Transforming Cancer Care: Insights That Bring Hope and Change with Lorenzo Cohen, PhD

[00:00:00] Dr. Lorenzo Cohen: At least 50% of cancers, uh, and, and certainly cancer related deaths could be prevented uh, just by engaging in really uh, the, a healthful approach to the mix of six.

[00:00:15] Dr. Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level

[00:00:46] Dr. Melinda Ring: Hi everyone and welcome to Next Level Health. A few years ago, my own husband was diagnosed with prostate cancer and surgery was absolutely critical for his treatment, but it was the integration of nutrition and mindfulness movement and emotional support that really helped him heal both physically and emotionally. Cancer touches so many of us, yet what many people don't realize is that over half of cancer cases and deaths are considered preventable. My guest today, Dr. Lorenzo Cohen, is one of the world's leading experts in integrative oncology and says that how we live, what we eat, how we sleep, how we move, how we manage stress, can dramatically influence not just a risk of getting cancer, but also our ability to recover and thrive after a diagnosis. Dr. Cohen's, the Richard E. Haynes Distinguished Professor of Clinical Cancer Prevention and Director of the Integrative Medicine Program at the University of Texas, MD Anderson Cancer Center. He's past president of the Society of Integrative Oncology, vice Chair of the Academic Consortium for Integrative Health and Medicine, and co-author of Anti-Cancer Living Transform Your Life and Health with the mix of six written with his wife Alison Jeffries. We'll explore how science-backed lifestyle changes can empower each of us, whether we're looking to prevent cancer or improve outcomes after diagnosis. Welcome,

[00:02:18] Dr. Lorenzo Cohen: Oh, thank you. Thank you, Dr. Ring. And, let's go by first name so that

[00:02:22] Dr. Melinda Ring: Yeah, Lorenzo. Great.

[00:02:26] Dr. Melinda Ring: So, what exactly is integrative oncology and how did you find your way into this pioneering work?

[00:02:33] Dr. Lorenzo Cohen: So I think to do honor to the Society for Integrative Oncology organization, I helped to co-found, now it's actually more than 20 years ago. I'm gonna share the definition that a working group came up with. Integrative Oncology is a patient-centered, evidence-informed field of cancer care that utilizes MINDBODY practices, natural products and or lifestyle modifications from different traditions alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life and clinical outcomes across the cancer care continuum and to empower people to prevent cancer and become active participants during, before and beyond cancer treatment. Living longer and living poorly are, are not necessarily what patients are striving for. Um, they, they want to have a good quality of life for as long as, uh, possible. And importantly that phrase across the cancer care continuum. So we all have mutating cells in our body. We may not think of ourselves as people with cancer uh, but a mutating cell that grows into uh, a, a, mass of multiple cells is the definition of cancer. This uncontrolled cell growth. And that process is happening in our bodies all the time. The question is, do we create a body as inhospitable to cancer as possible uh, through things that are in our control? And and again, that is. Uh, An important phrase in that definition is to empower people. Um, And a lot of what we do in integrative medicine in general is to give some control back to the individual, always alongside the conventional treatments.My initial research focused on stress, harms of stress and oncology showing that stress innervates the immune system and that patients who are stressed or depressed or anxious don't live as long. And we're able to document some of the biological pathways whereby stress literally gets under your skin and into the tumor microenvironment, making it a more aggressive disease. And then of course to mitigate it. And we started looking at some of the eastern modalities alongside conventional things like cognitive behavioral therapy, but things like yoga and meditation. And then a very seminal paper was published in 2000 in the Journal of Clinical Oncology showing that over 70% of our own MD Henderson patients were using some form of what we were calling then complementary, or in fact even alternative medicine. So using things in place of conventional care. the institution had to make a decision of do we kind of ignore this area and let patients flounder and search and find their own way? Or do we, do, we put a stake in the ground? And so we formally started the integrative medicine center within a, a medical division at MD Anderson in 19, in, in 2002. But in 1998 when we opened what we called then the place of wellness, it was actually the first. Um, Integrative Medicine Center on the campus of a comprehensive cancer center. And now the majority of comprehensive cancer centers have uh, integrative oncology as part of conventional cancer care.

[00:06:13] Dr. Melinda Ring: Yeah, it's really amazing how. This idea of integrative oncology has shifted from being seen as an alternative to now being embedded in lead in cancer centers like MD Anderson. It was interesting what you said. You said that when that study, about 70% of patients using things like yoga and meditation, that it raised an alarm in people with, now I understand oncology really, I think biomedicine in general gets a little bit iffy when it comes to things like dietary supplements or things that can directly interact with chemotherapy, with radiation therapy. Do you think that back then there was even concern that they were using yoga and meditation and

[00:07:02] Dr. Lorenzo Cohen: No. No. So.

[00:07:04] Dr. Melinda Ring: No. Okay.

[00:07:05] Dr. Lorenzo Cohen: No. I mean, you know, whether, you know, if a patient said, Hey, will meditation or yoga help me? And they say, well, it's not gonna hurt you, is what they would probably say back then. But the biggest concern from that survey is that, you know, 40 some odd percent were taking some type of supplement or herbal product as well as indicating their own kind of some kind of special diet. So, you know, that'd be ketogenic diet

[00:07:31] Dr. Melinda Ring: Gerin diet or, yeah,

[00:07:33] Dr. Lorenzo Cohen: Yeah, some type of thing that we know is gonna modify a person's biology. And the biggest alarm bell was when they were asked if they had disclosed their use to anyone on the team. The majority said they had not. And further, when asked why, they said, because nobody asked me. And now actually, when asked, do you think yoga would be helpful? They would answer in the affirmative because it's on all the clinical guidelines, yoga, mind, body diet, exercise. Um, Now they're, their patients are getting the message from uh, the physicians because the clinical guidelines are telling them that this needs to be part of cancer care, which is. In integrative oncology has, has uh, been so successful in that regard in creating the evidence-based integrative medicine overall, right? Creating the evidence base and, and, getting on the guidelines, which has been critical.

[00:08:35] Dr. Melinda Ring: one thing I didn't see on that checklist was something that I know you've been researching yourself and an area that's maybe a little more controversial. So I'm gonna, just because you mentioned the guidelines I I wanted to lean into that a little bit because you have this new, well, certainly not a new, this is a thousands year old practice, but this idea of the biofield therapies, and as far as I know, that is not showing up on any of the guidelines. But can you talk about this umbrella of biofield therapies that are sometimes met with skepticism and the work that you've been doing towards those? And really if you think they should be long on the guidelines.

[00:09:19] Dr. Lorenzo Cohen: Yeah, so, so the listeners may not be familiar. Some of course will be with. With biofield therapies. Um, a more colloquial term that is used is energy medicine or energy based therapies. We're trying to as a working group come up with a different term for these as well as other areas and using the term consciousness based therapies. And so within this category, there could be a lot of different modalities and, and something like yoga, Tai Chi, Qigong, they actually fall into the category of energy medicine to some degree. If you look at the sort of lineage of these practices, there's something that, you know, we call energy, energy flow in the body. Uh, The Chinese would call that qi, the Japanese call it q, that Tibetans call it lung. Of course the Indians call it prana. And so there's this belief that there's an energy system in the body that's independent from the central nervous system, independent from the vascular system, that is, energy that's flowing. Now, we are energetic beings. You know, there is no controversy that, that we emit photons uh, from our body, albeit at a low level. And photons are what is being beamed at cancer patients uh, when they're getting radiotherapy. It's, It's high frequency photons that are uh, being shot into the body to treat cancer. So those, what we view as mind body practices fall into that category. Now, where things get a little uh, controversial is a theory and the practices whereby an individual with their own energy pro, et cetera, can emit that into another person or another living system for therapeutic purposes. Those are things that are well known to some called reiki or therapeutic touch or healing touch or external Qigong. So there can be internal Qigong, which is your own self practice. And then a q Gong master can purportedly emit this energy into another human being. So should energy therapies, biofield therapies be on the guidelines? I think that when they looked at the clinical trials of things like reiki healing touch therapeutic touch, for which there are some clinical trials, they weren't robust enough with appropriate enough controls to make it onto the guidelines.

[00:12:24] Dr. Melinda Ring Yeah. What about the recent study that you did that was published in Nature and their scientific reports?

[00:12:32] Dr. Lorenzo Cohen: Yeah. And scientific reports. So, you know, there's clearly, uh, controversy with that concept.  But what we wanted to do, and we've published a couple of prior studies, but less rigorous, is to put this to the test. You know if. if. People claim that they can manipulate living systems with their own energy or their own consciousness, or the hard thing is, is knowing what it is that they are doing. Uh, we can measure these things. We can put cells in a Petri dish and, and we can measure the cells behavior. We can put cancer in animals, and we can measure how the tumor grows and we can, you know, measure simple things like cell replication all the way down to uh, gene expression pathways and change in protein expression um, et cetera. So for the past I guess it's now been over six years we've been focusing in particular on pancreatic cancer because the lack of effective conventional treatments really that can help that population really has the highest mortality rate of any cancer. And looking at different cell lines. Working with animals. Um, And our large publication that is currently under review uh, was in fact actually accepted at Scientific Reports. This is part of the backstory uh, proofs approved and everything. And then they retracted it uh, after a year of peer review. And, partly because they say, well, we're not documenting the mechanism. So they weren't debating that the phenomenon was real and, and that we actually. There was a there, there as, as we've kind of been saying uh, but that we don't document the mechanism. We weren't able to measure biophoton emission, we didn't measure uh, electrical activity, leaving the body, entering the animal cells, et cetera. But we were to document, we were able to document really that this form of treatment decreased the metastatic potential. And that's of course what ends up uh, shortening an individual's life. It's not typically the primary. We know how to treat primary cancer quite well. It's when it becomes metastatic traveling to another part of the body and, and growing in a place where it shouldn't. Biofield therapy repeatedly in, in, in vivo and in vitro settings decreased uh, the metastatic potential. And again we have all the biological pathways and, and uh, hopefully that'll be published soon. What we did publish though was uh, an initial foray of trying to understand what the mechanism is. Now, again, purportedly, and we haven't done systematic research yet uh, in this area uh, biofield therapists can do this from a distance, so that becomes even crazier to kind of accept.

[00:15:45] Dr. Melinda Ring: I think that's the thing. We need some scientific plausibility to get some acceptance here and, until we can measure something, it's very hard for biomedicine to change their view that something can work or not. But when you can see something happen in a cell, it's very hard to say that's a placebo effect when it's happening in a Petri dish. So I think it's a really incredible kind of work. And I will say too, that, you know, Reiki has personally touched my life. When I was a fellow in integrative medicine over 20 years ago, I took a Reiki level one training for a weekend, and I did it because, you know, I'm like, oh, you know, it's part of, you know, I'm in this exploratory phase. I don't believe in this at all. I have to say I was extremely skeptical but, I'm like, I should experience this. And I had such a profound experience during that weekend where I walked away saying, I have no idea what just happened, but there is something happening there. And that led me to then go on and complete the next two levels of Reiki training. And,

[00:16:57] Dr. Lorenzo Cohen: I didn’t know I was talking to a reiki master! 

[00:16:58] Dr. Melinda Ring: Yes, you are. Yes. I will say you're talking to a reiki master here. I think it's really important to do that, to find those answers from a mechanistic standpoint so we can understand that there is something very real happening there.

[00:17:13] Dr. Lorenzo Cohen: When we first started doing this research, we had an internal advisory committee, and one of the responses was, well, the effect's small. Yeah, okay, but somebody's waving their hands over a Petri dish. The effect's small. It should, there shouldn't be an effect, shouldn't we as human beings and as scientists, first and foremost. I want to explore that for human potential. Um, and, and you know, what is going on? And so I think it's incumbent upon us to search for the answer to what humans are capable of doing. What is this relationship that we have, uh, between all living things uh, and some suggest even inanimate uh, objects uh, to explore it scientifically. If there's a clinical application, that's great and if there isn't uh, we've still understood something more fundamental, uh, about us.

[00:18:09] Dr. Melinda Ring: We've talked a little bit about some of the therapies that might be considered a little more unconventional by conventional medicine. Let's switch now to those things that I think everybody can agree with we need to focus on, that I think you cover amazingly well in your book and, you talk about this mix of six. Can you talk about why these mix of six are so important? Maybe a little bit more about what they are, the science behind them, and what you recommend to people.

[00:18:45] Dr. Lorenzo Cohen: the areas that in anti cancer who are living, we call them a mix of six, which is love and support, managing stress, healthful sleep movement diet and decreasing environmental exposures. Uh, The evidence is really clear, one, that the engagement in those in a, you know, colloquially unhealthy manner modifies key biological pathways that make the risk of cancer go up. And the opposite, of course, very importantly is true that if one has a healthy love and support, managing stress in one's life, getting the appropriate amount of, of length and quality of sleep, eating primarily a plant centered diet, exercising on a daily basis. Decreasing environmental exposures. Those individuals tend to live longer after a diagnosis with cancer. And there are albeit more limited clinical trials in that area. A lot of the research is what we would consider epidemiological in nature but really overwhelming epidemiological data. And then the correlative lab studies in the area of stress and in the area of diet, in particular fiber research that we published in uh, science with Jen Wargo and Jen McQuaid and actually a 80 some odd other uh, scientists, including Jim Allison who won the Nobel Prize for his work in immunotherapy. We showed that melanoma patients eating a high fiber diet. Uh, Lived longer, had a higher probability, responding to immunotherapy and then recapitulating all that in animal studies and the clinical trials uh, feeding studies are ongoing. Uh, There was a study published in the new jour New England Journal of Medicine uh, Carrie Cornea from uh, up at Alberta uh, showing in a well controlled clinical trial of over, I believe it was 800 advanced colorectal cancer patients, stage two three, that a relatively moderate exercise program over the course of the year led to much better survival outcomes. So now we're seeing the clinical trials supporting all the epidemiological evidence.So uh, back in uh, 2018 when I was diagnosed with my own cancer stage three melanoma at that point I was of course already living and the majority of the mix of six, but probably not to the degree that I should have been. in particular in the area of mind and body. So then I, during my immunotherapy, did my 200 hour yoga teacher certification. Not because uh, you know, I had the dreams of becoming a yoga teacher and leaving academia. But so that I would have that accountability. I would have that support network of other people uh, going through the yoga training. And every week we would share our experiences But it as, as you said in the introduction, you know, at least 50% of cancers uh, and, and certainly cancer related deaths could be prevented uh, just by engaging in really uh, the, a healthful approach to the mix of six.

[00:22:13] Dr. Melinda Ring: Yeah, I love that. You know, you highlight the synergy of it and that. You start at one place, you know, it's not like you have to start all of them at once, but you just sort of prioritize what is most important to me, what's going to give me more success with the other ones? Where am I in these areas? Where do I need to focus? And, now, because I think that's what we need to avoid getting overwhelmed, both this, the, if you're a practitioner trying to talk to a patient about it, or if you're a patient who's just trying to make those changes.

[00:22:45] Dr. Lorenzo Cohen: That's right.

[00:22:46] Dr. Melinda Ring: gone through this cancer journey yourself. You've written this book, you've been researching this, you've been here at all levels. What's one piece of personal wisdom that you would share with listeners to help them reach their next level of health?

[00:23:00] Dr. Lorenzo Cohen: you know, we tend to focus on the negative. Um, and evolutionarily speaking, we have evolved from ancestors who are really good at focusing on the negative, being ready for the worst, right? And, and planning for the worst, and being, being sensitive to the worst thing that could happen. Uh, And so our brains are wired to, to see negative, to see threat uh, and and it takes work to see the positive. Um, And I think that's an important thing to have as part of your day. And there's a formal exercise in, in, our book, Anti-Cancer Living. Uh, And there's many uh, forms of this to be able to, to see the positive and to see the things on a daily basis that, that you should be grateful for. And the more that we become mindful and aware of the positive things uh, the easier it is. It's a, in some sense, it's a training, it's a practice. And that part of the brain and some evidence to support it will actually be modified. Um, And more of the positive will start to come in. Uh, So, so see the positive, be grateful for, for things that are supportive in your life, and know that uh, tomorrow is, is a new day that you can start fresh.

[00:24:26] Dr. Melinda Ring: Beautifully said, and yeah, I think. Also, sometimes we just go through the checklist of, I ha I did this, I did this without celebrating it. And like really from a somatic perspective, like feeling it in the body like feel the excitement, the joy, feel the gratitude. Um, because I think that helps it stick more too. So. Thank you, Lorenzo. Thank you for the incredible work you're doing. Thank you for sharing your both practical and hopeful insights today with our listeners. And I think this conversation is gonna spark a lot of reflection for those who are navigating cancer themselves or maybe supporting someone they love. So if anybody's looking to take action today, I highly recommend checking out Lorenzo and his wife Allison's book, Anti-Cancer Living. It is one of my go-to resources for patients. I have it on my little smart phrase in books. These are the three books I recommend for you as you're going through this. Until next time, remember how your life matters and healing is always possible. Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers.

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