I have argued that the power of lifestyle -- physical activity, dietary pattern and avoiding that death grip around a cigarette -- constitute the master levers of medical destiny. In response, I have received some push-back on behalf of genes. The counter-arguments to mine are that what we do will not reliably determine what happens to us, because of the potent influence of our genetic inheritance.
There is of course some truth to this rebuttal. But it's a bit like dismissing the value of master-level seamanship because of the risk of stormy seas. We will never control the wind and waves, but give me a well captained ship any day! In the poem "Invictus," the ship of which we are each captain is our soul. In my purview, it is health.
Let us concede that storms may arise -- in our chromosomes and elsewhere -- that we do not, and cannot control. Let us acknowledge that bad things happen, alas, to good people. Let us be clear that bad outcomes do not mean bad behavior. Let us proclaim no tolerance for blaming the victim of bad fate.
But let us also avow that to a substantial and gratifying degree, we are, indeed, masters of our fate -- captains of our health. Let us respect the modern science that shows the nature vs. nurture debate serves up a false choice -- for we can, in fact, nurture nature.
Your genes are not your medical destiny. With relatively uncommon exception, that is the rule established by ground-breaking research published over recent years, and nicely illustrated by a 2008 paper in the Proceedings of the National Academy of Sciences. That rule could, and perhaps should, remake the way you play the game of life.
The illustrative trial was a pilot study of 30 men with early stage prostate cancer who were eligible to be observed carefully for disease progression without undergoing surgery, radiation or chemotherapy. These men were enrolled into a trial called GEMINAL, developed and implemented by my friend, Dr. Dean Ornish, and his colleagues at the University of California, San Francisco.
Dr. Ornish is best known as the ardent proponent of a very low-fat, plant-based diet for heart disease prevention. His Lifestyle Heart Trial, published almost 20 years ago, showed that an intensive lifestyle program -- including a plant-based diet, daily exercise, stress management and more -- could cause the plaques that block coronary arteries to shrink. A follow-up study published in the Journal of the American Medical Association in 1998 showed that this same intervention substantially cut down on the rate of heart attacks. After 16 years of work on this program, Dr. Ornish finally received news this week that Medicare will reimburse for his "heart disease reversal program" as an alternative to bypass surgery. This is a well-deserved, long-in-coming, seminal achievement.
More recently, Dr. Ornish and his colleagues have been focused on the potential for lifestyle interventions to prevent and treat prostate cancer. Prostate cancer is of particular interest for several reasons. First, it is a highly prevalent cancer, among the leading causes of cancer death in men in the United States. Second, although we have tests to screen for prostate cancer, we can't always predict the behavior of the disease once we find it.
Some prostate cancers progress and metastasize throughout the body, to bone in particular. When this occurs, the disease is both devastating, and often lethal. But some tumors of the prostate are indolent; in essence, they just sit there, doing nothing. As many as 80 percent of men in the U.S. who die after age 80 have prostate cancer, but they die with it rather than of it.
The 2008 study took advantage of this indolent variety of prostate cancer to assess the effects of a lifestyle intervention, without the confounding influences of medical or surgical cancer treatments. The men participating in the GEMINAL study received a lifestyle intervention much like that in the earlier Lifestyle Heart Trial: low-fat, whole foods, plant-based nutrition; stress management techniques; moderate exercise; and participation in a psychosocial support group. The study lasted three months.
Many of the usual measures of overall health were tracked in this study: weight, blood pressure, cholesterol levels and so on. They all improved significantly, as one would expect. The PSA, a tumor marker for prostate cancer, improved, but only trivially.
But what makes this study unique -- and groundbreaking -- is that it measured health markers beyond the list of usual suspects. Using advanced laboratory techniques, the investigators measured the effects of the intervention at the level of the genes.
What they found was remarkable. By examining prostate biopsy specimens before and after the three-month intervention, they saw significant changes in gene activity. Roughly 50 genes associated with cancer suppression became more active in generating RNA, and nearly 500 genes associated with cancer progression became less active. The pattern of change observed in gene activity was consistently, and decisively associated with lower risk of cancer development and progression.
We have long known that lifestyle has a powerful influence on health across a wide array of outcomes. It is not news to you that eating well, being active, controlling your weight, managing stress and not smoking, for instance, can influence your fate.
But we have tended to think in terms of "nature versus nurture" -- with lifestyle and genetic influences on health as independent and potentially competing forces. This study, and others like it, ostensibly change the game. They suggest that lifestyle and genetics are not independent after all, but interact. Even our genes are influenced by lifestyle choices. We can, it seems, nurture nature.
To a Preventive Medicine specialist like me, this is of profound importance. Complacency and fatalism are enemies of disease prevention. For many people, the notion that their medical destiny is written in their genes is a disincentive to take matters into their own hands.
The lifestyle intervention in GEMINAL was rather intense, allowing only 10 percent of calories from dietary fat, and requiring more than an hour and a half of exercise and meditation daily. We don't yet know if less intensive lifestyle approaches would influence genes as this program did. And there is only so much certainty that can derive from a pilot study, limited to 30 men with prostate cancer. More research is required to prove what the current body of evidence suggests. But what it suggests is quite provocative enough for now: take good enough care of yourself, and even your genes will get a makeover.
What we have in this study and others like it is nothing less than an indication that the concept of "nature versus nurture" is flawed and obsolete. Genetic influence is not walled off from the world. Epigenetic influences prevail.
Be careful, though; do not be seduced into thinking that by living well, you get a guarantee of good outcomes. There is, alas, no such guarantee. We can trim the sails, but we do not command the wind and waves.
But on the flip side, recognize that healthful behaviors are not a mere attempt to bluff our way through whatever genetic hand we were dealt. They are, it turns out, an opportunity to reshuffle the genetic deck in our favor.
My concluding perspective on that opportunity, and I hope yours as well, is simply this: deal me in!
Dr. David L. Katz; www.davidkatzmd.com
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz
Dr. Frank Lipman: Is Our Health Determined By Our Genes?
Deepak Chopra: Weekly Health Tip: Prostate Cancer -- To Screen Or Not To Screen?
You can make yourself more alert reduce stress and improve cognitive functioning with a nap.
A ‘power nap’, means more patience, less stress, better reaction time, increased learning, more efficiency and better health
New research from the University of California, Berkeley, shows that an hour's nap can dramatically boost and restore your brain power. Indeed, the findings suggest that a biphasic sleep schedule not only refreshes the mind, but can make you smarter.
Some have concluded that sleep is needed to clear the brain's short-term memory storage and make room for new information.
This seems to fit right in with nurturing your genes. Lots of sleep and good food and exercise, plus staying away from cigarettes, dope and alcohol.
You can see with an electron microscope how the DNA reacts to negatives like anger and criticism, upregulating the 'bad' genes; and how it reacts to positives like gratitude, love and compassion, by downregulating those genes and upregulating the good guys.
Prevention on the dietary/lifestyle level cannot go very far without taking into account the attitudes and emotions that literally shape our bodies' pattern-makers and our future health.
What you *can* do is affect the *expression* of genes. That's a very different thing.
Claiming you can change your genes when you're really just affecting their expression is like claiming to have rewired your house when all you did was flick a switch.
that simple statement has multiplied itself [ maharishi effect and actually the effect any great teacher or blog or book has on the world ] into epigenetics
i had contented to the orthodox medical profession which is focused too narrowly on drugs and gene deficiencies , [ they are in too little a subset of reality not because they are deficient but because complexity is overwhelming ], that it is not a deficient gene expression which causes e.g. cancer ; it is bad habits, the accumalation of stress and frankly gunk , from bad habits which sets in motion a disease [ damage ] process and this process causes faulty gene expression
in the practice of maahrishi's TM and to some extend any spiritual practice [ including attending church etc] the opposite happens ; deep rest from TM practice improves for instance the DNA repair mechanism ; relief from stress in each sittin gof TM meditation allows the prefrontal cortex , thalamus ,hypothalamus to function better AND it enlivens the genetic machinery
to maximize this people possessing money can attend a maharishi Ayur Veda spa
in 1971 ? in a conference attended by David Suzuki ,Hans Selye , Maharishi said " infinity inscribed on genes "
Even if we accept a determinative role for epigenetic programming, much of that is not "lifestyle." It is prenatal insult, early childhood enviromment, unintended exposure to toxins and pathogens, and physical trauma. Considering all of these factors, lifestyle choices must make up only a small portion of epigenetic programming. So for health professionals to endlessly hector people with chronic illness and suboptimal health that they got and remain that way because they are stress-aholic, physically lazy junk food addicts is not just distasteful but foolish as well.
Think of your body as your vehicle (because really, that's what it is - as well as many other VERY important things). If you treat your vehicle poorly, drive fast, hit potholes, don't change your oil, don't do regular maintenance, it begins to fall apart. Your body is the same. If you eat unhealthy food, you smoke, you drink, you don't exercise, it takes a huge toll on your body to the point where it can no longer handle the abuse.
The funny thing is, I know people who smoke, drink, eat poorly, and don't exercise, but spend hours per day working on their vehicles to make them faster and prettier. There is a real disconnect today between what's important and what we actually spend our time on.
It's very attractive: it's not your fault; blame your parents. Appeals to everyone.
Researchers know that less than 5% of high cholesterol cases are genetic.
Yet statin ads constantly imply that it's your genes, not lifestyle.
So, fight the good fight, but you won't win, the drug ads on TV will.