Monday, June 30, 2008

Cancer, Nutrition, and the Word of Wisdom

Photo by Summer Drake, Pikes Place Market
By William T. Stephenson, MDDr. Stephenson is a physician at Kansas City Cancer Center, Kansas City, Missouri. He also has a degree in nutrition from Brigham Young University and currently serves as a bishop.

William T. Stephenson, “Cancer, Nutrition, and the Word of Wisdom: One Doctor’s Observations,” Ensign, Jul 2008, 42–47
Knowing our health and our spirituality are interrelated, I would like to offer a few medical insights into what the scientific world is learning about cancer.
Doctrine and Covenants 89, known commonly as the Word of Wisdom, is a remarkable revelation given to the Prophet Joseph Smith almost 175 years ago—long before there was any scientific proof to influence him on issues of health.
Though at first reading, Doctrine and Covenants 89 may seem to be simply a list of dos and don’ts about such nonspiritual topics as tobacco, alcohol, and diet, it is much more. The Lord says, “all things unto me are spiritual, and not at any time have I given unto you a law which was temporal” (D&C 29:34).
On Tobacco
“And again, tobacco is not for the body, neither for the belly, and is not good for man” (D&C 89:8).
While studying cancer medicine at Indiana University, I was assigned to the oncology clinic at the Veterans Administration hospital there. The patients I saw were almost all heavy current or former smokers. They came in with lung cancers, bladder cancers, esophageal cancers, and other smoking-related malignancies. At the same time, they had emphysema and heart disease made worse by years of tobacco use, rendering their treatments both more difficult and less effective.
Tobacco has now been linked to many types of cancer, including lung, bladder, esophagus, head and neck, throat, cervix, stomach, pancreas, and kidney cancers, as well as acute myeloid leukemia.1 Lung cancer, however, is foremost among them. Smoking causes about 90 percent of male lung cancer deaths, about 80 percent of female lung cancer deaths,2 and a total of approximately 440,000 deaths annually.3
A 2004 report from the U.S. Centers for Disease Control and Prevention indicates that “compared to nonsmokers, men who smoke are about 23 times more likely to develop lung cancer, and women who smoke are about 13 times more likely.”4 In addition, smoking is a major cause of emphysema, coronary heart disease, stroke, osteoporosis, infertility, dental diseases, and other diseases.5
On Hot Drinks and Caffeine
“And again, hot drinks are not for the body or belly” (D&C 89:9).
The consumption of coffee or tea, whether hot or cold, is recognized by the Church as a violation of the Word of Wisdom. Coffee and tea contain substances such as caffeine, which has been linked to disease. While the Word of Wisdom does not specifically mention caffeine, it is commonly understood in the medical community that higher doses of caffeine are associated with infertility, Meniere’s disease (a disease affecting balance), insomnia, sudden infant death syndrome (with maternal consumption in utero), and fibrocystic disease of the breasts. In addition, gastric acid disease (ulcers of the stomach and duodenum) may also be linked to consumption of both caffeinated and decaffeinated coffee, lending credence to the Word of Wisdom’s advice to avoid “hot drinks.” From the perspective of medical science, most investigators who have examined the effects of caffeine suggest that caffeinated beverages should not be consumed in large quantities.6
On Alcohol
“Inasmuch as any man drinketh wine or strong drink among you, behold it is not good. … And, again, strong drinks are not for the belly, but for the washing of your bodies”(D&C 89:5, 7).
The Word of Wisdom is clear on this point. Among doctors, as a result of scientific studies, it is commonly accepted that alcohol consumption is associated with cancers of the esophagus, liver, and pancreas. A relationship between alcohol and the development of breast cancer has been debated for years. The largest study on this subject was presented recently. The Nurses’ Health Study, a study of 121,700 nurses followed over a 20-year period, found that even modest alcohol intake was associated with an increased risk of postmenopausal breast cancer.7
On Dietary Recommendations
Although we often consider the verses teaching us to avoid alcohol, tobacco, and hot drinks to be the most important parts of the Word of Wisdom, the larger portion of this revelation is actually devoted to teaching us what we should consume: wheat, other grains, fruits, and vegetables. Grains are mentioned repeatedly in this revelation, with special mention of “wheat for man” in verse 17.
“And again, verily I say unto you, all wholesome herbs God hath ordained for the constitution, nature, and use of man—
“Every herb in the season thereof, and every fruit in the season thereof; all these to be used with prudence and thanksgiving.
“Yea, flesh also of beasts and of the fowls of the air, I, the Lord, have ordained for the use of man with thanksgiving; nevertheless they are to be used sparingly;
“And it is pleasing unto me that they should not be used, only in times of winter, or of cold, or famine.
“All grain is ordained for the use of man and of beasts, to be the staff of life, …
“All grain is good for the food of man; as also the fruit of the vine; …
“Nevertheless, wheat for man” (D&C 89:10–14, 16–17).
What does medical science teach us about this kind of diet? Certainly all kinds of diets are being recommended by one seeming authority or another. The diets in fashion change from year to year. Consistently over the years, however, the evidence favors a diet in keeping with the recommendations contained in the Word of Wisdom. The medical community widely accepts that a low-fat diet consisting mostly of complex carbohydrates found in whole grains, fruits, and vegetables, along with limited amounts of nuts and high-protein foods like low-fat meats, is associated with lower incidences of disease and a longer life.
The benefits of this type of diet are likely related to many different interrelated nutritional factors. For example, such a diet is naturally low in fat. I recently attended the American Society of Clinical Oncology meetings, where I heard research presented on postmenopausal women who had undergone treatment for early-stage breast cancer. Women who followed a low-fat diet, which was remarkably similar to the foods recommended in the Word of Wisdom, were less likely to have their breast cancer return after treatment.8
On Nutrition and Cancer Prevention
It would be impractical to discuss all the data in support of the dietary principles promoted by the Word of Wisdom, but I would like to review a few examples from the cancer literature that I find particularly interesting.
Several studies have looked at the ability of vitamin supplements in pill form to prevent cancer. One study examined male smokers from Finland who took vitamin E (alpha-tocopherol) and vitamin A (beta carotene) in tablet form. The results were unexpected. The authors found no reduction in the incidence of lung cancer among these smokers after five to eight years of dietary supplementation with alpha-tocopherol (vitamin E); they found an 18 percent increased risk of lung cancer among those supplemented with beta carotene (vitamin A).9
In several follow-up studies, participants were asked to give dietary histories showing what kinds of foods they commonly ate.10 The results were also surprising. Those individuals who had the highest intake of fruits and vegetables had a lower incidence of lung cancer.11 The best results were seen in individuals with diets high in vitamin A–rich foods, such as tomatoes and dark green or dark yellow vegetables and fruits. A second study, the Beta-Carotene and Retinol Efficacy Trial (CARET) Study, confirmed these results.12 Other studies have also confirmed the value of eating a diet rich in fruits and vegetables.
Additional studies have linked diets high in whole grains and rich in fiber to lower incidences of colon and other cancers. Nuts also appear to be important and could logically be included in the Word of Wisdom’s “fruit of the vine” (D&C 89:16).
In a modern world we often look for easy ways to live healthily by substituting fad diets or pills for healthy eating habits. Many fad diets promote the opposite of the Word of Wisdom, including diets high in meat and fat, which may temporarily lower weight. However, research indicates that a diet following the recommendations outlined in section 89 of the Doctrine and Covenants, consisting primarily of grains, fruits, and vegetables, is generally considered the healthiest way to eat.
On Cancer Incidence and Longevity
Science has also looked specifically at Latter-day Saints to see if our health practices influence our chances of getting cancer. The results are encouraging.
When looking at Latter-day Saints living in Utah, one study found a 24 percent lower rate of developing cancer. Looking at just smoking-related cancers, the study found a 50 percent lower incidence in men and a 60 percent lower incidence in women compared to the U.S. rate.13
A University of California Los Angeles (UCLA) study of Latter-day Saint high priests in California found they were about 50 percent less likely to die from cancer and 70 percent less likely to die of tobacco-related cancers than the general population.”14
Life expectancy for Latter-day Saint males living in Utah is 7.3 years longer than their non-LDS counterparts. Female Latter-day Saints appear to live longer too—an average of 5.8 years.15
Standards for Temporal Health
While the Word of Wisdom does not rely on scientific proof, it has stood the test of time, and science is slowly proving the truths it contains. The Lord revealed and the Prophet Joseph Smith taught important standards for temporal health that science is now corroborating many decades later.
Thanks to the recommendations contained in section 89 of the Doctrine and Covenants, Latter-day Saints live longer and are less likely to get cancer. Although members of the Church often focus on aspects relating to avoiding smoking, alcohol consumption, coffee, and tea, the Word of Wisdom provides further direction for blessing Latter-day Saints. Eating a diet consisting primarily of wheat and grain products, fruits, and vegetables, as outlined in the revelation, is being shown scientifically to be the best possible way to eat. Since the Lord promises that those who follow these teachings will have “health in their navel and marrow to their bones” (v. 18) and will “find wisdom and great treasures of knowledge, even hidden treasures” (v. 19), I am eager to do all I can to live by the precepts taught in the Word of Wisdom.