There is a growing appreciation within medicine of the tremendous interconnectedness of the mind and body. In fact, there is a whole new paradigm emerging. A paradigm is a model used to explain events. While the old medical paradigm viewed the body basically as a machine, the new paradigm focuses on the interconnectedness of body, mind, emotions, social factors, and the environment in determining the status of health. In this chapter, we will explore the roles of attitude, personality, emotions, lifestyle, stress reduction, exercise, and sleep in the prevention of cancer. Specifically, we will focus on the role of these factors in influencing the immune system. These factors play a signifcant role in cancer treatment as well.

In Chapter 1, we described the prototypical cancer personality as someone who suppresses anger, avoids conflicts, and has a tendency to feel helpless. The suppression and repression of emotions amplify che negative effects that stress produces on the immune system.

The link between the brain, the emotions, and the immune system has led to a field of scientific research known as psychoneuroimmunol ogy. What research in psychoneuroimmunology tells us is that every part of our immune system is connected to the brain in some way, be it via a direct nervous tissue connection or through the complex chemical language of chemical messengers and hormones.

What scientists are discovering is that every thought, emotion, and experience send a message to the immune system that will either enhance or impair its ability to function. A simplistic view is that positive emotions such as joy, happiness, and optimism tend to boost immune system function, whereas negative emotions such as depression, sadness, and pessimism tend to suppress immune function.

Since the immune system is so critical in preventing cancer, if emotions and attitude were risk factors for cancer we would expect to see an increased risk of cancer in people with long-standing depression or a pessimistic attitude. Does research support such an association? Absolutely. For example, smokers who are depressed have a much greater risk of lung cancer than smokers who are not depressed.

Depression and the harboring of other negative unresolved emotions contribute to an increased risk of cancer in several ways. Most of the research has focused on the impact of depression and other negative emotions on white blood cells known as natural killer cells. These cells received their name because of their ability to destroy cells that have become cancerous or infected with viruses. They are the body’s first line of defense against cancer development.

Considerable scientific evidence documents the link between negative emotions, stress, and a low level of activity of natural killer cells and an increased risk for cancer. Studies have also shown that the classic cancer personality has lower natural killer cell activity compared with other personality types. Negative emotions and stress paralyze many aspects of immune function and can cause natural killer cells literally to burst. Furthermore, studies indicate that individuals with a personality type that is prone to cancer have an exaggerated response to stress, compounding the detrimental effects that stress has on natural killer cells and the entire immune system.

Interestingly, in one of the largest studies it was shown that regular exposure to stress situations actually appears to reduce the risk of cancer. It seems that the regular exposure to stress dampens the stress response to major life events such as a death of a spouse, divorce, or loss of a child or parent. Major life events such as these are associated with a significantly increased risk for cancer in people who cannot externalize emotions and obtain appropriate help and counseling. When faced with a major life challenge, it is important to seek out the support and comfort of family and friends and, if needed, the support of a counselor or a member of the clergy.

Depression and stress not only affect the immune system, they appear to hinder the cell’s ability to repair damage to DNA as well. Most carcinogens cause cancer by directly damaging DNA in cells, thereby producing abnormal cells. One of the most important protective mechanisms against cancer in the cell’s nucleus are enzymes responsible for the repair or destruction of damaged DNA. Several studies have shown that depression and stress alter these DNA repair mechanisms; for example, in one study, lymphocytes (a type of white blood cell) from depressed patients demonstrated impairment in their ability to repair cellular DNA damaged by exposure to X-rays.

Interestingly, in one of the largest studies it was shown that regular exposure to stress situations actually appears to reduce the risk of cancer. It seems that the regular exposure to stress dampens the stress response to major life events such as a death of a spouse, divorce, or loss of a child or parent. Major life events such as these are associated with a significantly increased risk for cancer in people who cannot externalize emotions and obtain appropriate help and counseling. When faced with a major life challenge, it is important to seek out the support and comfort of family and friends and, if needed, the support of a counselor or a member of the clergy.

Depression and stress not only affect the immune system, they appear to hinder the cell’s ability to repair damage to DNA as well. Most carcinogens cause cancer by directly damaging DNA in cells, thereby producing abnormal cells. One of the most important protective mechanisms against cancer in the cell’s nucleus are enzymes responsible for the repair or destruction of damaged DNA. Several studies have shown that depression and stress alter these DNA repair mechanisms; for example, in one study, lymphocytes (a type of white blood cell) from depressed patients demonstrated impairment in their ability to repair cellular DNA damaged by exposure to X-rays.

Developing the “Anticancer” Personality

Just as research has identified personality, emotional, and attitude traits that increase the risk of cancer, likewise the field of psychoneuroimmunology has identified traits to reduce your risk for cancer. This collection of immune power” traits includes a positive mental attitude, an effective strategy for dealing with stress, and a capacity to openly admit traumas, challenges, and feelings to yourself and others.

The Importance of a Positive Mental Attitude

The first step in devepoling the anticancer personality is expressing a positive mental attitude.As we have seen over in our patients lives (and our own),it is not what happens in our lives that determines our direction; it is our response to those challenges that shapes the quallity of our lives and determines to a very large degree our level of health. Surprisingly, it is often true that hardship, heartbreak, disappointment, and failure serve as the spark for joy, ecstasy, compassion, and success. The determining factor is whether we view these challenges as stepping stones or stumbling blocks.

Fortunately, according to the world’s leading authority on attitude and explanatory style (the manner in which we explain the events in our lives), humans are optimists by nature. Optimism is not only a necessary step toward achieving optimal health, it is critical to happiness and a higher quality of life.

Detailed evidence supports the contention that optimists live longer, suffer from fewer and less severe diseases (including cancer), and are much healthier than pessimists. In a 30-year study conducted by researchers at the prestigious Mayo Clinic in Rochester, Minnesota, the survival rate among optimists was 19 percent greater than that of pessimists. All causes of death were reduced, including cancer.

To determine your level of optimism, we encourage you to take the selfassessment developed by he (see Appendix H, on page 346).

Learning Optimism

Our attitude is like our physical body: In order for it to be strong and positive it must be conditioned. Conditioning your attitude to be positive and optimistic means adopting specific healthy habits. Here are three key habits to help you develop a positive mental attitude:

• Improve the way you talk to yourself. We all conduct a constant running dialogue in our heads. In time, the things we say to ourselves percolate down into our subconscious minds. Those inner thoughts, in turn, affect the way we think and feel. Naturally, if you feed yourself a steady stream of negative thoughts, it will have a negative impact on your mood, immune system, and quality of life. The cure is to become aware of your self-talk and then consciously work to feed positive self-talk messages to your subconscious mind.
• Ask better questions. An expert in motivation, Anthony Robbins, believes that the quality of your life is equal to the quality of the questions you habitually ask yourself. For example, if you experience a setback, do you think, “Why am I so stupid?” or “Wh do bad things always happen to me?” Or do you think, “Okay, what can I learn from this situation so that it never happens again?” or “What can I do to make the situation better?” Clearly the latter response is healthier. Regardless of the situation, asking better questions is bound to improve your attitude. Here are some questions to start you off:
  • What am I most happy about in my life right now?
  • What am I most excited about in my life right now?
  • What am I most grateful for in my life right now?
  • What am I enjoying most in my life right now?
  • What am I committed to in my life right now?
  • Who do I love? Who loves me?
  • What must I do today to achieve my long-term goal?
• Set positive goals. Learning to set achievable goals is a powerful method for building a positive attitude and raising self-esteem Achieving goals creates a success cycle: You feel better about yourself, and the better you feel about yourself, the more likely you are to succeed. Here are some guidelines for setting health goals:
  • State the goal in positive terms and in the present tense; avoid negative words. It’s better to say, “I enjoy eating healthy, lowcalorie, nutritious foods” than to say, “I will not eat sugar, candy, ice cream, and other fattening foods.”
  • Make your goal attainable and realistic. Start out with goals that are easily attainable, like drinking six glasses of water a day and switching from white bread to whole-wheat. By initially choosing easily attainable goals, you create a success cycle that helps build a positive self-image. Little things add up to make a major difference in the way you feel about yourself.
  • Be specific. The more clearly you define your goal, the more likely you are to reach it. For example, if you want to lose weight, what is the weight you desire? What body fat percentage or measurements do you want to achieve?

Dealing with Stress

Stress can be devastating to immune function that is why we are more susceptible to the common cold and the flu during stressful times. Usucally the greater the stressor, the greater the negative impact. The stress response causes increases in adrenal gland hormones, including adrenaline and cortisol. Among other things, these hormones inhibit the formation and action of white blood cells and cause the main organ of the immune system the thymus gland to shrink (involute). Since stress seems to be an inevitable part of modern living, it is critical to develop effective methods to deal with stress.

Whether you are aware of it or not, you have developed a pattern for coping with stress. Unfortunately, most people have found patterns and methods that ultimately do not support good health. Negative coping patterns must be identified and replaced with positive ways of coping, Try to identify any negative or destructive coping patterns listed in Table 5-1 that you may have developed and replace the pattern with more positive measures for dealing with stress.

Calming the Mind and Body

Learning to calm the mind and body is extremely important in relieving stress. Among the easiest methods to quiet the body and mind are

relaxation exercises. The goal of relaxation techniques is to produce a physiological response known as relaxation response a term coined by Harvard professor and cardiologist Herbert Benson in the early 1970s. Although an individual may relax by simply sleeping, watching television, or reading a book, relaxation techniques are designed specifically to produce the relaxation response.

Producing the relaxation response requires breathing with the diaphragm. By using the diaphragm to breathe, a person dramatically changes his or her physiology: It literally activates the relaxation centers in the brain. Here is a popular relaxation technique to breathe with your diaphragm.

• Find a comfortable and quiet place to lie down or sit.
• Place your feet slightly apart. Place one hand on your abdomen near your navel. Place the other hand on your chest.
• You will be inhaling through your nose and exhaling through your mouth.
• Concentrate on your breathing. Note which hand is rising and falling with each breath.
• Gently exhale most of the air in your lungs.
• Inhale while slowly counting to 4. As you inhale, slightly extend your abdomen, causing it to rise about 1 inch. Make sure that you are not moving your chest or shoulders.
• As you breathe in, imagine the warmed air flowing in. Imagine this warmth flowing to all parts of your body.
• Pause for 1 second, then slowly exhale to a count of 4. As you ex hale, your abdomen should move inward.
• As the air flows out, imagine all your tension and stress leaving your body.
• Focus on relaxing your toes and progressively move up your body as you imagine the stress melting away.
• Repeat the process until a sense of deep relaxation is achieved.

Lifestyle

A healthy lifestyle not only reduces the risk of cancer, but also reduces the risk of heart disease and improves the quality of life. The key recomniendations for an anticancer lifestyle are don’t smoke, follow a regular exercise program, and make sure that you get enough sleep.

Don’t Smoke

We have already stressed that smoking is a major risk factor for lung cancer as well as every other cancer. In fact, cigarette smoking is the single greatest cause of cancer death in the United States. Tobacco smoke contains more than 4,000 chemicals, of which more than 50 have been identified as carcinogens. Cigarette smokers have overall cancer death rates twice those of nonsmokers. The greater the number of cigarettes smoked, the greater the risk.

If you want good health and a lower risk for cancer, you absolutely must not smoke. How do you stop? Based on the results of published studies, it appears that the best strategy for quitting smoking is to just stop to go “cold turkey.” Nicotine-replacement therapy (using gum or the skin patch) is effective for about 13 percent of the people who try it. Behavioral modification (rewards and punishments) only works for about two people in every hundred. Acupuncture is only slightly better. Some people have been able to quit following hypnosis.

Exercise

Regular exercise is a powerful prescription for a positive mood. Tensions, depressions, feelings of inadequacy, and worries diminish greatly with regular exercise, Exercise alone has been demonstrated to have a tremendous impact on improving mood and the ability to handle stressful life situations.

Regular physical exercise is obviously a major key to good health, and its ability to prevent cardiovascular disease is well known, but can it prevent cancer? Yes! As mentioned in Chapter 1, increased physical activity, whether from structured exercise or physical labor, has been found to cut the overall cancer risk nearly in half. The preventive effects of exercise are seen even in people who have other risk factors, such as poor diet, excess body weight, and smoking.

The benefits of regular exercise in the battle against cancer may be

due to its effects on the immune system. For example, some studies have shown that regular exercise leads to a significant increase (up to 100 percent) in natural killer cell activity. Although more strenuous exercise is required to benefit the cardiovascular system, light to moderate exercise may be best for the immune system. The research thus far suggests that light to moderate exercise stimulates the immune system, while intense exercise (e.g., training for the Olympics) can have the opposite effect.” In other words, walking, yoga, and stretching exercises may actually provide greater benefit to immune function than aerobics.

In fact, the best exercise for boosting immune function may be tai chi a martial arts technique that features the movement from one posture to the next in a flowing motion that resembles dance. Studies have found thae immune function, including natural killer cells, was significantly increased by the practice of tai chi exercises. Tai chi is described in more detail on page 209.

So why does engaging in regular strenuous exercise damage the immune system. Because it is associated with increased generation of free radicals and other reactive compounds that can cause tissue damage. The underlying factor appears to be depletion of antioxidants. Although some studies have shown that supplementation with individual antioxidants (mostly vitamin E) have some benefit in offsetting some of this damage, unfortunately, there have been no clinical studies with a comprehensive antioxidant program. The use of any single antioxidant (like vitamin E) is not recommended, because each antioxidant requires partner nutrients in its battle against free radicals. Therefore, the studies that have been conducted suffer from a serious flaw. The bottom line is that individuals who train heavily need to bolster their defenses by following the dietary and supplement recommendations given in Chapters 2 and 3.

While the immediate effect of exercise is stress on the body, with regular exercise the body adapts; it becomes stronger, functions more efficiently, and has greater endurance. The entire body benefits from regular exercise, largely as a result of improved cardiovascular and respiratory function. Exercise enhances the transport of oxygen and nutrients into cells. At the same time, exercise enhances the transport of carbon dioxide and waste products from the tissues of the body to the bloodstream and ultimately to the eliminative organs. As a result, regular exercise increases stamina and energy levels.

Benefits of Exercise

MUSCULOSKELETAL SYSTEM

• Increases muscle strength
• Increases flexibility of muscles and range of joint motion
• Produces stronger bones, ligaments, and tendons
• Lessens chance of injury
• Enhances posture,poise,and physique
• Prevents osteoporosis

HEART AND BLOOD VESSELS

• Lowers resting heart rate
• Strengthens heart function
• Lowers blood pressure
• Improves oxygen delivery throughout the body
• Increases blood supply to muscles
• Enlarges the arteries to the heart
• Reduces heart disease risk
• Helps lower blood cholesterol and triglyceride levels
• Raises levels of HDL, the “good” cholesterol

HODILY PROCESSES

• Improves immune function
• Aids digestion and elimination
• Increases endurance and energy levels
• Promotes lean body mass and burns fat

MENTAL PROCESSES

• Provides a natural release from pent-up feelings
• Helps reduce tension and anxiety
• Improves mental outlook
• Helps relieve moderate depression
• Improves the ability to handle stress
• Stimulates improved mental function
• Induces relaxation and improves sleep
• Increases self-esteem

CREATE A REGULAR EXERCISE ROUTINE

Exercise is clearly one of the most powerful medicines available. The time you spend exercising is a valuable investment in your good health. To help you develop a successful exercise program, see Appendix I, on page 356.

The Importance of Sleep

Sleep is the period of time that the body and mind are recharged. Sleep is also the time the most potent activators of the immune system are released. Evidence is emerging that failure to get a good night’s sleep increases the risk of cancer. Every cell of the body is compromised and will be running on less than all cylinders, leaving the cell more susceptible to damage, with a reduced capacity to heal. In one study, healthy male volunteers were deprived of four hours of sleep for a single night. The next day, the activity of certain immune cells their natural lailler cells -fell by as much as 30 percent. Fortunately, a single good night’s sleep restored the cells to their normal level of functioning.

In a study of women at risk for cervical cancer because of an abnormal result on a Pap smear, sleep quality was shown to be directly related to immune function–the higher the quality of sleep achieved, the better the immune function. The evidence was so significant that the researchers concluded it was “important to systematically screen for and manage sleep discurbance in women at high risk for cervical cancer.” We would extend that recommendation to everyone.

The group most susceptible to sleep disturbances are shift workersthose whose job hours change over the course of weeks or months. Night shift workers have more trouble falling asleep and staying asleep. Poor sleep quality is probably the factor explaining why shift workers have a greater risk for cancer, suffer more illnesses, have more accidents, and die younger than do people with more stable schedules.Inside our brain is a kind of master clock that coordinates the timing of many physiological functions. One important role of sleep is to help orchestrate these various biological rhythms. We achieve optimal health if we keep our rhythms in sync. If you are a shift worker, we recommend taking 3 mg of melatonin ar bedtime and 3 mg of a special form of vitamin B, known as methylcobalamin (available at health food stores) upon arising.

Melatonin is a hormone secreted by the pineal gland, a small peasized gland at the base of the brain. The exact function of melatonin is still poorly understood, but it is critically involved in regulating the natural biorhythm of hormone secretion referred to as the circadian rhythm as well as the control of sleep/wake cycles. Release of melatonin is stimulated by darkness and suppressed by light. Shift work tends to disrupt melatonin secretion and as a result disrupt the circadian rhythm. If melatonin is taken before going to sleep, it can help reset the biological clock and promote a good night’s sleep.

Several studies have shown that methylcobalamin-a special form of vitamin B -is an effective treatment to improve sleep in shift workers as well as in people with excessive daytime sleepiness, restless nights,and frequent nighttime awakenings. The subjects taking methylcobal amin experienced improved sleep quality and increased daytime alerta ness and concentration, and in some cases they also reported improved mood. Much of the benefit appears to be a result of methylcobalamin’s influence on melatonin secretion and resetting the biological clock Specifically, methylcobalamin causes a significant decrease in daytime melatonin levels while increasing nighttime levels.

Here are some additional tips for improving sleep quality:

1. Avoid sleep inhibitors such as sources of caffeine and alcohol.
2. If you eat bedtime snacks, choose whole-grain cereals and breads to keep blood sugar levels steady throughout the night and to increase serotonin levels within the brain.
3. Get regular exercise, but avoid exercising two hours or less before bedtime.
4. Consider nutritional and supplemental strategies to improve sleep:
5. • Melatonin can help promore sleep at a dosage of 3 mg at bedtime.
   • Some people benefit by taking herbal products known to promote sleep, such as valerian (150 to 300 mg of dry powdered extract), 45 minutes before bedtime.
   • If you have muscle cramps or “restless legs” that disturb sleep, try taking magnesium (250 mg at night) and vitamin E (400 to 800 IU a day).