Steven Spielberg has recently made his case for Super 8. In the spirit of less-is-more, I make mine for Super 6: the list of six factors most likely to add years to our lives, and life to our years.
What prompts me to focus now on my 'Super 6' list is a patient I saw in clinic recently who had experienced a potentially life-threatening cancer a year or so ago, and is now living in the aftermath of a surgical "cure." He came to my clinic looking for ways to reduce the likelihood of that cancer ever recurring, or any other ever occurring in the first place.
Such collisions with our mortality tend to sharpen the focus of patient and clinician alike. Whereas any given patient might like to know how to promote their health, this patient approached the topic as a veritable quest. And whereas I might rattle off a number of suggestions to my healthy patient looking to stay healthy, this patient was a goad for me to rack my brain, and re-scour the relevant literature.
As you might expect, discussion with this patient was far-ranging. He wanted to know about everything he could do to bend fate and probability in his favor. So, naturally, we discussed both conventional medical therapies such as drugs (there is no clear role for them in his case), and nutrient/botanical supplements (these might contribute some benefit, discussed below).
But three principal considerations drove this discussion, as they should drive any discussion about intervening to prevent future disease: risk/benefit trade-offs; the magnitude of any likely effect; and the quality of underlying evidence.
Those three considerations drove our discussion inevitably in the direction of the Super 6: feet, forks, fingers, sleep, stress and love.
There are, of course, innumerable reports about supplements, but overall evidence for cancer prevention by use of any given supplement or combination of supplements is slim. There is an argument to be made for vitamin D, particular among those living in northern climes and/or disinclined to eat dairy, and thus prone to relative deficiency.
There is a case to be made for antioxidant rich foods and beverages, such as green tea (or, perhaps even better, white tea). But the evidence for benefit from any given antioxidant supplement is lacking. To the contrary, studies have hinted at potential increases in cancer risk with certain antioxidant supplements, notably beta-carotene.
My clinic is intrigued by, and makes use of, modified citrus pectin, which appears to have some potential to interfere with the spread of cancer cells, and also appears to be entirely safe. The same applies to Avemar, a product derived from fermented wheat germ with an extensive, albeit still evolving, literature supporting its use in cancer prevention.
But in general, evidence to support the use of supplements to prevent cancer is inconclusive. And there is an additional concern based on the risk/benefit trade-off. Supplements that don't perform as hoped may exert unintended effects, potentially including an increase in cancer risk. For someone devoted to risk reduction, this is a bad chance to take.
So risk/benefit ratios, the magnitude of any potential benefit and the quality of science all militate against undue reliance on supplements. But all three weigh in favor of the Super 6. The Super 6 are the best medicine we have for preventing cancer and other chronic disease, and all are good for health anyway. The only real potential side effect of their use to prevent cancer is that you might also get healthier in ways you didn't intend.
Regular physical activity (feet) is associated with weight control, reduced inflammation, enhanced immune function and reduced cancer risk specifically. Optimal diet (forks) exerts far-ranging effects on every aspect of physiology, and similarly stands to reduce the risk of all chronic disease. Combine eating well and being active with a commitment to never hold a cigarette (fingers), and the risk of all chronic disease declines by roughly 80 percent.
Those are my top three, but the list of health promotion priorities very reasonably extends to three more. The quality and quantity of sleep has profound effects on psychology, immunology and neurology. A linkage to cancer risk is suggested by a rudimentary connection of these dots. Much the same is true of stress, which can contribute to hormonal imbalances and inflammation that propagate cancer -- or can be managed to prevent such effects.
And, finally, there is love. We are, from our earliest origins, social creatures much influenced by our relationships with others. While love may seem a "warm and fuzzy" topic, it is in fact the cold, hard scrutiny of clinical trials demonstrating that those with loving relationships are far less vulnerable to chronic disease and death than those without.
Combine all six salutary practices, and the evidence is clear that benefits reverberate all the way to our chromosomes, altering the behavior of genes in a way apt to reduce chronic disease risk in general, and cancer risk specifically.
I hasten to append to this paean for the power of lifestyle a proviso: there is never a guarantee. Think of it this way: lifestyle practices are the ship and sails, but there is still the wind and waves. The former we can control to increase the probability of a safe crossing; the latter, we cannot -- and thus even a well-captained ship may founder.
But the Super 6 can assuredly put probability on your side. And these factors most likely to make a difference for a patient in the aftermath of cancer are as relevant for you and me, regardless of whether or not we have faced a similar peril.
You'll need a little help with love, but the other factors are up to you. No need to wait for that brush with mortality -- I commend the Super 6 to you right now.
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz