 59 Whereas other dietary programs such as Atkins, Pritikin, or South Beach are extreme as they espouse low- 34 carbohydrate, high carbohydrate, low-fat, or another extreme, which is what the American public seems to want, The Zone Diet seems boring because it is formulated upon the concept of "moderation." It is neither too low carbohydrate, nor too high carbohydrate; neither too low fat, nor too high fat, and so on. Dietary balance and moderation reduce silent inflammation primarily by controlling the hormone insulin. Moderation is the key to balancing insulin, as well as to balancing critical related hormone and biochemical systems including the hypothalamus, pituitary, adrenal system (the HPA axis); also, cortisol, epinephrine, norepeniphrine, adrenalin, and noradrenalin; and, the key fat-storage hormones, leptin and ghrelin. Sears outlines aspects of the immunological system that are part of the inflammation response and that bring into play specific hormone interactions.60 According to Sears, when foreign invaders attack the body, the body calls into action five different groups: 1. chemical mediators (including histamine, bradykinin, and serotonin), 2. complement systems (which is very complex, made up of twenty proteins), 3. eicosanoids (bad ones include prostaglandins, and leukotrienes), 4. cytokines, and 5. immunological attack cells (including macrophages and neutrophils). These are activated by pro-inflammatory cytokines, and the release of cytokines is stimulated by pro-inflammatory eicosanoids.61 This immunological and inflammatory response is a chain reaction which begins at stage one (above), and progresses through stage five. It is the balancing of these anti-inflammatory hormones (including good eicosanoids, prostaglandins, and cytokines) with pro-inflammatory ones (bad eicosanoids) that ultimately maintains homeostasis and wellness. Eicosanoids, prostaglandins, and cytokines can be either pro or anti-inflammatory depending upon the type. 35 Though a complex system, one simple example of a common chemical mediator that people are familiar with is histamine. Histamine is inflammatory because in the presence of foreign attackers (allergens) its job is to dilate blood vessels. Functions of histamine are to call other components of the immune system into play to get to the injury site and other quick response defensive measures such as effect the lung passages, and release of fluids from the nose. 62 Inflammation and silent-inflammation are actually different. However, their difference is primarily only in intensity. Inflammation, symbolized by 4 classic signs: redness, swelling, heat, pain, and silent-inflammation are caused by exactly the same mechanisms, it's just that silent-inflammation is below the threshold of pain, which is why it is so dangerous. Sears created a test marker, which he named the silent information profile, or SIP, that he believes is the best way to quantify this silent inflammation. The SIP is the ratio of AA/EPA, or, the ratio of dangerous, inflammatory arachadonic acid, AA, to the health promoting anti-inflammatory fatty acid eicosapentoic acid, EPA. 63 Both arachadonic acid and eicosapentoic acid are clearly controlled by our food choices: fish oils rich in omega 3 fatty acids are shown to increase EPA levels, and diets heavy in animal fats, particularly from grain-fed cattle, increase levels of AA. In the field of nutrition, Sears has perhaps done the most to research and promote the concept of cellular inflammation and its relationship to disease as well as its causation: diet and lifestyle. His work started in the 1980s and set off a firestorm of interest and activity. However, before that, one significant event to spark this wave was the discovery of aspirin as a powerful non-steroidal anti-inflammatory (NSAID). Researcher John Vane won the Nobel Prize for this work on aspirin and 36 inflammation in 1971. 64 It has become common practice for physicians to suggest aspirin as an over the counter remedy for preventing heart attacks, as arterial and vascular inflammation are clearly understood as significant in coronary heart disease. Aspirin is shown to reduce risk factors for heart attacks, which is the reason it is referred to as the "miracle drug." However, less well known are its dangerous side effects such as excessive blood thinning, hemorrhaging in the brain, tinnitus, and more. 65 What we have learned from studying aspirin is that a serious underlying condition of low-grade inflammation is occurring. Unfortunately, rather than treat the source of the problem, modern healthcare practitioners typically treat the symptom by using aspirin, steroids, or other anti-inflammatory drugs. They do so rather than attempting to understand what the ancient Chinese knew intuitively thousands of years ago: that lifestyle creates what is described in TCM as "Yang excess," or an inflammatory condition.66 The underlying problem of low-grade or silent inflammation, which is very much a condition of the developed world, emanates from our toxic lifestyle. Consider the following statistics: • 70 million Americans suffer from arthritis, twice as many as did in the 1980's • 50 million Americans suffer from allergies, doubling since the 1980's • 64 million Americans have cardiovascular disease • An estimated 15 million Americans have eczema • 1 million Americans have inflammatory bowel disease 67 When a health topic appears on the cover of Time Magazine, it is usually a big- 37 time ordeal. A recent article titled "The Secret Killer: The Surprising Link Between Inflammation and Heart Attacks, Cancer, Alzheimer's and other Diseases" graced the cover, stating that, "suddenly inflammation has become one of the hottest areas of medical research." The article indicates that a test called the C reactive protein (CRP) is a common procedure in primary care medicine today, and a marker of inflammation; the article explains that, "CRP is a molecule produced by the liver in response to an inflammatory signal." 68 Most of the major pharmaceutical companies, including Pfizer, for example, are launching research and development efforts to target inflammation. Tepper, president of research and development at Millennium Pharmaceuticals in Cambridge, MA reveals that, "virtually our entire research and development effort is now focused on inflammation and cancer." 69 A special report published by the American Medical Association showed links between chronic inflammation and breast cancer, stating, "Inflammation induced by infections or irritants has been linked to a substantial proportion (one sixth to one third) of incident cancers worldwide” and further, “Compelling evidence for a link between inflammation and breast cancer comes from preclinical and epidemiologic observations suggesting that non-steroidal anti-inflammatory (NSAIDS) protect against the development of breast cancer" 70 However, in my view conventional healthcare erroneously treats the symptom rather than the problem. To illustrate, if one mistakenly dumps acid on the floor of a boat and it eats away the floorboards, causing the boat to fill up with water, though it may work temporarily, the long-term answer is not endlessly running from one hole to the 38 other trying to seal them. Rather, one would first remove the cause of the holes (the acid), ensure it does not happen again (by sealing the container from which it spilled), and then patching up the holes. By using pharmaceuticals in inflammation and cancer, we are patching the holes but not removing the acid so to speak, the dietary or environmental causes of inflammation. To help manage this problem at its root, blending the modern science of inflammatory markers and the wisdom of Eastern practices, nutritionist Monica Reinagel has created a system, an inflammatory foods database that rates the levels of inflammation in common foods. 71 72 Chapter Three: Conclusions and Future Considerations In closing, my belief in integrative, holistic interventions is only enhanced by doing research on cancer. Yet simultaneously, perhaps ironically, I have also developed a deeper respect for the importance of conventional medicine. The reason is I can now see clearly the enormous challenges that exist for someone diagnosed with cancer; in many instances, a cancer patient would have no option but to use acute conventional measures in order to survive. Interestingly, it is also why I have become more steadfast to learn about and promote preventive health: as I now realize the devastating repercussions of cancer and harsh treatments, I have a greater sense of purpose to help individuals avoid getting into the situation of cancer to begin with. I am in support of preventive, holistic interventions, again, emphasizing the following important point: whether or not one chooses to use severe conventional cancer treatments designed to, as Sears says, "burn, cut, or poison," 73 proper care for health, and whole-person care is critical in order to build a foundation of health. I think common sense says that a cancer patient needs to cultivate such a foundation of health in order to 39 fight cancer and improve chances for survival no matter which type of cancer he or she faces. Fortunately, it seems that science is moving in a positive direction to substantiate this. Nonetheless, basic intelligence additionally says it is true. Regardless of any deterring political or financial influences, the healthcare establishment is moving in the direction of whole person care. LaTour says, “It’s amazing how far the cancer community has come in accepting that cancer is a multidimensional disease and a journey with dual paths—one purely medical, the other addressing the more obtuse parts of our lives (our souls, hearts, spirits, and minds)—and that these two aspects of our humanness may interact in ways that we are only beginning to understand” 74 Similarly, Finestone states that the common mantra for holistic cancer care, and ideally, for all care is to “treat the patient, not the disease” 75 To encapsulate the main theme here, four important tenets are crucial in holistic cancer care, or any care. They are, according to Berman, first that the relationship between the patient and caregiver is paramount, including positive communication, listening, attention, and intention. Second, that the healing process is based upon, as Finestone stated above, "whole-person" treatment, meaning that client's mind, body, and spirit are all acknowledged aspects of the therapeutic process; and among the most important dimensions of this, according to Berman, are a person's moods, attitudes, beliefs, culture, environment, and spiritual beliefs, integral components of health psychology. Thirdly, integrative, holistic care is a blending of many healthcare modalities; and a practitioner must constantly remain aware of a "bigger picture" of care, and be prepared to work interdependently with allied practitioners. Finally, holistic care places self-healthcare in very high regard; that is, the need for client empowerment and 40 the teaching of a preventive lifestyle, including diet and healthy behaviors. 76 Regardless of whether I have been able to convey a compelling argument in this book, I am nonetheless convinced that the mode of healthcare espoused by Berman above, if adamantly adhered to, will offer a cancer patient greater chances to beat cancer than if ignored. This is true, I believe, with the implementation of either conventional or alternative treatments. I am convinced that the interviewed case studies, as supplement to this book, are strong pieces of evidence of the strength of this process. 77 Certainly, at least part of the reasons why the interviewees have survived, even thrived, in their plight with cancer is because of their devotion to wellness and healing, including their ability to remain flexible in the face of adversity, a willingness to change problematic health behaviors, and, eagerness to engage whole-heartedly in the clienthelper relationship. This last point is significant. Simple, time-tested, wisdom tells us, and intuitively we know that, "no man is an island" 78; in the Book of Psalms, it says that God, "guides the humble in what is right." 79 Unquestionably, each of the interviewees considers him or herself fortunate to have been able to work with a gifted healer like Mincolla. In part because of the synergy of the client-helper relationship, including each patient’s ability to reach out for support and assistance, they did not allow the tendency of demoralization to overcome them, offering success in their ultimate life and death battle. Additionally, without question, the perspective one takes facing an extreme illness makes a substantial difference in the experience he or she has with it. A golden rule of cognitive behavioral psychology, and stress-management, (also, Niebuhr's quote in the introduction), is that we do not always have control over circumstances, though I would add, we usually have far more control than we think we do. However, we always have at 41 least some measure of control over how we respond, which is how we must choose to focus our psychic energies. This is why holistic wellness practices such as mindfulness and diet are so important: initiating them allows a cancer patient to know they are participating in something to challenge their condition – they are not helpless. For example, Feuerstein writes of his battle against brain cancer, "My neurosurgeon told me that the prognosis was not good. The tumor was a type that had tentacles that could spread to many parts of my brain. He suggested I get my affairs in order. At age fifty-two, I probably had less than a year to live." Yet Feuerstein reached into his soul, writing emphatically, "I decided to live longer than that." 80 Feuerstein decided that he would make an empowering decision and not be a passive spectator in the deadly game of brain cancer. His attitude must have taken great courage. What Feuerstein likely realized is that life is temporary, we all eventually leave this world – in the end each of us must face our own decisions and live with how we have handled the crises along the way. Feuerstein is alive and well today and is professor of medical and clinical psychology and preventive medicine at the Uniformed Services University of the Health Services in Bethesda, MD. I wonder, Is it partly his attitude that saved him? He certainly would not have changed his health behaviors without a can-do attitude. This is the same attitude that the patients in my video have taken, and perhaps one important reason they are still alive. Yet there is also another important adage: sometimes the spirit is willing but the flesh is weak. The physical aspects of cancer are real, and at times strength of spirit only goes so far. We also need the best care, both preventive and acute, to challenge disease. We need tactics from a psychological and mind-body perspective including support 42 groups, counseling, techniques for relaxation, meditation, and guided imagery. We need to cleanse the body of toxins to allow nature’s healing process to work, to strengthen the internal forces of immunity by providing nutrition for building healthy cells and tissue (anabolic processes); and, to prevent the breakdown of healthy body tissue (catabolism). A diverse diet of vegetables, fruits, healthy fats, complete proteins, and whole grains will encourage a Yin condition, and reduce inflammation. Every nutrient in the diet including the macro and micronutrients, are vitally important. We must also reduce or eliminate contaminants in foods to maintain the Yin condition, such as excess sugars, carbohydrates, and fats, and antibiotics, pesticides, fungicides, steroids, and toxic metals, among others. Cancer is extreme, and causes extreme demands upon the body ― therefore one should approach cancer similar to the way an athlete would approach a grueling event, every detail must be covered to improve risk factors. In a significant section of the book, I questioned whether there is such thing as a “cancer personality.” If there is, then it would likely mean there are set traits that would be either unchangeable or very difficult to change that would predispose one to the risk of contracting this disease, or influence the way one handles it psychologically and emotionally. Based upon my review of studies in psychology and integrative health, as well as my intuitive sensibility, I believe likely there are stress-prone personality characteristics that would seemingly increase peoples’ risks for chronic illness; though I am unsure if it would apply specifically to cancer, or to any other disease. My guess is rather that the influence of personality applies more globally to diseases in general than to one specific disease such as cancer, though I may be wrong. I am an optimist, however, and believe that in most instances each of us is born with inherent potential, God-given 43 abilities for change. In my view, each person has an innate ability to manage how they respond to stressors. Of course, some have a naturally easier task than others; also, some have an easier task of facilitating self-improvement than others. If I were to attempt to base my views solely upon existing research, it would be difficult, because the research is conflicting. For instance, according to the researchers like Simonton, Temoshok, LeShan, and others, positive correlations exist between personality and cancer, including one’s sense of self, feelings of empowerment, ability to release anger, and so on. However, at the same time, interestingly, recent studies also show no connections between cancer and personality. A study in Japan with a research team led by Tsubono showed no correlation between four measures for personality. A metric called the Eysenck Personality Questionnaire was used, accounting for extroversion-introversion, neuroticism, psychoticism (cruelty, intolerance, and aggressiveness), and truthfulness (“faking” good in order to please others).81 According to DeNoon, referring to prior studies such as Simonton’s, and Temoshok’s, and others, that showed positive correlations between personality and cancer, “These studies had various weaknesses. They tended to focus on small numbers of people. And they often failed to control for important cancer risk factors, such as smoking.” 82 What can be made of the seeming incongruencies? Conflicting reports seem to be a trend in science in general and may or may not have to do with the sharp political divisions, as well as financial interests that exist today concerning the outcomes of research. Therefore, it is often difficult for researchers and students to discern truth from fallacy. 44 In closing, cancer and personality is certainly an interesting topic for debate. Yet I have clearly indicated in this book that besides the standard conventional treatments, in my view, the most interesting research is concerning self-awareness, mindfulness, meditation, cognitive behavioral processes, imagery, and holistic interventions such as diet and exercise, in regards to cancer. This, I believe, is where the crux of our time, energy, and research dollars should be allocated in future healthcare endeavors. Endnotes 1 Simon, D. 1999. Return To Wholeness: Embracing Body, Mind, and Spirit in the Face of Cancer. New York, NY: John Wiley & Sons. 1999, 35. 2 Quillen, P. 2005 (4th Edition). Beating Cancer With Nutrition: Combining the Best of Science and Nature For Full Spectrum Healing In The 21st Century. Carlesbad, CA: Nutrition Times Press, 24. 3 Varona, V. 2001. Nature's Cancer Fighting Foods: Prevent and Reverse the Most Commoon Forms of Cancer Using the Proven Power of Great Food and Easy Recipes. Paramus, NJ: Reward Books, ix-xii. 4 Ibid, xiii. 5 Simonton, O. C. 1988.Getting Well Again. New York, NY: Bantam Books, 36. 6 Ibid, 41. 7 Ibid, 98. “The Immune System: Key Players.” Cancer.org. 14 December 2006. The American Cancer Society. 28 November 2007 <http://www.cancer.org/docroot/ETO/content/ETO_1_4X_The_Immune_SystemKey_Players.asp?sitearea=ETO> 8 9 Bittman, B. & Berk, L. & Felten, D.L. & Westengard, J. Jan. 2001. Original Research: Composite Effects of Group Drumming Music Therapy on Modulation of Neuroendocrine-Immune Parameters in Normal Subjects Journal of Alternative Therapies in Health and Medicine. Vol 7, Issue 1, 38. 10 Thoreau, H.D. 2004. Walden: A Fully Annotated Edition. New Haven: Yale University Press, 88. 11 Aspinwall, L.G., & Brunhart, S.M. 1996. Distinguishing optimism from denial: beliefs predict attention to health threats. Personality and Social Psychology Bulletin, Vol 22, 993-1003. 45 12 Brown, S.E. & Trivieri, L. Jr. 2006. The Acid Alkaline Food Guide: A Quick Reference To Foods & Their Effect On pH Levels. Garden City Park, NY: Square One Publishers, 1. 13 Zablocki, E. June, 2004. Integrative Care Mind-Body Methods Aid Cancer Patients. Townsend Letter For Doctors and Patients. 14 Gentry, M. 2000. Stopping Cancer Before It Starts: The American Institute For Cancer Research’s Program For Cancer Prevention. New York: St. Martin’s Press. 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Giving Up as a Final Common Pathway to Changes in Health. Advanced Psychosomatic Medicine, Vol 8, 20-40. 22 Simonton, O. C. 1988.Getting Well Again. New York, NY: Bantam Books, 5. 23 Ibid. 24 Simonton, O. C. 1988.Getting Well Again. New York, NY: Bantam Books, 11-13. 25 Zabat-Zinn, J. 2005. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion. “Cancer Patients Can Be Well Just As They Are: Jon Kabat-Zinn Shares Mindfulness Meditation At Cancer Center.” Cancerwise.org. March 2005. Cancerwise: Journal of the UTexas MD Anderson Cancer Center. 28 January 2008. <http://www.cancerwise.org/March_2005/display.cfm?id=42F070C2-129A-44E38DAE0A1BA923C864&method=displayFull&color=green> 26 46 27 Byers, J. Personal interview. 18 December 2007. “Post Traumatic Stress Disorder Seen in Some Cancer Patients: Nurses Can Step In to Help Ease Symptoms” Cancer.org. July 2002. The American Cancer Society. 11 March 2008 <http://www.cancer.org/docroot/NWS/content/NWS_1_1x_PostTraumatic_Stress_Disorder_Seen_in_Some_Cancer_Patients.asp> 28 29 Pennebaker, J.W. 1990. Opening Up: The Healing Power of Confiding in Others. New York: William Morrow Co. 30 Zabat-Zinn, J. 2005. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion. 31 Germer, C.K. & Siegel, R.D. & Fulton, P.R. 2005. Mindfulness and Psychotherapy. New York: The Guilford Press. 32 Zhang, Y. 2004. Zen and Psychotherapy. UK: Trafford. 33 Germer, C.K. & Siegel, R.D. & Fulton, P.R. 2005. Mindfulness and Psychotherapy. New York: The Guilford Press. 34 Kabat-Zinn, J. 2005. Wherever You Go, There You Are: Mindfulness Meditation In Everyday Life. .New York: Hyperion. 35 Olson, R.P. 2002. Religious Theories of Personality and Psychotherapy: East Meets West. Binghampton, NY: Haworth Press. 36 Csikszentmihalyi, M. 1990. Flow: The Psychology of Optimal Experience. New York: Harper Perennial. 43,19. 37 Simonton, O. C. 1988. Getting Well Again. New York, NY: Bantam Books. 38 Dr. Andrew Weil is founder of the Program in Integrative Medicine of the College of Medicine,University of Arizona and a foremost authority on holistic health. Dr. C. Norman Shealy is a worldwide expert in pain management and holistic medicine. Dr. Jeanne Achterberg is an internationally recognized scientist and expert in the field of mind-body medicine, holistic cancer research and treatment. 39 The ECaP program is the renowned Exceptional Cancer Patient program that treats cancer patients using holistic mind-body treatments. The program was developed by Dr. Bernie Siegel and Dr. Barry Bittman in 1978 and affiliated with Yale University. Stevens, R. “Unconventional Cancer Treatments” Princeton.edu. September, 1990. Report issued by the Office of Technology Assessment, United States Congress. 25 March 2008 < http://www.princeton.edu/~ota/disk2/1990/9044.html> 40 41 Spiegel, D. & Bloom, J. & Kraemer, H.C. et.al. 1989. Effect of Psychosocial Treatment on Survival of Patients With Breast Cancer. Lancet Vol 2, 8668, 888-891. 42 Ibid. 47 43 Benson, H. May/June 2001. Mind-Body Pioneer: The Connection Between Your Mind and Body is Stronger Than You Think. Psychology Today. 44 Quillen, P. 2005 (4th Edition). Beating Cancer With Nutrition: Combining the Best of Science and Nature For Full Spectrum Healing In The 21st Century. Carlesbad, CA: Nutrition Times Press, 7. 45 Ibid, 10. 46 Tiner, J.H. & Denman, M.L. 1999. Louis Pasteur: Founder of Modern Medicine. MI: Mott Media. 47 Seaward, B.L. 2004. Managing Stress: Principles and Strategies For Health and Well-Being. Sudbury, Massachusetts: Jones and Bartlett Publishing, 45. 48 Ibid, 45. “Types of Cancer” MDAnderson.org. The MD Anderson Cancer Center. 20 February 2008. <http://www.mdanderson.org/patients_public/about_cancer/display.cfm?id=411A240D-77B9-11D4AEC300508BDCCE3A&method=displayFull> 49 50 Straub, R. O. 2002. Health Psychology. New York, NY: Worth Publishers, 419. 51 Ibid. 52 Kaput, J. (edit.) 2006. Nutritional Genomics: Discovering the Path to Personalized Nutrition. Hoboken, NJ: Wiley Science Publishing. 53 Ibid, 422. 54 Stuhler, G. & Walden, P. 2002. Cancer Immune Therapy: Current and Future Strategies. Wiley Publishing, 96. 55 Seaward, B.L. 2004. Managing Stress: Principles and Strategies For Health and Well-Being. Sudbury, MA: Jones and Bartlett Publishing, 479. 56 Ibid. 57 Pitchford, P. 2002. Healing With Whole Foods: Asian Traditions and Modern Nutrition Berkeley, CA: North Atlantic Books, 49. Sears, B. 2005. The Anti-Inflammation Zone: Reversing the Silent Epidemic That’s Destroying Our Health. New York: Harper Collins. 58 59 Ibid, 261. 60 Ibid, 228. 48 61 Ibid, 228. 62 Ibid, 228. 63 Ibid, 227-8. 64 Jeffreys, D. 2004. Aspirin: The Remarkable Story of a Wonder Drug. New York, NY: Bloomsbury, 233. “Cerebral Vascular Disease.” Lef.org. June, 2004. The Life Extension Foundation. 24 March 2008 <http://www.lef.org/protocols/prtcl-031.shtml> 65 66 Mincolla, M. 1995. The Tao of Ch’i: Healing With The Unseen Life Force. Pennyroyal Press, 134. 67 Chilton, F.H. 2006. Inflammation Nation: The First Clinically Proven Eating Plan to End Our Nation’s Secret Epidemic. New York, NY: Fireside Publishing, 3-4. 68 Gorman, C. & Park, A. February 23, 2004. “The Secret Killer: The Surprising Link Between Inflammation and Heart Attacks, Cancer, Alzheimer’s, and Other Diseases.” Time Magazine. 69 Ibid. 70 Ness, R.B. & Cauley, J.A. February 18, 2004. Antibiotics and Cancer: What’s The Meaning of This? Journal of the American Medical Association. Vol. 291, 7, 880-881. 71 Reinagel, M. 2006. The Inflammation Free Diet Plan: The Scientific Way to Lose Weight, Banish Pain, Prevent Disease, and Slow Aging. New York, NY: McGraw-Hill. The anti-inflammatory foods database can be viewed in Reinagel’s book (see previous citation), or at the website, www.nutritiondata.com. 72 Sears, B. 2005. The Anti-Inflammation Zone: Reversing the Silent Epidemic That’s Destroying Our Health. New York, NY: Harper-Collins, 261. 73 74 LaTour, K. 2003. The Other Side of Healing: Healing Means Integrating Issues of The Heart And Soul Into The Cancer Experience. Cure Magazine. Fall Issue. 75 Ibid. “What is Integrative Medicine?” The New Medicine. The Public Broadcasting Service. 24 April 2006 <http://www.pbs.org/thenewmedicine/interview.html> 76 77 Schlosberg. P. 2008. From Illness To Wholeness. Unpublished mini-documentary, thesis. Lesley University. Donne, J. 1999. “Devotions Upon Emergent Occasions.” Devotions Upon Emergent Occasions and Death’s Duel. Ed. Motion, A & Walton, I. New York, NY: Random House, 103. 78 49 79 King David. “Psalm 25” Life Application Study Bible: New International Version. Wheaton, Ill: Tyndale House Publishers, Inc., 850. 80 Feuerstein, M. & Findley, P. 2006. The Cancer Survivor’s Guide: The Essential Handbook to Life After Cancer. New York, NY: Marlowe and Company, xx. 81 Tsubono, Y., Tsugi, I. et. al. June 2003. Personality And The Risk of Cancer. Journal of The National Cancer Institute. Vol 95, Number 11, 799-805. DeNoon, D.J. “No Such Thing As A ‘Cancer Personality’: Personality Types Unrelated to Risk of Developing Cancer.” Webmd.com. 3 June 2003. WebMD. 19 February 2008 <http://www.webmd.com/cancer/news/20030603/no-such-thing-as-cancer-personality> 82 Appendix A: Key Terms carcinoma, cytokines, dialectical behavior therapy (DBT), endogenous, exogenous, homeostasis, imagery, immune surveillance theory, immunity, leukemia, lymphokineactivated killer cells, lymphoma, malignant, metastasis, (NKC) natural killer cells, nonsteroidal anti-inflammatory (NSAID), oncogenes, sarcoma, silent inflammation profile (SIP), suppressor genes, t cells, tumor, visualization