Ornish et al at the University of California in San Francisco and the Preventive Medicine Research Institute in Sausalito, California, performed a 5-year study¹ including 35 men on active surveillance (10 in a lifestyle-intervention group and 25 in a control group) with low-risk prostate cancer. The study was a follow-up of a 3-month study performed 6 years ago.²

The authors hypothesized that men compliant with a comprehensive diet and lifestyle change would have improvement in their peripheral blood telomere profile (length and activity), compared to a control group that did not participate in the lifestyle intervention. They noted that short telomere length in peripheral blood mononuclear cells is associated with aging and age-related diseases such as cancer, stroke, vascular dementia, and diabetes.

Considerable Commitment

The comprehensive lifestyle intervention required considerable commitment from the patients and the team of investigators to carry out the study procedures. The intervention consisted of whole foods, plant-based protein, fruits, vegetables, unrefined grains, and legumes, and was low in fat (approximately 10% of calories) and refined carbohydrates, with take-home meals being provided to patients for the first 3 months of the intervention. The intervention also consisted of moderate aerobic exercise (eg, walking 30 minutes per day on 6 days per week), stress management (eg, gentle yoga-based stretching, breathing, meditation, imagery, and progressive relaxation for 60 minutes daily), and increased social support (eg, 60-minute support group sessions once per week).

At each weekly support session, patients performed 1 hour of moderate exercise supervised by an exercise physiologist and 1 hour of stress-management techniques supervised by a certified stress-management specialist. They also attended a 1-hour support group led by a clinical psychologist at each session and a 1-hour lecture during dinner, generally from a dietitian, registered nurse, or physician. All members of the intervention staff were available to answer patient questions and to provide counseling at the weekly support sessions. Spouses and partners were encouraged to attend support sessions but were not required to do so.

Hypothesis-Generating Findings

The investigators reported that the comprehensive lifestyle group had a relative increase in telomere length compared to the control group, though there was no change in telomere activity and no statistical difference in telomerase activity between the groups. This was a pilot study and, therefore, should be considered hypothesis-generating.

Subjects in the control group had slightly higher weight and body mass index and were older than the intervention group (though these differences were not statistically significant), and this may have impacted the results. In addition, this was a nonrandomized trial. Perhaps the health-seeking personalities of the individuals who were willing to participate in the comprehensive lifestyle changes may have factored into the outcome.

Nonetheless, the findings are intriguing and form a strong basis for prospective randomized trials. We look forward to more studies on diet and lifestyle interventions in men with prostate cancer from this group of highly experienced and committed investigators.

Further Considerations

Whereas medical scientists will continue to prove benefits to diet and lifestyle changes, social scientists will need to create the incentives to cause people to change their lifestyles. Full knowledge that smoking and obesity cause innumerable diseases and hundreds of thousands of deaths has not dissuaded tens of millions of humans from abusing their bodies.

With the rapidly evolving field of computer and sensor technology, we would anticipate interactive computer-based, mobile programs as having a positive impact in the future. Hopefully there will soon be a highly effective “app for that.”

Disclosure: Drs. Boxer and Aronson reported no potential conflicts of interest.

References

1. Ornish D, Lin J, Chan JM, et al: Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol 14: 1112-1120, 2013.

2. Ornish D, Lin J, Daubenmier J, et al: Increased telomerase activity and comprehensive lifestyle changes: A pilot study. Lancet Oncol 9:1048-1057, 2008.

Dr. Boxer is Visiting Professor at the David Geffen School of Medicine at UCLA, Clinical Professor at the University of Wisconsin, Madison, and the Medical College of Wisconsin (Milwaukee), and former Professor of Clinical Urology at the University of Miami. He is also an Associate Editor of The ASCO Post. Dr. Aronson is Clinical Professor, UCLA Department of Urology, and Chief of Urologic Oncology, VA Medical Center, Greater Los Angeles Healthcare System.