Thursday, February 26, 2009




As some of you know, I have lately been trying to follow closely, the Dean Ornish, MD, approach to cancer lifestyle treatment, described in his new book, The Spectrum, especially after my CEA (Colon Cancer marker) started to inch up a tad two months ago. Dr. Ornish has shown conclusively, in good clinical trials, that his approach works for early prostate cancer, and he proposes that it will be equally effective for breast cancer. I think colon cancer is not all that different biologically from those other two, and so the program should work for me as well. The program includes exercise (I am going for 18METs per week--the amount shown in previous research to reduce colon cancer recurrence by 50%), meditation and stress reduction (I am aiming for an hour a day), and the diet. 


The diet is essentially a very low fat vegetarian diet. I have been on a pretty strict vegan diet (I have been eating some wild salmon) for the last 2 years, after reading the wonderful book The China Study by T. Collin Campbell 2 years ago, and I credit this as a big part of the reason for me having had such small and surgically available recurrences since then. I had not really been following the low fat part of the diet though, because this made the diet harder to follow, but since committing to the Ornish approach I have been doing a better job of it. So, you can imagine how excited I was when I read the following report of a new study that came out this morning. The title was: Excessive Dietary Fat Caused 300 Percent Increase in Metastasizing Tumor Cells In Animal Models. The link is:  


Basically they found that eating a higher fat content diet caused the cancer cells to be able to separate from the herd and go wondering off for new living quarters (metastasizing), whereas on a low fat diet, they stayed put. And since it is metastasis that makes cancer so deadly, preventing this process is really a major benefit to us cancer patients. Wow!


Also, there has been a very positive side effect to the low fat diet that I didn't expect. Ever since all the surgeries on my colon and small bowel, I have been troubled by lots of diarrhea. This diarrhea leads to hemorrhoids and rectal fissures, and can be a literal pain in the ass! Well, that is all much better since cutting out the fat. Here is how dietary fat might be effecting this. When we eat fats, bile acids are dumped in the GI tract by the gall bladder. The bile is used to break up the fats (emulsify them) in order for them to be absorbed. The bile should then be reabsorbed back into the body in the last part of the small bowel, the terminal ileum. Unfortunately,since I have had quite a bit of that cut out every time they take more colon, and also since I have so little colon left, the bile is probably not well reabsorbed and just hangs around in the stool. This then causes more water to be pulled into the colon and leads to we docs call, osmotic diarrhea. Also, the unabsorbed bile itself is probably directly irritating to the rectal tissues. The good news is that this has gotten MUCH better since cutting back on the fat, and having this problem get better, certainly makes following this part of the diet a lot easier.


I wish I had started on this sooner, but, of course, that isn't possible. It is nice though to get some confirmation that what I have been doing, is actually helpful. Hopefully, when I get my next PET/CT in a month or so, we still won't be able to see any cancer spots anywhere in my body. What a lovely thought.

Tuesday, February 17, 2009


I have been thinking about this issue for a long time, and certainly more so since being diagnosed with cancer. I reflect often on how many people, friends, colleagues, and acquaintances, have told me to be "positive." "You know" they say, "attitude is the most important thing with cancer!" It is funny how these kinds of comments are made with the utmost sincerity and assuredness. I think those who have told me this actually do believe that this is true. I don't. Here is why.

There is considerable research that optimistic people do better with cancer and other illnesses as well, so it would seem that there should be a correlation between positive thinking and better outcomes, and in fact there is. The problem is that this conventional wisdom, that thinking positively will result in a better outcome is based on observing a correlation, not a cause. That is to say, folks who naturally are able to be optimistic about their cancer seem to do better than people who don't. But, I contend, people who are not naturally optimistic, and try to be, or to fake it in order to have those around them not worry about their supposedly dangerous negativity, actually do worse than if they dealt with their fears and worries in a different way.

One of the most helpful books that I have read about this is called: The Positive Power of Negative Thinking by Julie K. Norem.

In this book, Dr. Norem presents her considerable experimental evidence that there are a number of effective anxiety coping styles, and that different people respond differently to them. There are the "strategic optimists" who do best by denying that there is a problem and just going forward in a positive manner. This is the style that those folks who are trying to be helpful by telling us cancer patients to be optimistic seem to be promoting. The other effective style she calls "defensive pessimists." These folks (I think I lean toward this style) do better when they spend their energy thinking through every possible problem that could arise in the situation they are worried about, and make plans ahead of time about how they are going to handle those problems should they arise. The really interesting finding in her research is that for people at the extreme of each of these styles, having them do activities that would help people with the other style, actually makes them worse, and more anxious, not less. So, strategic optimists who are given a relaxation tape before a stressful event, do better than without it. But "defensive pessimists" do best if they are given a tape that guides them through a process of listing all the possible negative issues that might arise and gives them time to plan ahead what they might do in those circumstances. When the strategic optimists were given this tape, they became more anxious and eventually performed more poorly in the task. When the defensive pessimists were given the relaxation tape, they also were more anxious, and performed more poorly; presumably they felt stressed having to relax rather than prepare!

A recent study demonstrated the long known correlation between stress, fear, and cancer growth. Melanoma cells that were exposed to adrenaline, one of our main stress hormones, grew much faster than those not exposed. The effect was so marked that the researchers suggested using drugs called Beta-blockers to stop this reaction when telling a patient of their diagnosis. Many other studies have confirmed similar findings. So, it is clear that helping cancer patients feel less stressed will result in better outcomes. But the rub is in how to do this. And the idea, that one style fits all, and that that is to "be positive" seems to me to be a big mistake. Strategic optimists probably would do better with this kind of encouragement, but the defensive pessimists would probably do worse.

Another wrinkle in this issue comes from the work of Dr. James Pennebaker from Texas. His seminal book is entitled "Opening Up: The Healing Power of Expressing Emotions" . It is out of print but you can still get used copies. It is well worth it. In addition, many of his studies are available for free on his web site:

In his many studies he found increased immune function in people who were able to express their deeper thoughts and feelings about a trauma, to another person, or even a journal, compared to those who didn't, and just kept those feelings inside. I think that this is at least one of the reasons why the studies that showed that cancer support groups increased life span of cancer patients actually worked.

I know that I always feel less anxious and worried after I am able to talk about those feelings, either with a therapist, a friend, my wife, or even to other patients in the chemo room. For me, being told to be positive makes me feel like I am all alone with these emotions that seem to be unacceptable to that other person. I feel shut down, as if, I have to just carry the thoughts and feelings around all on my own. Of course, no one wants to bring others down, so I try to choose carefully who I can unburden myself with. On the other hand not feeling alone with my negative feelings, and knowing that these feelings and thoughts are accepted, has always helped me to feel better. I believe strongly, that for me, having to pretend all the time to feel positive, when I actually felt bad, would probably be worse for my health, and probably creates the local conditions around the cancer that would encourage its growth. I often talk to my wife Janet, but sometimes I worry that hearing my worries too frequently could be too much for her. Fortunately, I have found friends that I feel comfortable talking to and sharing my feelings with. When friends are not available for that, I turn to my journal, and perhaps in the future, this blog, and unburden myself there.

So, here is my advice for those of you who are thinking of what to say to your friend or relative who is dealing with cancer. Maybe you could ask them how they would like to be talked with. "Would you prefer to talk about your cancer and your feelings, or would it be better to act like you don't even have it and just act like everything is normal?" You might be surprised by what they say. They might even have different answers on different days. Relating to them how they feel best at that time might be the best present you could give them.