John Shin, MD
When Cancer Strikes
AMEN President John Shin, MD, a hematologist-oncologist at Loma Linda University Health, answers questions about cancer.
Q: It seems like more people are getting cancer now than in the past. What are you seeing?
A: It is true that some cancers are increasing in incidence,, but some are decreasing as well. For example, as smoking has decreased, the incidence of squamous cell carcinoma of the head and neck has decreased overall. However, HPV-related squamous cell cancers of the head and neck are on the rise in younger people due to unsafe sexual practices. Many cancers that have a strong lifestyle component are also on the rise because, in general, people’s lifestyles are not getting healthier, and we are seeing a worrisome increase in some cancers such as colon cancer among younger people. In fact, due to this trend the national guidelines for colon cancer screening now recommends that colonoscopies begin at age 45 instead of 50.
Q: What are some of the most important lifestyle factors associated with increased cancer risk?
A: In the 1980s, two British epidemiologists, Richard Doll and Richard Peto, were tasked by the U.S. Congress to identify the preventable causes of cancer deaths in America. They determined that about 30% of all preventable cancer death was due to an unhealthful diet. These numbers have been refreshed for the modern era and still appear to hold true today. Many other lifestyle factors play a role as well such as lack of exercise, insufficient (or poor quality) sleep, stress, lack of exposure to sunlight, smoking, and alcohol use. What is amazing is that all of these factors were identified by Ellen White over a hundred years ago as being detrimental to our health, and her counsel holds true today more than ever before.
Q: What is the likelihood of developing cancer over the course of one’s lifetime?
A: Statistically, in the United States one in two men and one in three women will be diagnosed with cancer at some point in their lifetime. Therefore, cancer will impact all of us, if not directly then through someone you know.
Q: What impact do lifestyle choices make for a person with an existing cancer diagnosis?
A: Many people, including physicians, think that if you have already been diagnosed with cancer (especially if it is an incurable form of cancer) that lifestyle changes will not make a difference. A lot of doctors essentially tell their patients, “Eat, drink, and be merry because you have cancer.” This is bad advice because we have abundant data showing that lifestyle changes can make a difference for cancer patients. For example, clinical trials have shown that if you optimize the gut microbiome by eating a plant-based, high-fiber diet, you will increase the probability of responding to cancer immunotherapy and even some immunogenic chemotherapy. Also, cancer patients who exercise regularly and get good quality sleep report more energy and fewer side effects from cancer therapy.
Q: What about in cases where the cancer has already progressed to a late stage?
A: When a cancer is advanced and incurable, although lifestyle interventions may not change the overall prognosis, the data show that they can dramatically improve quality of life and even length of life. I therefore counsel all of my patients on making healthy lifestyle changes.
Q: Can you explain in more detail some of the more significant risk factors for cancer?
A: Yes. It has been shown that a diet high in animal protein, fat, and sugar and low in fruits and vegetables promotes cancer growth. In fact, plants are the only things you can eat that can fight cancer, and the optimal diet for preventing and treating cancer is a whole food, plant-based diet. Let me unpack what I mean by that, because many people think they are eating healthfully as long as they are vegetarian or vegan. Oreo cookies are completely vegan, but we can all agree that they are not a health food. Whole food means minimally processed food. If your food comes in a package and contains ingredients that are hard to pronounce, chances are it is processed. Plant-based means nothing that had a mother. Therefore, you want to eat plants in a form that is as minimally processed as possible.
Many jobs involve sitting all day with very little physical activity. This kind of sedentary lifestyle significantly depresses the immune system. However, it doesn’t take a lot of exercise to make a difference. For example, studies show that in elderly people, just 30 minutes of walking a day can almost double the number of natural killer cells in their body that fight infection and cancer cells. Exercise and movement are very tightly connected to overall immune health.
Another really important factor is sleep. We live in a culture that works hard at the expense of sleep. It’s almost looked upon as a badge of honor to be sleep-deprived. However, sleep deprivation produces devastating results because, among other things, sleep plays a very powerful role in maintaining a healthy immune system which helps to prevent cancer. A lot of cancer patients have shortchanged themselves on sleep for decades, and this has likely played a role in the development of their cancer. Getting a solid 7-8 hours of sleep a night can dramatically decrease your risk of cancer.
There are some simple steps you can take in order to improve the quality of your sleep. First, don’t eat within four hours of when you want to go to sleep. Also, you get more cycles of deep restorative sleep in the hours before midnight so even if you can’t increase the amount you sleep, by simply shifting your sleep earlier will allow you to benefit more from the sleep you do get. Another important factor is to avoid exposure to electronic screens three hours before bedtime because the blue light emitted from screens suppresses melatonin production. Lastly, people who are physically active during the day sleep better at night. One of the reasons people may struggle to sleep at night is because they’ve been sedentary all day. Getting exercise—ideally in the fresh air and sunshine outside—is very important in improving your sleep quality.
Q: Are there some less commonly understood risk factors for cancer?
A: Yes. One that is often overlooked in cancer prevention is the mind-body connection. Mental, emotional, and spiritual health all impact your immune system which guards against cancer. If you neglect these areas of health, it doesn’t matter how healthfully you eat or how much you exercise. I’ve seen many miserable, skinny vegans with late-stage cancer.
It is also important to note that health is a means to an end. When living as long as possible becomes your ultimate objective in life, you make health your idol. The pursuit of health outside of a greater meaning or purpose in life does not satisfy the needs of the soul.
Q: Can you share any examples?
A: In my practice one day I had to share the diagnosis of metastatic colon cancer with a young man in his 40s. His prognosis was less than a year to live. After I told him, he broke down and wept. He had a wife and young children. He was devastated. The news shattered his world.
One month later he returned to see me for a follow up appointment. He was smiling and in much better spirits. I said, “I notice you’re in a better place. What changed?”
This is what he told me. After he went home, he had a pity party. He felt angry with God. He was drowning in hopelessness and fear. One morning, however, as he was eating breakfast with his family, he looked around the table and realized that people sitting by him were the most important people in his life. He thought, these simple moments are the best moments of life. Those are the moments to treasure the most.
Before, he had always assumed that his happiest days were yet ahead of him, when he might get his dream home or car or reach some milestone. But in that moment he realized he could never be happier than he was right then, being surrounded by the people he loved most.
He changed his schedule in order to prioritize time with his family. He decided that taking a walk around the lake with his family or reading a book to his son was the most important thing he could be doing with his time, and this realization enabled him to fall in love with ordinary moments. He said, “I never knew what it meant to live until I knew I was going to die.” His only regret, he told me, was that he wished he had lived his entire life this way. He said, “The way I am living now is the happiest I have ever been.”
Q: In what way does this experience connect with spiritual well-being?
A: The theologian John Henry Newman once said, “Fear not that your life will come to an end but that it will never have a beginning.” Winning the fight against cancer is not about how long you live, but how well you live whatever life you have left. However, this principle applies to all people, not just those with cancer. None of us know how much time we have left, so rather than being preoccupied by the length of our lives, we should focus on living the best life we can today.
Q: Some people don’t believe in God. What can you say to encourage them?
A: I first build scientific credibility in viewing spiritual health as a valid dimension of health by reviewing the evidence for the mind-body connection. This leads to a discussion of how people who describe themselves as being deeply spiritual report higher levels of happiness and peace and how this translates into physical health benefits. I point out that it’s as if our bodies were designed to be healthiest and happiest in the context of a relationship with a Higher Power. If I’ve developed good rapport with my patient and I feel it is appropriate, I ask them if they are certain that God does not exist. If they acknowledge that they could not be sure, then I suggest they have nothing to lose by praying, “God, if you exist, you need to reveal yourself to me because I don’t have much time.” I’ve had patients pray this prayer and have their lives changed as a result.
Q: For people facing a new cancer diagnosis, what do you recommend?
A:
1. Lifestyle practices. Practicing the principles of the health message is especially important now.
2. Build trust and rapport.
3. Prioritize loving relationships in your life, the most important of all being a relationship with God.
This follows Jesus’ pattern. When people suffered from physical maladies, they sought Jesus for healing. However, Jesus saw the deeper need in their hearts, and healed not just their bodies, but also their souls. Although God does not afflict people with cancer, if He uses a cancer diagnosis to make people feel their need for Him and draws them closer to Him, it is a blessing in disguise.
Q: What challenges do you encounter among Adventists facing cancer?
A: I feel that Adventists tend to struggle with feelings of guilt more than the general public when they are diagnosed with cancer. This is especially true for those who have been following the health message. They automatically assume that they must have done something wrong, and that is why they developed cancer. Although it is true that many cancers have a lifestyle component, it is absolutely not true that a healthy lifestyle will guarantee that you will never get cancer. You can do everything right but still get cancer and other diseases due to factors outside of your control such as environmental toxins/exposures and genetics. I remind my Adventist patients that we are living with fallen DNA that has degenerated due to being thousands of years removed from the tree of life.
Another problem I frequently run into is that many Adventists believe Ellen White was opposed to drug medications, and therefore, they are very resistant to receiving chemotherapy and other forms of drug therapy. It is true that Ellen White wrote very strongly against drugs, but we must take it into historical context. The drugs of Ellen White’s day were literal poisons which included arsenic and mercury, and they had zero therapeutic value. This was the era before evidence-based medicine, and the state of medical education was deplorable. Every doctor did what was right in their own mind, and therefore, patients had a higher risk of dying by visiting a doctor than by staying at home. It was so bad that in 1872, Charles Eliot, the president of Harvard University, said, “It is fearful to think of the ignorance and incompetence of most American doctors who have graduated at American schools. They poison, maim, and do men to death in various ways, and are unable to save life or preserve health.” If the president of Harvard spoke so strongly against the state of medicine in his day, is it any wonder that Ellen White would do so as well?
However, Ellen White was evidence-based and was open to the use of drugs when the benefits outweighed the risks. For example, her son Willie White wrote in 1924 that his mother was initially opposed to vaccines because he had experienced adverse effects after being vaccinated as a child, but when it was explained to Ellen White that methods of vaccinations had been improved, and when Willie and his companions visited a city where smallpox was raging, she did not object to them being vaccinated (W. C. White letter to L. C. Kellogg, February 5, 1924). In another example, while Ellen White was in Australia, a missionary told her about his son who had died of malaria. Although the boy was gravely ill, the missionary recalled how strongly Ellen White wrote about the dangers of quinine and therefore withheld it from his son. As a result, his son died. He then asked Ellen White, “Would I have sinned to give the boy quinine?” She answered, “No, we are expected to do the best we can.” (W. C. White letter, September 10, 1935). Ellen White went on to receive radiation treatment for skin cancer on her forehead and endorsed the use of surgery and blood transfusions even though they were far riskier in her day because she understood that even treatment modalities with a high risk of harm could still be beneficial in the right circumstances.
Based on the above, I believe that Ellen White would support the appropriate use of modern-day drugs today. I say appropriate because like anything else, drugs can be abused. There are many people who think drugs are the solution and try to find “a pill for every ill” without changing their poor lifestyle choices that lead to disease. Drugs can and do get overprescribed, often with significant consequences. However, this doesn’t change the fact that drugs can also be lifesaving when used appropriately.
Q: What do you think about alternative cancer treatments?
A: Most people are referring to natural remedies when they talk about alternative therapies for cancer. I have no problem with natural remedies, and in fact, I encourage the use of many natural remedies such as hydrotherapy as long as there is proven benefit. Even when there is no proven benefit, if the risk of harm is low, I don’t mind my patients using natural remedies. However, if there is a risk of harm that can outweigh any potential benefits, or if patients indicate a desire to pursue a treatment of unproven (or even disproven) benefit in the place of a treatment with proven benefit, that is when I object. I freely admit that western medicine does not have a monopoly on medical truth, and there are likely many treatment modalities out there with therapeutic benefit which may never be studied in the context of a randomized, placebo-controlled trial. I also acknowledge that our application of evidence-based medicine is fraught with limitations because the scientific literature (like any human endeavor) is not perfect. However, of all the imperfect systems out there for obtaining and advancing scientific knowledge, evidence-based medicine is the least bad, and therefore we must use it.
Another issue I frequently run into among my cancer patients is the tendency to think that anything natural is inherently good and of God while any pharmaceutical or synthetic product is inherently toxic and of man. Therefore, some of my patients feel they are forced to choose between God’s way (i.e. that which is natural) and man’s way (i.e. modern medicine), and they feel that God cannot bless them if they choose man’s way since that is the way of faithlessness. This is a false dichotomy. If God has given us the intelligence to develop beneficial medications and medical advancements, how could it be an act of faithlessness to avail ourselves of its use? In Ministry of Healing, p. 231, Ellen White writes, “It is no denial of faith [for the sick who request prayer for healing] to cooperate with God, and place themselves in the condition most favorable to recovery. God has put it in our power to obtain a knowledge of the laws of life. This knowledge has been placed within our reach for use. We should employ every facility for the restoration of health, taking every advantage possible, working in harmony with natural laws.” Notice that Ellen White encourages us to “employ every facility for the restoration of health” while “working in harmony with natural laws.” To me, this means combining the best of medical science with the best of natural remedies and lifestyle modifications. Indeed, this is the approach that in my experience produces the best results in cancer therapy.
One last point I’d like to make about this topic is that many Adventists put their faith in natural remedies or lifestyle interventions and not God. I call this “green pharmacology,” and in principle it is no different from the doctor who trusts only in modern medicine. These people are on a quest to do anything to cure their cancer naturally, and they are convinced that if they can just find the right herbal concoction, juicing routine, or naturopathic expert, they can beat their cancer. I once shared a story about a patient of mine with leukemia who miraculously went into remission but eventually relapsed and succumbed to her disease. The point of the story was to highlight the spiritual healing that she experienced which gave her complete peace with God at the end of her life. After I finished my talk, an Adventist woman approached me, and the first question she asked was, “Did you share the health message with your patient? Was she still eating meat at the time of her death?” The implication of course was that my patient could have lived had she just followed the right diet. In this person’s mind, God did not factor into the equation; diet change would have saved my patient. Although I believe strongly in the power of adhering to God’s laws of health, I have also seen many instances when God was willing to sacrifice the body to save the soul.
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