The Total Health Experience: Eat, Play, Learn
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Cancer—it’s arguably the most terrifying diagnosis anyone can receive. Coming from the Greek karkinos, a word used to describe carcinoma tumors by the famous physician Hippocrates (460–370 BC), cancer is the second leading cause of death in the United States and around the world, behind only cardiovascular disease.[1][2]
Cancer isn’t inevitable, though. We know from the work of T. Colin Campbell, PhD, as discussed in The China Study, that cancer is largely preventable.[3] Though there may be some exceptions, Campbell contends that cancer most often develops because of our rich Western diets, not our genes.
If food is the primary enemy, why does nearly everyone automatically turn to surgery, chemotherapy, and radiation? Most patients ask almost no questions when their doctors direct them toward these conventional treatments, largely because most don’t know about the alternatives. Shouldn’t we be trying to change that and think outside the box of modern medicine, given the horrendous side effects and often meager results of many twenty-first–century treatments? At the very least, shouldn’t we be implementing lifestyle changes in conjunction with modern medical interventions?
These are billion-dollar questions—literally—as the US is projected to spend nearly $250 billion annually on cancer treatment by 2030![4]
I certainly don’t have the answers to every situation involving cancer (no one does), but I will do my best in this article to give you some food for thought when it comes to treating cancer. For context, I’m a clinical hospital pharmacist, educated in and surrounded by the best that modern medicine has to offer. In my line of work, I see the slicing and dicing, the bombardment of radiation, and the administering of chemotherapy all the time. I’ve thought to myself, There must be more options for those facing this life-and-death disease. Did my education and training neglect something critical? What I’ve learned is that perfect solutions don’t exist because not every individual or cancer is created equal.
Breast, prostate, and colon cancer are three of the most common cancers in America. While the data runs deep when it comes to modern medical treatments (surgery, radiation, chemotherapy, etc.), high-quality research comparing these treatments with a whole food, plant-based (WFPB) lifestyle is largely missing. (Learn about the history of cancer research and why it favors conventional treatment options.)
To my knowledge, only prostate cancer has controlled interventional studies (the gold standard for determining medical practices) to evaluate whether a WFPB diet should be the standard treatment for any type of cancer. Even then, these interventional studies, which I will discuss below, measured blood markers as the end result, not morbidity and mortality due to prostate cancer. This is the equivalent of measuring the drop in a person’s cholesterol level after taking a statin drug rather than measuring the rate of heart attacks and deaths had the statins not been taken.
While it would be nice to someday have studies using a WFPB diet as the only treatment option for different types of cancer, and comparing this diet with modern medical therapy, the available studies on nutrition and cancer are still valuable in their own right.
An estimated 2.7 million men lived with prostate cancer in the US in 2011.[5] At the time of diagnosis, 81 percent of those men had localized prostate cancer (confined only to the prostate gland), 12 percent had cancer that had spread to the lymph nodes, 4 percent had cancer that had metastasized to other organs, and 3 percent were unstaged.
Common treatment options include watchful waiting, surgery, radiation, hormone therapy, and chemotherapy. Treatment with diet alone is considered unconventional and not practiced by most physicians. I will mostly discuss available data regarding low-risk patients (i.e., those with localized prostate cancer) since most men fall into this category.
A 2010 article published in Annals of Oncology examined several treatment options for low-risk prostate cancer, including active surveillance (watchful waiting), radical prostatectomy (surgical removal of the prostate gland), and radiation therapy.[6] The authors write, “Ten-year prostate cancer specific survival approaches 100% for each management option, including active surveillance for selected patient groups.” In other words, all forms of treatments, including doing nothing (watchful waiting), led to the same results.
For the intermediate-risk group, results were slightly different:
The actuarial risk of death from prostate cancer at 12 years was 12.5% for surgery compared to 17.9% for watchful waiting. Put it another way, the number needed to treat (NNT) to avoid one death from prostate cancer was 18.5. This means that on average a little over 18 men had to be treated in order for one man to avoid death due to prostate cancer. This beneficial impact of surgery on prostate cancer mortality was restricted to men age 65 or younger. Radical prostatectomy increased the rate of erectile dysfunction (ED) by 35%, and urinary leakage (incontinence) by 28%, in comparison with watchful waiting.
Essentially, men receiving this surgery compared to men who did nothing experienced a 5.4 percent absolute risk reduction in death after twelve years. With this risk reduction, a significant percentage of the men experienced at least one of the unwanted and potentially long-lasting side effects of ED or urinary incontinence.
Another common treatment for prostate cancer is hormone therapy, otherwise known as androgen deprivation therapy (ADT), whereby a medication like Zoladex (goserelin) or Lupron (leuprolide) is given to lower testosterone levels in the body. These medications are considered antineoplastic agents, meaning they inhibit the proliferation of malignant cells.
In theory, lowering testosterone makes sense because elevated testosterone levels in men typically go hand in hand with prostate cancer risk. However, whether these agents are likely to show any benefits depends on a patient’s risk level. A 2008 article in the Journal of the American Medical Association (JAMA) looked at using ADT in more than nineteen thousand men with localized prostate cancer. Researchers found the ten-year survival rate in men treated with the medication was actually worse than the rate for those practicing watchful waiting.[7] ADT is therefore only recommended in men with advanced or high-risk disease, such as those where the cancer has spread to the lymph nodes or beyond.[8]
ADT therapy is also not without its side effects. Among the adverse effects are changes in serum lipid profiles, risk of insulin resistance, and risk of coronary artery disease.[8] In addition, 27–49 percent of men will develop erectile dysfunction while on these medications.[9] Any male candidate for ADT therapy should weigh these risks against the potential benefits as they talk to their doctor about prostate cancer.
In 2005, Dean Ornish, MD, published a study on halting and potentially reversing prostate cancer with lifestyle changes, including a low-fat vegan diet similar to the WFPB diet.[10] Published in the Journal of Urology, Ornish took ninety-three male patients with biopsy-proven low-grade prostate cancer and randomized them into an experimental group (forty-four men) with lifestyle changes or a control group (forty-nine men). “The diet,” writes Ornish et al., “was predominantly fruits, vegetables, whole grains (complex carbohydrates), legumes and soy products, low in simple carbohydrates and with approximately 10% of calories from fat.” A blood marker called prostate-specific antigen (PSA) was measured at baseline and one year.
The PSA test is not always accurate; estimates suggest that the risk of overdiagnosis in prostate cancer in men in their fifties and sixties is between 5 and 44.9 percent.[11] Nevertheless, it remains one of the best ways to screen noninvasively for prostate cancer. The higher the PSA level, the higher the risk of prostate cancer. PSA levels between 4 and 10 ng/ml typically indicate low-grade prostate cancers, and a definitive biopsy is ordered if PSA levels are elevated.
Returning to Ornish’s study, patient results at baseline and one year for PSA levels are shown here for both dietary groups:
In short, the prostate cancer in the experimental group reversed course, while those without the dietary changes saw a worsening of their disease. Even more significant than the PSA test is this: none of the men in the experimental group required further conventional medical treatment for their prostate cancer, whereas six men in the control group underwent further treatment due to rising PSA levels. Side effects of the lifestyle changes were all positive, including a drop in total and LDL cholesterol levels, plus an average weight loss of ten pounds. No erectile dysfunction or urinary incontinence was reported with the switch to a healthy plant-based diet.
These results were confirmed in another study published in 2006 by Saxe et al.[12] Researchers found either a reduction in PSA levels or a decrease in the rate of PSA rise in men who adopted a plant-based diet for six months.
An estimated 2.9 million women were living with breast cancer in 2011.[5] At the time of diagnosis, 61 percent of women had localized breast cancer (confined only to the breast tissue), 32 percent had cancer that had spread to the lymph nodes, 5 percent had metastasized cancer, and 2 percent of cases were unstaged.
(Although I’m focusing in this article on the main treatment options for breast cancer, the diagnosis of the disease is also an interesting topic. Please see my article here for more information on annual mammogram screenings and how beneficial they are.)
Two of the most common treatments for breast cancer are chemotherapy (specifically anthracycline and taxane agents) and hormone therapy (tamoxifen, which exerts an antiestrogen effect on breast tissue). Tamoxifen typically follows chemotherapy for five years.
Below are the success rates of taxane and anthracycline agents for five- and ten-year breast cancer recurrence and survival rates. These are typically what patients with breast cancer are most concerned with—death and the return of their breast cancer. Statistics are reported in absolute risk reduction.[13][14]
Taxane + Anthracycline vs. Anthracycline Alone
Anthracycline Alone vs. No Chemotherapy
For tamoxifen therapy, the five-year success rates are listed below for hormone receptor-positive cases of breast cancer in women. (In hormone receptor-negative breast cancer cases, tamoxifen has little or no effect on recurrence and death rates.) Once again, results are reported in terms of absolute risk reduction.[15]
Tamoxifen vs. No Treatment
Now that you’ve seen the benefits of taking these drugs, let’s take a look at potential side effects.[16][17][18]
Taxanes (Taxol)
Neutropenia (a decrease in a particular kind of white blood cell, which leaves patients at increased risk of infections): 78–100 percent
Alopecia (hair loss): 55–96 percent
Anemia: 47-96 percent
Arthralgia/myalgia (joint or muscle pain): 93 percent
Diarrhea: 90 percent
Leukopenia (a decrease in circulating white blood cells): 90 percent
Nausea/vomiting: 9–88 percent
Opportunistic infections: 76 percent
Peripheral neuropathy (nerve damage beyond the brain and spinal cord): 42–79 percent
Thrombocytopenia (reduced blood platelets, which leaves patients at increased risk of excessive bleeding): 4–68 percent
Mucositis (inflammation of the mucous membranes in the mouth and GI tract): 5–45 percent
Hypersensitivity: 2–45 percent
Renal (kidney) impairment: 34 percent
Hypotension (abnormally low blood pressure): 17 percent
Bradycardia (slow heart rate): 3 percent
Anthracyclines (Doxorubicin)
Neutropenia (a decrease in a particular kind of white blood cell, which leaves patients at increased risk of infections): 52 percent
Anemia: 52 percent
Leukopenia (a decrease in circulating white blood cells): 42 percent
Pruritus (itchiness): 37 percent
Nausea: 37 percent
Stomatitis (inflammation or soreness of the mucous membranes in the mouth): 37 percent
Fatigue: 33 percent
Congestive heart failure (CHF): 30 percent
Thrombocytopenia (reduced blood platelets, which leaves patients at increased risk of excessive bleeding): 24 percent
Vomiting: 22 percent
Rash: 21 percent
Alopecia (hair loss): 15 percent
Anorexia: 12 percent
Constipation: 12 percent
Diarrhea: 10 percent
Cardiomyopathy (disease making it more difficult for the heart muscle to pump blood): 0.5-9 percent
Tamoxifen
Hot flashes: 64 percent
Vaginal discharge: 30 percent
Amenorrhea (absence of menstrual periods): 16 percent
Menstrual changes: 13 percent
Oligomenorrhea (infrequent menstrual periods): 9 percent
Cataracts: 8 percent
Bone pain: 6 percent
Nausea: 5 percent
Cough: 4 percent
Edema (excess fluid collecting in the tissues, leading to swelling): 4 percent
Fatigue: 4 percent
Musculoskeletal pain: 3 percent
Ovarian cyst: 3 percent
Depression: 2 percent
Abdominal cramps: 1 percent
Anorexia: 1 percent
As I mentioned earlier in this article, I am unaware of any controlled interventional studies that used a 100 percent WFPB diet in the treatment of breast cancer and reported recurrence and mortality data. This would be the gold standard in terms of evidence, providing the highest quality of data that can be obtained. Nevertheless, an impressive array of evidence, including epidemiological and laboratory data, suggests that such research is worth pursuing.
John McDougall, MD, conducted a controlled interventional study in 1984 using a low-fat, starch-centered plant-based diet on a small group of postmenopausal women who had previously been diagnosed with breast cancer. McDougall found that specific markers commonly associated with a poorer prognosis in breast cancer (obesity, high cholesterol levels, high estrogen levels, and high prolactin levels) were all reduced after three months on his diet.[19]
Numerous studies show that a Western diet is associated with higher incidences of breast cancer.[20][21] These studies show a definite link between unhealthy dietary patterns containing foods higher in fats (processed foods, meat, dairy, and animal fat) and breast cancer. Data like these should sound alarm bells for any woman wanting to avoid breast cancer. It is certainly a case of “better safe than sorry” when considering cutting out beef, chicken, pork, fish, dairy, eggs, and processed foods.
Additionally, a few randomized, controlled interventional trials have analyzed a low-fat diet and breast cancer recurrence risk and death rates among breast cancer sufferers. A meta-analysis published in 2014 looked at two such studies.[22] The two studies tested a “low-fat” (approximately 20–22 percent of calories from fat) diet that included both plant and animal foods. This is a far cry from the 8 percent of calories from fat in the diet that McDougall tested in 1984 (or the 10 percent in Ornish’s prostate cancer study, mentioned above). Nevertheless, in these studies, there was a 23 percent reduction (statistically significant) on average in breast cancer recurrence rates and a 17 percent reduction (not statistically significant) on average in all-cause mortality in breast cancer patients.
Another prospective cohort study, published in 2013, followed nearly ninety-two thousand women who had never been diagnosed with breast cancer over a period of fourteen years.[23] The investigators analyzed dietary intake patterns and breast cancer occurrence rates. The plant-based pattern (high consumption of fruits and vegetables) was associated with a reduction in breast cancer risk, whereas the salad and wine pattern (high consumption of salad, low-fat dressing, fish, wine, coffee, and tea) was associated with an increased breast cancer risk. While all dietary patterns analyzed included both plant and animal foods in their respective groups, each particular pattern consisted of significantly higher amounts of the foods listed in parentheses.
Cancer is a frightening disease. The suffering that cancer patients endure during their disease often incites fear in not only those suffering from the cancer but also those looking in from the outside. While not all forms of cancer are created equal, we have certainly made great strides in understanding the disease better. However, we have a long way to go in finding the ever-elusive “cure.”
Conventional treatments such as chemotherapy, radiation, and surgery have their own challenges in treating this disease, especially in terms of side effects. I’ve always maintained that our best bet is to prevent cancer in the first place by adopting healthier lifestyle habits, especially a healthier diet. We can and should use these same prevention strategies for cancer treatment.
A health-promoting, cancer-fighting WFPB diet should be implemented in all patients with cancer, regardless of whether that patient chooses to undergo conventional treatment options. There are no risks, only upsides, of doing so.[24]
If you find yourself facing cancer, make sure to perform your due diligence in exploring all your treatment options. Knowledge is power, and you’re going to need all the knowledge in the world to help you get through a disease like cancer. May life bless you with an abundance of health and happiness.
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