Creating Healthy Habits
Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Nancy Hepp, MS, BCCT Project Manager
Last updated September 11, 2021.
Creating healthy habits beyond the 7 Healing Practices includes keeping your weight at a healthy level, giving up smoking and limiting alcohol intake.
You may be nodding your head right now saying “I know, I know: obesity, smoking and too much alcohol are not good for me and changing this could save my life and not changing this will likely shorten my life and make me feel bad in the meantime. But . . . . “
We recognize that breaking an unhealthy habit and replacing it with a healthy one is a big deal. Most people need guidance, information and support to pull off such big changes.
We point you to some of the wealth of resources to inform you about these additional anticancer strategies and guide you in creating healthy habits that stick. You will also find ideas in each of the 7 Healing Practice summaries, as well as in some of the integrative therapies summaries, such as the use of acupuncture in smoking cessation, or employing stress management skills to replace using eating, smoking or drinking alcohol to deal with stress.
The first step is to commit to your health.
Lifestyle, Body Terrain and the Tumor Microenvironment
BCCT advisor, physician, and researcher Dean Ornish, MD, explains Lifestyle Medicine.
The real power of adding healthy lifestyle practices and stopping unhealthy ones is in making your body’s terrain inhospitable to cancer and other diseases, tipping the balance toward well-being. Healthy living helps you take charge as your own internal environmental engineer!
We’re already seeing compelling evidence that lifestyle factors may be the missing ingredient of the existing cancer treatment model.
Much more detail is found in the Body Terrain and Tumor Microenvironment section, describing the influence of each of the 7 Healing Practices on your internal environment. Each of the opposites of the 7 Healing Practices—unhealthy eating, inactivity, poor sleep, unmanaged stress, isolation, frequent exposure to environmental toxins, and despair and hopelessness—can contribute to cancer growth and spread, in part by fostering these conditions in which cancer grows and thrives:
- Chronic inflammation
- Insulin resistance
- Oxidative stress
- Increased circulating estrogen
- Impaired detoxification and the resulting build-up of toxic metabolites
- Impaired break down and absorption of nutrients
Cancer does not grow in isolation. It develops within an environment we help create by the things we eat day after day, by our stress levels, our physical activity, our support network, the quality of our sleep, and our exposure to environmental toxins.
Your doctor might throw the most powerful surgery, radiation and drugs at cancer, and even though these therapies might effectively kill most of the cancer cells, they were not designed to keep cancer from returning. Usually some cancer cells survive, and we must count on our own internal anticancer defenses to kill the remaining cells and keep cancer from recurring. We need to “meet conventional cancer treatment in the middle”, letting healthy lifestyle practices carry the baton from there.
As portrayed eloquently in A Story of Health, many of the risk factors associated with cancer are also risk factors for other diseases:
Similarly, a large study published in 2021 found that traditional risk factors for cardiovascular disease were also related to increased risk of cancer, while a heart-healthy lifestyle is associated with a lower risk of future cancer. Factors that reduce risk (Life's Simple 7):5
Four More Anticancer Strategies to Consider
Researchers estimate that more than 50 percent of cancers are caused by lifestyle factors over which we have some degree of control:6
- Obesity (from poor diet and sedentary behavior)
- Tobacco use
- Viral infections (such as human papilloma virus transmitted through sexual contact)
- Radiation (including from too much sun exposure)
- Alcohol use
- Exposure to environmental toxics
The 7 Healing Practices address some of these factors. However, four healthy habits provide further anticancer strategies beyond these healing practices. These habits can further deprive the tumor of the microenvironment that drives its growth and spread:
- Manage your weight
- Stop smoking
- Limit alcoholic drinks to two for men and one for women per day at most. Fewer is even better: the American Cancer Society now states it is best not to drink alcohol.7
- Hydrate to maintain an optimal level of body fluids
Click the chart to open a spreadsheet showing which cancer types have known links with obesity, tobacco use, alcohol consumption and various terrain factors.
The World Cancer Research Fund/American Institute for Cancer Research includes these recommendations to prevent cancer:8
- Be a healthy weight.
- Limit alcohol consumption.
- Stop smoking and avoid other exposure to tobacco; avoiding excess sun is also important in reducing cancer risk.
Be a Healthy Weight
- Higher risk of colorectal cancer-specific mortality among people who are obese before diagnosis in a meta-analysis of observational studies9
- Women with breast cancer who kept their weight stable in the first few years after diagnosis had the lowest risk of overall mortality. Greater than 10 percent weight gain or loss was linked to higher risk of death. Excessive weight loss after diagnosis of breast cancer, especially in patients with other chronic illnesses such as cardiovascular disease, was associated with reduced overall survival—patients were more likely to die from one of these chronic illnesses than from cancer.11
- BMI was not associated with premenopausal breast cancer mortality in a large meta-analysis of observational studies12
- In a more recent study, body weight was not linked to short-term survival among people undergoing chemotherapy for colon cancer. Neither body weight nor weight gain during treatment was linked to any change in survival over three years or so.13
- Moderately higher risk of pancreatic cancer mortality with higher body mass index (BMI) during early adulthood, and slightly higher risk with higher waist-to-hip ratio, waist circumference in a pooled analysis of observational studies14
Lower cancer mortality with dietary interventions targeting weight loss (usually low in fat and saturated fat) among adults with obesity (very low quality evidence) in a meta-analysis of RCTs15
In certain cancer types treated with immune checkpoint inhibitor therapy or targeted therapy, researchers have found a link between obesity and longer survival, sometimes called the obesity paradox (this advantage is not found for people receiving chemotherapy):
Is this survival advantage due to immunotherapy's action against targets more common in cancer types related to obesity? Researchers are trying to answer this and other questions:
- Is the survival advantage more related to having been obese for a long time or for a short term?
- Did obesity contribute to the development of a subtype of cancer with the targets that immunotherapy works against?
- Is obesity driving the advantage in survival, or is it that obese patients tend to have a cancer that happens to have a target against which the immunotherapy is effective?
Until we know some of these answers, we cannot encourage you to gain weight as a treatment approach.
As weight gain is a common occurrence following breast cancer diagnosis, and survivors are at increased risk for conditions such as cardiovascular disease and diabetes, we encourage you to achieving a healthy weight through a combination of Eating Well, Moving More, and other behavioral strategies.
Optimizing Your Body Terrain
As you gain weight beyond a normal body weight, the ratio of some microbes changes, altering your microbiome.19 Losing weight partially reversed obesity-associated microbial and metabolic changes in obese individuals.20
Managing Side Effects and Promoting Wellness
- A substantial link between obesity and anxiety in a meta-analysis of observational studies21
- Increased frequency of anxiety with increasing body weight in meta-analysis of observational studies22
Increased Cancer Risk with Excess Weight
For Healthcare Professionals
Obesity and Angiogenesis
A vast body of evidence has established strong links between tobacco use and cancer. Please see these resources for more information:
- Centers for Disease Control and Prevention: Smoking and Cancer
- National Cancer Institute: Harms of Cigarette Smoking and Health Benefits of Quitting
- Cancer Research UK: How does smoking cause cancer?
- Cancer Council NSW: 16 cancers caused by smoking
- American Cancer Society: Health Risks of Smoking Tobacco
- Memorial Sloan Kettering Cancer Center: How Do Cigarettes Cause Cancer?
Treating the Cancer
Smoking is related not only to higher risk of a cancer diagnosis, but of higher mortality after diagnosis for many cancer types:37
- Bladder cancer,38
- Colorectal cancer,39
- Lung cancer,40
- HPV-positive oropharyngeal cancer,41
- Prostate cancer42
The evidence isn't as strong for these cancer types:
- Breast cancer,43
- Kidney cancer44
- Oral squamous cell carcinoma45
- Ovarian cancer: 37% increased risk of mortality among women with ovarian cancer with a combination of current smoking, overweight/obesity, and physical inactivity before diagnosis compared to women who never smoked, had normal body mass index (BMI), and were physically active in a meta-analysis of observational studies46
- 56% higher risk of mortality among current smokers with pancreatic cancer, and 15% higher risk among former smokers compared to never-smokers in a very large observational study47
Optimizing Your Body Terrain
- Increase in the diversity of gut microbiota and microbes found in a healthy gut microbiome with smoking cessation in a review48 an observational study49 and a small RCT50
Managing Side Effects and Promoting Wellness
Anxiety, Depression, or Stress
Modest evidence of long-term improvement in symptoms following short-term increases
- Fewer symptoms of anxiety, depression or stress with smoking cessation in a meta-analysis of controlled trials: “Research has shown that smoking actually increases anxiety and tension."51
- Increase in anxiety, anger/irritability, depressed mood /sadness, and composite negative affect in the 24 hours following smoking cessation52
Quality of Life
- Better quality of life with smoking cessation in a meta-analysis of controlled trials53
Smoking is related to a higher risk of diagnosis or recurrence of many kinds of cancer:54
- Bladder cancer
- Blood cancer (acute myeloid leukemia)
- Cervical cancer
- Colorectal cancer
- Esophageal cancer55
- Head and neck cancer
- Kidney cancer
- Liver cancer
- Lung cancer
- Pancreatic cancer
- Stomach cancer
Limit Alcohol Consumption
A 2018 analysis of data from 195 locations found that any alcohol consumption is hazardous:56
The conclusions of the study are clear and unambiguous: alcohol is a colossal global health issue and small reductions in health-related harms at low levels of alcohol intake are outweighed by the increased risk of other health-related harms, including cancer.
Treating the Cancer
Limiting alcohol consumption is linked to better survival among people with cancer..57 Although light and moderate consumption of wine is linked to better survival among people with colorectal cancer, liquor consumption is linked to higher mortality.58
36% higher risk of death from esophageal cancer with consumption before diagnosis59
Optimizing Your Body Terrain
Alcohol alters the composition of your gut microbiota and the permeability of your gut, producing “leaky gut” problems.60 Stopping alcohol intake is linked to an increase in the diversity of your gut microbiota and microbes found in a healthy gut microbiome.61
Managing Side Effects and Promoting Wellness
Anxiety or Depression
Anxiety and alcohol use or abuse are closely related,62 . Viewed August 24, 2021; Smith JP, Randall CL. Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Research. 2012;34(4):414-31; Anker JJ, Kushner MG. Co-occurring alcohol use disorder and xnxiety: bridging psychiatric, psychological, and neurobiological perspectives. Alcohol Research. 2019 Dec 30;40(1):arcr.v40.1.03.. “The only sure way to avoid anxiety caused by drinking is to stop drinking or drastically reduce your alcohol consumption.”63
The effects of alcohol on sleep quality have been studied for decades and are fairly consistent across many studies.64
- Alcohol can disrupt melatonin production as well as cause repeated awakening from sleep in both randomized controlled trials and observational studies.65
- Less insomnia with abstinence among alcohol-dependent people in a meta-analysis of randomized trials66
Alcohol consumption is clearly linked with higher risk of breast, colorectal, esophageal, head and neck, and liver cancers, and possibly linked to higher risk of pancreatic and prostate cancers, plus melanoma.6768
- 11% higher risk among postmenopausal white women genetically predisposed to breast cancer with alcohol three or more times per week compared to less intake in a large observational study69
Smoking and Drinking Together
- Drinking alcohol and smoking tobacco contribute to changes in your stomach and microbiome and can affect disorders related to Helicobacter pylori (H. pylori) bacteria, including the risk of stomach cancer.70 Other bacteria are also affected, such as depletion of protective Lactobacillus GG and A. muciniphila and a rise in inflammation with alcohol and smoking.
Maintaining optimal levels of fluid in your body has several positive outcomes:71
- Prevent the unpleasant and even dangerous symptoms of dehydration
- Enable your body to optimize digestion, hormone balance, immune system function, inflammation and other terrain factors
- Allow your body to flush toxins out
- Reduce treatment side effects, such as nausea, weakness, constipation and fatigue
- Contribute to a general sense of well-being
For people with cancer, dehydration may cause your treatment to be delayed until you can be rehydrated, so staying hydrated is an important consideration in your treatment.
Stay hydrated with water or unsweetened beverages (avoid caffeine and alcohol if you're at risk for dehydration).
Find out more about hydrating on our Dehydration and Hydration page.
Lifestyle and the 7 Healing Practices
In addition to directly impacting the body terrain, these four strategies also interact with the 7 Healing Practices and your ability to integrate them into your life:
Potential impacts of a high body weight:
Smoking and Pain
A 2020 study found that daily smokers and former daily smokers "reported higher levels of bodily pain compared with never daily smokers at all ages."75 The reason or mechanism for this association is still unknown.
Potential impacts of smoking and tobacco use:
Potential impacts of excessive alcohol consumption:
It’s so important to resist blaming yourself if you get cancer: Our message is always, "Begin now. Don’t look back. We have no idea what caused your cancer . . . But we do know that there are things you can do differently that will make a radical difference in how you feel."
Getting Started with Healthy Living
Anticancer Lifestyle Program
Using expert videos, animation, text and interactives, the Change Module of the Anticancer Lifestyle Program introduces you to the course, and help you make lasting lifestyle changes that will decrease inflammation and enhance your immune system’s ability to fight disease.
This course is offered on a “pay-what-you-can” basis for 90-day access to all course modules.
The Circle of Health
Imagine a circle (or draw one on a page). Imagine or draw the word “HEALTH” in the middle of that circle. Think of some activities or practices that might get you into the center of HEALTH. Write them on the circle, if you wish. Outside the circle, picture or write some things that keep you from getting to the center of HEALTH. Finally, think of what will open up your access to the Circle of Health.
You do not need to overwhelm yourself trying to do too much. Once you commit to your health, it only takes one practice to bring you into the Circle. Once one practice has brought you in, the nature of the circle is that other practices that are right for you will find their way in at the right time. All your practices will flow in an integrated way. This is why we depict the 7 Healing Practices as puzzle pieces forming the perimeter of a circle.
Lots of different ways are available to create healthy habits that stick. Find a strategy for change that works for you: some people are more successful stopping smoking cold turkey, while others do better with a gradual tapering, for example. Some people find that it helps to add on a healthy pleasure before taking away an unhealthy one.
Changing Behaviors and Habits
Comprehensive lifestyle change, combined with conventional cancer care, is powerful medicine that can help control, and potentially prevent, cancer.
We consider two approaches from experts on changing your lifestyle behaviors and habits. Perhaps one will resonate with you.
Creating Healthy Habits That Stick
Dr. Mark Alloia, a behavioral psychologist who guides people in lifestyle changes offers the following advice in creating healthy habits that stick:90
Commit first to your health, rather than committing to one behavior or habit. This opens the door to practicing a variety of health-promoting behaviors that add up and lessen the risk of feeling that you’ve failed. Ambivalence is normal when thinking about changing your behavior. The process is not about succeeding or failing, but of committing to your health.
Pick It and Stick with It Rhyme
Takes a few months for a change to stick.
Tell your plan to a person who’ll encourage.
But that’s not the time to let things slide—
© Laura Pole. All rights reserved.
Pick It and Stick with It: Tips for Making Change
Some practical change tips from the Smith Center’s Cancer Help Program retreats and their Healthy U workshop series:92
- Ask: “Am I ready to make change?” If yes, continue.
- Start by paying attention. See what speaks to you or appeals to you, and use that as a starting place to choose a practice or change you’d like to make.
- Set your daily minimum of a new practice: "I will chew my food slowly two meals a day." then cut it in half and stick to it. Choose something you know you can accomplish. Don’t underestimate the power of a short practice.
- Expect backsliding so that when you experience it you won't give up—you'll know to just start again.
- Change your environment to make it easy to do your practice.
- Tell someone: have a “purpose partner", someone sympathetic to your desire for change but to whom you'll feel some level of accountability. If someone knows you're making a change and might ask you about it, you have extra motivation to stick with it.
- Track your changes with a checklist, a spreadsheet or some other record-keeping method.
- Create ongoing support from your coach, counselor, therapist, teacher or supportive friend and follow up with him or her regularly for several months. Creating a new habit takes two to eight months, much longer than the 21 days believed for a long time. Anticipate your need for ongoing support.93
In their book chapter, Block and Gyllenhall suggest that “dietetic consultants should be made available to patients concerned about weight gain or weight loss . . . [and] continuing support in weight management” is critical in supporting patients in maintaining their weight-control practices. Block and Gyllenhall also recommend monitoring weight-losing patients for cardiovascular disease.94