AN INTERVIEW WITH Lorenzo Cohen, PhD and Alison Jeffries, MEd
By Anthony T. Eaton
Anthony: Lorenzo and Alison, thank you so much for sitting down with me today to talk about your book and cancer. As you know, I recently lost my husband to multiple myeloma after a four-year battle. So, it is very personal to me. We had lost both of our mothers and other family members to cancer as well.
Allison: We’re so very, very sorry for your loss. And that’s so many losses, and we’re pleased to be here to talk about this subject of cancer.
Anthony: You both have had distinguished careers. What drew you into this kind of work?
Lorenzo: My training is specifically as a research psychologist; I have a Ph.D. in medical psychology. That’s the application and understanding of disease and the role of psychosocial and behavioral factors. A lot of my graduate work focused on the negative effects of stress down to the biological level and the link between stress and immune function.
Allison: I Joined Lorenzo on this book, anticancer living, but I’m actually a teacher by training and got a master’s in educational psychology. Lorenzo would come back from work talking about cancer research and lifestyle, and it was fascinating what he was doing and what others in his field were doing.
We realized that by raising small children, we had an opportunity to influence their health and fill their toolbox with tools that would hopefully help them lead healthy lives. Then we realized we were not living this life. We were just making it possible for our children. So, we started making changes in our own life with a group of friends. Then we started speaking in our community because we realized that we had a unique vantage point.
It was really surprising how little people really knew about this area. So, we decided to write a book, and the day we submitted our final draft, Lorenzo was diagnosed with advanced cancer. So we went from husband, wife, educator, and scientist to cancer, patient, and cancer caregiver.
Anthony: I liked the way the book is laid out. It was very easy to read and very easy to follow. Did you initially have a concept when you started working on it? Was that how you started, or was it just an evolution?
Lorenzo: It followed in the footsteps of David Servan-Schreiber’s book Anticancer: A New Way of Life. I met David in 2009 when we invited him to speak at MD Anderson at one of our grand rounds. After his talk, we went out for dinner. We were with a group of Houston-based philanthropists who essentially asked, why is there not more of this as part of the regular medical care in terms of teaching people the importance and guiding them specifically in lifestyle diet exercise.
David and I designed and launched a clinical trial, but we’re still waiting on the data specifically focused and survival. David died in 2011. The second edition of his book was published in 2009; however, it’s out of date, and the next evolution is Anticancer living.
David’s book essentially lays out all the evidence in four specific areas, diet, exercise, stress, and the environment, and why it’s so important. It is very personal and based on his own cancer story. We wanted to update the evidence and bring in Allison’s voice on the prescription. How do you do this? I’m convinced I need to lead a healthier life. What do I do?
Allison: We also felt that it was crucial we have six areas that we focus on, and they are laid out in a specific order because we think that love and support is the most important thing that you have in place to make a change.
We all set goals for tomorrow; today, I feel motivated. I’m going to start it. And then by lunch, you feel sabotaged, you’re racked with guilt and blame and shame, and you feel hopeless. And we wanted to get rid of that piece of this process by putting love and support so that you prepare to make the change you wish to do so that you make sure you have the support in place. And we do so little by ourselves, and when we have support, we can manage change. We can handle situations; we can do things. And so that’s why we put love and support first.
Anthony: That’s true. I think that’s an excellent foundation for what you outline in the book. And again, I like the way you approach each of the six. It’s easy to implement if you follow the pathway, you have set forth.
On March 8, 2018, the day that Lorenzo and Alison signed off on the final version of the book, Lorenzo received his own diagnosis of melanoma cancer.
Lorenzo, you mentioned your battle with cancer and getting that diagnosis the day, the book went to the publisher. What was your experience with sitting on the other side of the table? And Alison, you mentioned that you go from being a partner and collaborator, but then your roles change. Can you share more about that?
Lorenzo: It is a very strange experience, but I must say not, for some reason, overly disturbing or stressful. Weirdly, when I received the initial news, it was almost a relief on a psychological level.
It was also because I could say to myself; that now I have the permission, both from myself and my community, particularly the work community, to take care of myself and prioritize my health.
Allison: While Lorenzo may have had that reaction, I had a completely different response as a caregiver. The wave was overwhelming. I ended up lying on the floor with my feet on a chair, taking a little time to understand and even feel this first wave.
It’s a very challenging experience all around. Still, support is the key, and having tools at your fingertips that you can use to help yourself just at a most basic level, feel better, and feel like you’re doing something good for yourself or your loved one.
There are so many things that you can do no matter how many days you have in your future to feel in control, to help your body be healthier and respond to treatment because ultimately, that’s what you want.
You want your body to be as inhospitable to cancer as possible. And if you’re getting conventional treatment, you want to do things that will support that treatment that will make your body receive that treatment better.
Anthony: You raised some excellent points. I know we went through that because things were going on in my husband’s case, and we didn’t know what was wrong. Luckily, we had a great team of doctors and a doctor who recognized that his other health issues were the cause of his cancer, multiple myeloma.
In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States
Let’s talk about the book. You provide a significant amount of statistics in the beginning. Even though I’ve gone through this journey with my husband, I was shocked by the numbers. It was surprising to me that we don’t share these statistics more.
Lorenzo: Absolutely. Four in ten individuals will be diagnosed with cancer in their lifetime. It’s gotten a little better for men and worse for women. But essentially, almost half of our society is diagnosed. And, of course, that means that everyone’s touched by cancer.
When we started talking with our community about the evidence, we realized most people didn’t know that most cancers are preventable. That doesn’t mean all cancers are preventable, and we can start with the percent that is not; it’s perhaps around 30%; it’s just random. A fraction is due to inheriting a gene mutation. People think cancer is in my genes. It’s inevitable; it’s in my family. And although there are mutations that you can inherit that increase your risk of cancer, that only accounts for five to 10% of cancers.
The vast majority of cancers are linked to things that we can actually control. And those same factors, what we call the mix of six, can influence outcomes after somebody is diagnosed with cancer. People hear the word cancer, and they think death sentence. And for some cancers, extremely challenging, even for the combination of conventional Western treatment and lifestyle factors, but others are much more sensitive to both behavioral interventions combined with the treatments.
Anthony: I know it was very educational as I read through it. There’s so much that you don’t know. It was enlightening to read about all of the different things you talked about in the book, genetics, environment, and lifestyle, to understand better the causes of cancer.
Even in the best of circumstances, navigating the health care industry can be overwhelming. We were lucky because we had a great team of doctors, but sometimes people don’t have that. And maybe they’re in a location where they don’t have access to the kind of medical systems, we did here in the Dallas area.
Alison, you mentioned being an advocate and your experience. Can you share more about that?
Allison: When Lorenzo was diagnosed, I came home, and the next day, I went out to the office supply store, bought the binder, purchased the dividers, and sat down. I thought, what are the different sections of Lorenzo’s illness that I know about just today or the night that I think I might need to be able to address.
I made up a paper for each doctor’s visit; I had a section for ideas. I had a section for supplemental treatments and doctors that would become part of the team. Organization was key for me just to keep everything in one place.
Not everybody handles things in the same way. And so, if you are not the person to organize the binder or to play that role, that’s fine. You find the person who is, and you’re providing the love and support to the person, or you are the person with the diagnosis, and you look around at your community. Who can I ask to step up and help me with this? So that I’m supported? It’s a huge job that is very complex and exhausting and requires immense expertise. There’s no way that we can be all of that in one person.
Lorenzo: Most hospital systems have peer-to-peer support, and they try and match you up with somebody in a similar situation. That can be helpful to have the peer caregiver side working with the caregiver to give support. And of course, the information exchange, but as Alison said, helping somebody feels good to her, the evidence suggests that it’s beyond just feeling good; volunteering, supporting others giving of yourself has profound, beneficial effects.
THE MIX OF SIX
Love | Stress and Resilience | Rest and Recovery |Moving for Wellness | Food as Medicine | The Environment and the Quest for Health
Anthony: Let’s talk about the six. You’ve got them laid out in order, and as you mentioned, that’s by design. Can you give us an overview of those six and why you laid them out the way you did?
Allison: Sure. Starting again with love and support, moving to stress, sleep, exercise diet, and exposure to environmental toxins. One area that we haven’t spoken about is the synergy between those six.
It’s not something that you have to dive into with all six areas. You assess your situation. What are the things that you think would be easy to accomplish? And what are the things that will take more time?
Lorenzo: But you got to start with love and support. If you don’t, perhaps you will be successful but very short-lived. To make that sustainable, you need to have support.
Stress comes next because chronic stress arises in our life, which we can’t avoid, but if you don’t learn how to manage it, it will sabotage all the good, healthy intentions. If you look at negative synergy, the main thing that we know and people acknowledge is it disrupts sleep.
We tell people to get a good night’s sleep, but stress can be the main factor making it hard to fall asleep at night. When you wake up in the middle of the night, stress starts intruding, and your heart rate and blood pressure go up. Your cortisol goes up, melatonin shuts down, and getting back to sleep becomes very difficult.
Lack of sleep decreases the beneficial effects of a healthy meal. So modifying your diet without managing your stress reduces the benefits of all that work you’re doing to try and get healthy food onto your plate.
At the beginning of the book, we lay out what are called cancer hallmarks. These biological processes are necessary to allow a cancer cell to grow and thrive in the body. There are multiple processes that keep cells behaving correctly, and if they don’t, then there are policies in place where that cell is supposed to die. Healthy cell growth is when cells behave correctly and normally divide in a controlled manner.
Cancer is cells that are out of control and essentially activate all these systems in the body that allow cells to mutate, grow and thrive. Exercise shuts down all the cancer hallmarks; exercise decreases inflammation, improves immune system functioning, and decreases cancer cells’ ability to form their own vascular system called angiogenesis.
Diet, social support, and lack of sleep also activate many cancer hallmarks, but nowhere near as many as diet and exercise. Exercise is an independent predictor of cancer risk and worse outcomes. So, the simple message is, sit less, move more.
Anthony: From a societal standpoint, are we sending people mixed messages? We know the benefits of exercise and eating well, minimizing our stress. But then we also promote these things, fast food, the idea you have to work more, longer hours. Sleeping less will make you successful. How do we counter the mixed messages we are sending to people?
Lorenzo: I agree a hundred percent; up until recently, the message was to work more. Work on the weekends and get your food as fast as possible, and often exercise in an unhealthy way.
I think that there is a change that’s happening. We see that workplace wellness programs and work-life balance is talked about more. Certain companies are more leaders in this area than others, perhaps companies that can afford to be.
Fast food restaurants now have more vegetarian options. I’m not sure if some meat substitutes are better than healthy meat, but you can’t get healthy meat at a fast-food restaurant. The more significant issue is to be successful at a societal level in decreasing chronic illness; we’ve been focusing on cancer. If you layer on to the mix of six diabetes, stroke, and heart disease, essentially, most premature deaths in our world could be prevented through lifestyle changes. And I think there’s often too much focus on the individual.
Anthony: How has the book been received?
Allison: We have heard the nicest compliments and reflections, you know you send something out there, and you hope that it will be a tool for people. And that’s what we wanted it to be; a tool in everybody’s toolbox to provide information about cancer and lifestyle. We’ve had many thoughtful and reflective notes back to us from it. So that part has been very, you know, close to our hearts.
Lorenzo: I think physicians are grateful to have something that they can give to their patients to guide them. I don’t know the statistic, but it’s probably close to a hundred percent of patients say, okay, now what can I do? What are the right foods for me to eat? Because I heard diet matters. And because the healthcare system and healthcare professionals are not trained in all of these areas, they have something they can share.
Studies suggest that simple lifestyle changes, such as following a healthy diet could prevent 30–50% of all cancers, and nutrition is thought to play an important role in treating and coping with cancer.
Anthony: You make an excellent point. I don’t remember anybody sitting down and talking about now that you have this diagnosis; these are the changes you should be making in your lifestyle.
Does it seem we can be doing a better job in providing a more holistic approach when somebody does end up with a cancer diagnosis beyond just here’s the treatment?
Lorenzo: We must! Again, from the prevention perspective, most premature deaths can be prevented. The U. S. spends more on healthcare than any high-income country, and we have some of the worst health outcomes. What we’re doing now is not working, and it’s not financially sustainable.
Many lay readers may not want to get into the science, but they don’t have to, they can skip over it, but it’s there to make sure that physicians know this isn’t conjectured. These are not just our ideas and something that’ll feel good; it’s good for people and their well-being. There is incredible science supporting all of this, not just for cancer but for all chronic noncommunicable diseases.
Allison: It’s crucial to have reliable sources of information for yourself and your loved one to make intelligent choices around treatment. You can be assured that this is science-based.
Anthony: Are we too reliant on our Western medicine? Are we not doing many things because there are cures and treatments for that? Even when if we get sick, shouldn’t we be integrating some Eastern philosophies into our well-being and healing? Things like meditation, deep breathing, and even acupuncture have been used for centuries.
Lorenzo: We’re definitely too reliant on just thinking that I’ll just do what the doctor says, and I don’t need to do anything. We know that for most diseases, that is not good enough. And there’s so much that can be done. The lore of traditional Chinese medicine was that the traditional Chinese medicine doctor would continue to be paid as long as the patient didn’t get sick. There was more focus on prevention and the whole ying-yang theory, which some would say originates from traditional Chinese medicine.
Still, this concept of balance exists within the air Vedic system, which is the Indian traditional medical system. Korean and Japanese medicine is about maintaining balance, and the Western lifestyle is definitely out of balance. I don’t want to leave people thinking that lifestyle is the cause of all cancers, and we have to be careful about this kind of this gray zone. Are you telling me I cause my cancer? In my case, melanoma, blistering sunburns under the age of 20; yeah, that probably is what set up my body to have those original mutations, but whether they grow and thrive may or may not have been more in my control than not.
As Alison said, the key is to make our body as inhospitable to cancer as possible. Follow what seems right from the Western perspective of conventional allopathic medicine.
Allison: And I think that what happens is that when you get sick, or somebody gets sick around you, we are initially channeled to go to the doctor to get the pill and hope that all is well. More and more, we are spending time looking at what could be some of the causes of this?
What can I do?
Lorenzo: And interestingly, there’s a lot of collateral damage from the necessary cancer treatments, radiation chemotherapy. The cancer guidelines all have supportive treatments; Yoga, Acupuncture is among cancer-related symptom guidelines. Exercise is the number one thing to combat cancer-related fatigue. There is much more acceptance and, again, recommendations that are very pointed around the area of what we call integrative medicine and lifestyle alongside conventional care. The key is getting it prescribed.
The first step, get it on the guideline. And then next is, well, how do we implement? How do we get every hospital to have a yoga therapist and an exercise coach, and a dietician so that they’re available for everybody?
Anthony: I agree. Some of the treatments are worse than the disease. In our case for multiple myeloma, for which there was no cure, the best you can hope for is to either keep it in check or get it into remission. And so, for us, we got to the point where it made sense to try to get in remission.
But ultimately, the method to do that, which was traditional chemotherapy, is the thing that tipped the scale. Unfortunately, now we knew what the risk was, and we took that willingly, I think to that point of, you know, starting now, before yourself, Yes, there are no guarantees.
There may be some other factor. But you set yourself up for a better outcome if you have started early versus starting late.
Allison: You’re exactly right. Many side effects from treatment are tough to handle. And you want everybody to have the best chance of success, and putting in place lifestyle change helps you find success in a variety of different ways.
Lorenzo: If you are disease free and engaging in this lifestyle, you’ll feel better than you ever did. And David commented that he never felt healthier than when he had cancer because he was engaging in all the lifestyle factors. And I would say, when I was going through cancer treatment, I never felt better because I was engaging in two to three hours of self-care every day, and I felt fabulous. I was prioritizing mind, body, and exercise, working less. And I felt fabulous even though I was getting immunotherapy.
Anthony: Any last thoughts for our audience?
Allison: The journey is possible with the support and love of those around you, and that anticancer living is a tool to put in your toolbox for yourself, your loved ones, and your family to help you live a better life today.
Lorenzo: And this is hard. So be kind to yourself, be compassionate with yourself. Every day is a new day, a unique opportunity. And if one day, you don’t engage in a way that you like, the next day is another opportunity. Take one day at a time, and it’s a practice, and the more you practice, the better you get.
Anthony: That’s an excellent point. I appreciate that. Lorenzo and Alison, I can’t thank you enough for speaking with me. Thank you so much, and I hope you have a blessed rest of your day.
Allison: Thank you so much. It’s been a pleasure to talk to you. Thanks for having us. Thank you.
Anti cancer Living is available in hardcover, paperback, and audible versions on Amazon