Walk More, Eat Less, Don't Stress

Langlais and colleagues (1) found that men with prostate cancer consuming a diet that limits chronic systemic inflammation and insulin hypersecretion have improved survivorship, especially when coupled with active lifestyle and healthy body weight. This is a very important finding showing that men diagnosed with prostate cancer can reduce their inflammation and insulin resistance by anti-inflammatory lifestyle interventions like healthy diet and physical activity. Langlais and colleagues (1) focused on physical activity and healthy diet. However, another important component of healthy, anti-inflammatory lifestyle is reduced psychologic stress. Studies have shown that healthy diet, exercise, and stress reduction are associated with reduced inflammation and epigenetic changes. DNA methylation and altered gene expression profile associated with unhealthy lifestyle can be modulated by healthy behaviors (2).

Numerous reports have shown that inflammation is associated with increased cancer risk and progression, and an “anti-inflammatory” lifestyle characterized by increased physical activity, healthy body weight, healthy diet, and low psychologic stress is associated with lower cancer risk and progression. “Walk more, Eat less, Don't stress” is a simple message which could be put into daily routine by patients with cancer. This simple message could be delivered repeatedly at each visit by the patient's physician. A simple, evidence-based healthy lifestyle message that is easy to remember and easy to implement makes it more practicable, sustainable, and successful. Patients must understand the message and appreciate its importance, and the implementation should not require too much extra time and financial burden. The message should be easily implemented anywhere and anytime, such as walking more and eating less. Studies show that a moderate-intensity walk, 30 minutes a day 5 days a week, would result in appreciable health benefits. It is the total amount of daily physical activity, not the continuity that is important. For example, walking 5 minutes every hour would result in 30 minutes of physical activity in 6 hours, which is doable for most people.

Health care providers need to provide their patients easy to achieve goals to prevent health problems. “Walk More, Eat Less, Don't Stress” is such a message and repetition of this message is the key to success. This simple and clear message that summarizes healthy living, is easy to remember and implement. Patients understand that these words are symbols for healthy lifestyle. “Walk More” symbolically means “do more physical activity of any kind within your exercise capacity and fitness level”. “Eat Less” symbolically means “Eat Healthy” and it is easy to understand because most Americans are overweight and have large meal portions. “Eat Less” symbolically means eat vegetables and fruits, avoid “empty calories” and unhealthy foods such as cakes, pies, cookies, and candies loaded with sugar, as well as processed meats and saturated fats. “Don't Stress” is a symbol for preventing and reducing stress by walking, socializing, getting sufficient good-quality sleep, avoiding stressful situations, and using stress-reducing mind-body techniques such as meditation, yoga, and tai chi. The healthcare provider could go into as much detail as necessary on these interventions or they could simply refer the patient to an expert.

Patients with prostate cancer on androgen deprivation therapy gain weight, lose muscle, and develop metabolic syndrome, cardiovascular disease, and cognitive decline. Therefore, patients with prostate cancer would greatly benefit from increased physical activity and healthy diet as shown by Langlais and colleagues (1). It is also important to include stress reduction practices to achieve a healthier lifestyle. Stress reduction is possible with mind-body approaches such as meditation, yoga, and tai chi, as well as walking in nature such as “forest bathing”, music, and social activities, promoting family and friendship ties and strengthening social support mechanisms. Reducing health care disparities and racism would also decrease stress in the minority populations, which carry a disproportionate burden of cancer risk and mortality. Psychologic stress is associated with oxidative stress, inflammation and DNA methylation, which leads to epigenetic changes that can also be passed on to future generations (3, 4). Studies show that diet, exercise, and stress reduction have profound effects on gene expression profiles (2).

Data from National Health and Nutrition Examination Survey (NHANES) showed that dietary intake of vegetables and fruits is inversely associated with serum PSA levels, suggesting that certain phytochemicals may have anticancer effects (5). Consumption of certain plant-based foods such as tomato and soy products or their bioactive ingredients, lycopene and isoflavones, respectively, is associated with lower PSA levels in patients with prostate cancer (6–10). Integrative oncology focuses on diet, nutrition, botanicals, and mind-body practices to improve lifestyle and reduce stress in cancer patients, at the same time improving therapeutic effects of standard cancer therapies and preventing their adverse effects (11).

National Center for Complementary and Integrative Health (NCCIH) is a branch of NIH that focuses on healthy lifestyle and complementary therapies. The mission of NCCIH is to determine, through rigorous scientific investigation, the fundamental science, usefulness, and safety of complementary and integrative health approaches and their roles in improving health. NCCIH is the lead federal agency for scientific research on the basic science, usefulness, and safety of complementary and integrative treatments. NCCIH supports research on psychologic and physical approaches including dietary supplements, plant-based products, and probiotics, as well as mind and body approaches, such as yoga, massage, meditation, mindfulness-based stress reduction, and acupuncture.

Mind-body practices and lifestyle interventions such as diet and physical activity, may reduce PSA levels in patients with early-stage prostate cancer choosing active surveillance to delay conventional treatments by making changes in their diet and lifestyle (12). Nutrition and lifestyle changes may modulate gene expression in the prostate, and understanding the molecular mechanisms may be valuable in developing effective prevention and treatment strategies (13). There is strong evidence supporting the use of plant-based foods in the prevention and treatment of prostate cancer (5). Botanicals may also have a role preventing adverse effects of treatment and improving quality of life. Androgen deprivation therapy is associated with metabolic syndrome and Alzheimer's disease, which may be preventable by physical activity and a plant-based diet including soy products. Soy isoflavones have been found to decrease hypertension, diabetes, and Alzheimer's disease (14, 15). Further research is warranted to explore potential benefits of soy foods and other integrative oncology interventions in prostate cancer prevention and treatment.

No disclosures were reported.