By: Dr. Mark Pettus, MD

Advances in the treatment of cancer are one of the great success stories of the last generation.  Cancer has shifted profoundly from an historical “dark and doom” diagnostic category to one that most survive with as a “chronic disease”.

It is also widely recognized that lifestyle choices play an enormous role in the risk-development and treatment success of all cancers. According to the American Cancer Society, 30% of cancer deaths could be avoided if people stopped using tobacco, and another one-third of cancer deaths can be attributed to poor nutrition, lack of physical inactivity, and obesity.

Poor diet, lack of exercise, and obesity are noted to play an increasing role in the development of cancer, contributing to an estimated 40–55% of new cancer cases. Persons who are overweight or obese are at elevated risk of a number of cancers, including breast, colorectal, endometrial (uterine), esophageal and kidney.

While genetics clearly play an important role in one’s cancer risk-prognosis, our environment (how we eat, move, interpret and respond to stress, manage toxic exposures, cultivate meaning, sleep, and interconnect with others) plays an even greater role. In the emerging field of epigenetics, we are coming to see that lifestyle can potentially trump our genetic predispositions. Here are few examples of what we currently know can improve the “oncometabolic (cancer promoting)” landscape in the challenging environment we now navigate.


Two of the greatest metabolic risks for cancer are inflammation and insulin resistance, sometimes referred to as metabolic or lifestyle syndrome. This takes the form of an increased waistline (35” or greater in women and 40” or greater in men), high triglycerides, low HDL (good cholesterol), and a high c-reactive protein (blood marker for inflammation). So what foods place one at greater risk for a revved up immune system and insulin resistance?

  • Sugar in all its forms, especially in processed foods, baked goods and soft drinks.
  • Refined grain flour or “white flour”, especially from wheat. These are “carb dense” foods that wreak havoc with our weight and health. This includes many breads, processed cereal grains, pasta, bagels, chips, pretzels, white potatoes, white rice, crackers, pastries, etc.
  • Frequent consumption of processed vegetable oils, especially when cooked at high temperatures (above 350), like corn, soy, safflower, sunflower, soy, and canola oil. Trans fats (aka hydrogenated oils) in packaged foods are bad news. Fresh grass-fed butter is always better than margarine and other “butter substitutes”.
  • We need sufficient fiber to feed the healthy critters in our gut’s ecosystem. This new science called the microbiome suggests that the bacteria in our gut ecosystem can influence our health from head to toe. When we provide them with fiber, a healthy ecosystem best maintains our health. Ideally, these sources would include fruits (berries are best), vegetables, beans, legumes, and some whole grains, such as quinoa, buckwheat, and more ancient wheat grains (i.e., emmer or einkorn). Modern wheat, even whole wheat, raises sugar and insulin, and for those sensitive to gluten (about 10% adults), wheat in all its forms can be a problem.
  • If possible, grass-fed eggs and meats are more nutrient-dense and have fewer toxins than those that come from “industrial” feed-lot sources or are heavily processed, e.g., many packaged lunch meats.
  • Healthy fats like grass-fed butter, olive oil, coconut or MCT oil (medium chain triglyceride), fatty fish like salmon, sardines, herring, trout, mackerel, and anchovies, nuts, eggs, and avocados reduce inflammation, unlike their unhealthy counterparts noted above.
  • Vitamin D: The “sweet spot” for 25-hydroxy Vitamin D blood levels is between 30-50 ng/dl. Many people living at more northern latitudes (above 20 degrees, e.g., Atlanta) will require on average 2-4,000 units/day supplementation. Sensible sun exposure up to 30” per day without protection will be therapeutic. Earlier morning and later afternoon sun exposure is best and reduces sunburn risk.


Any epidemiological study ever published demonstrates activity to be a major protector of all chronic complex diseases, including cancer. Walking for many is easiest, like for 30 minutes, 5 days per week. Resistance movements with light weights twice a week is very important to build and maintain muscle mass, which often becomes depleted in people treated for cancer. As I like to say, motion is the lotion. It will reduce inflammation and insulin resistance very effectively, independently of any weight loss. Make it fun by being with friends, a pet, outdoors whenever possible, or with music that makes you happy!


We all know how powerfully stress impacts our lives. Continuous stress provokes inflammation, takes away our energy, our joy, and our capacity to remain “in the moment” we are in. Stress happens, and there will never be stress-free days in our complex, modern lives. The opportunity is exploring different ways to interpret and respond to the stressors in our lives. Before we react to a set of circumstances that stresses us, a question to ask would be, “Is my response going to raise or lower my inflammation?” How we think, feel, and ultimately behave is often driven by the deeply entrenched patterns that uniquely define who we are…sometimes for the better and sometimes not. A few easy steps to consider:

  • When you start to feel overwhelmed, “catch yourself” and press the pause button.
  • Gently close your eyes and picture someone, something, or some place you absolutely love and that makes you feel happy.
  • Slow your breath by inspiring through your nose, if able, over a count of five seconds, hold that breath for five seconds, and slowly exhale through your mouth for five seconds.
  • Do this for three minutes whenever you need to decompress. This gift is there for you, always.


As many as 40-50% adults state they do not sleep well through the night and often wake up NOT feeling restored. While there are many reasons for this, chronically disrupted sleep also is a major contributor to inflammation. Consider some simple sleep hygiene steps:

  • Try to establish a daily rhythm-routine for rising and for going to bed.
  • Make your bedroom as dark as you can (cover any small lights, including your alarm clock) so that you should not be able to see your hand when placed outstretched in front of you.
  • Keep your room cooler, within a range of 62-64 degrees. Cold, yes, but better for sleep and metabolic healing.
  • Try some simple breath and guided imagery.
  • No caffeine after 2 p.m.
  • Gratitude journal: enter three things you are grateful for that day, and mindfully reflect on them as you relax in anticipation of a good night’s sleep.
  • Drink relaxing teas like chamomile, valerian, and passionflower.
  • In the morning, take advantage of a full spectrum “light box” for 30 minutes. This can help reinforce circadian rhythm and be particularly helpful over the long, dark winter season for mood, energy, and well-being.

While helpful for cancer care, these strategies improve our metabolic landscape in a way that improves health, vitality, and the capacity to thrive!

Dr. Mark Pettus currently serves as the Director of Medical Education, Wellness and Population Health at Berkshire Health Systems in western Massachusetts. In addition, he serves as The Associate Dean of Medical Education at The University of Massachusetts Medical School. He is the author of two books, The Savvy Patient: The Ultimate Advocate for Quality Health Care and It’s All in Your Head: Change Your Mind, Change Your Health. He serves on the teaching faculty at The Center for Mind-Body Medicine based in Washington D.C. and The Meditation Institute in Averill Park NY. He’s also a member of NWI’s Board of Directors.