Taking Steps to Optimal Wellness for Patients With MPN


Paying more attention to wellness could help both physical and mental facets for patients with MPN.

There are four pillars of wellness in Integrative Oncology that can help patients who receive a diagnosis of MPN as they navigate their disease, according to a presentation during the CURE® Educated Patient® MPN Summit. They can also help patients step closer towards the idea of optimal wellness.

The four pillars — which spark off of conventional medicine — include body (lifestyle medicine), mind (stress reduction), joy (promoting happiness and gratitude) and meaning (connection).

“In general, this is what integrative oncology is. It is looking at conventional medicine with all of this wonderful, supportive care,” said Dr. Krisstina Gowin, an assistant professor of medicine in the department of hematology oncology, bone marrow transplant, at the University of Arizona in Tucson, during her presentation.

After the presentation, Gowin spoke further with CURE® on the pillars, highlighting the importance of diet, physical activity and breathwork.

CURE®: You mentioned how optimal wellness can help to minimize inflammation. Can you go into more detail about this?

Gowin: I think diet is one of the most potent ways that we can really start to hone in on inflammation. But it's, really again, all of those pillars … but some of the most robust data really comes from cardiovascular disease researchers, and they have huge data sets, 7,000 patients. They do the intervention of the Mediterranean diet, and they measure the markers of inflammation and its significant reduction. And so, when we're talking about inflammation, and such a simple intervention such as Mediterranean diet, why not? … We’ve had several kind of basic biology papers showing that the MPN physiology, the biology, is really inflammation driven. And now there's actually trials that are focusing on looking at a Mediterranean-based diet as an intervention. (They are) early in development, we have so far to go to really prove this, but again, as we're borrowing from our cardiovascular colleagues, we can really put together a very compelling hypothesis that this is actually modulating inflammation, which (are) symptoms and disease progression and incidence even (in MPN).

What are some ways that patients can easily implement the Mediterranean diet into their day-to-day?

I actually give a packet to patients (who) come into the clinic and we talk about smoothies and soups, because it's so easy to really do a very powerful smoothie in the morning. We talk about a scoop of protein powder, maybe some healthy fats, avocados, lots of greens, berries, and even with that, it's a very potent, kind of nutrient dense, phytonutrient-dense powerhouse that you can get the rainbow … at every meal. … I do this to my children, and they don't know that they're eating cucumber, cauliflower and celery, and it tastes like a berry banana smoothie. So you can really … put a lot of good nutrition in. I also love omega threes with a smoothie and so we put in chia seeds, hemp hearts, flaxseed that's ground — you do have to ground your flaxseed to really absorb those lichens, which are very potent.

And then another is soups. And for a very similar reason. You can make a big batch, it's very easy. Do a big batch on Sunday, kind of nibble on it throughout the week, freeze it in small little aliquots. … You can put in so many vegetables, again, all of those phytonutrients a wide variety of vegetables. We can also do bone broth, the collagen is good for the lining of the gut, lots of greens. I love to do leeks because leeks are very potent microbiome food. That's one of the best foods for your microbiome.

In terms of physical activity and exercise, are there any limitations specific to patients with MPN?

It’s about listening to your body, being sure you're not getting into poses that are uncomfortable. And if you are, that's a hard stop knowing that perhaps you're pushing too far. … No major impact sports – so football, downhill skiing – if you have massive splenomegaly. Those are things that perhaps you want to avoid. But in general, the recommendation is to do three different kinds. You want some physical activity, which is aerobic in nature, strength training in nature to build that muscle mass, and then, in my opinion, meditative movement or stretching and calming. And so you want to get all of those aspects but in a safe way, and that safe way really is achieved by listening to the body, but also working with your doctor – and if you have a personal trainer – and having these back and forth conversations.

Can you speak more on the benefit of breathwork?

So we know that stress really drives a different microenvironment that surrounds cancer cells. And this has been proved in many different animal models, but also in some human studies, that cancer cells, when they're surrounded by those stress hormones — cortisol, norepinephrine, epinephrine, sort of these stress hormone drivers (that) really change that microenvironment where cancer cells tend to move more rapidly, divide more rapidly. If there is a virus associated, as many other cancers are, viral replication is faster, there's more blood vessel growth to the cancer cells, all of these really interesting microenvironment changes are happening in this environment of stress. So that is obviously a very good place to intervene. And so first, number one, is being mindful of stress. And then number two, (is) having those mechanisms to release it. And there's all different mechanisms. And you mentioned breathwork. … in meditation, they've done functional MRI scanning, and it actually changes the way the brain works. Even with as little as five minutes of meditation per day, stress hormones are reduced. And so yes, there is a measurable and physiologic benefit to these interventions. And there's no way to do it wrong. And so many patients say, “I don't even know how to start.” You just stop, you breathe, you become aware. And as thoughts arise and feelings arise, we let them go. And as long as you're doing that for five minutes, that’s meditation. It's not as fancy as we all think it is. And so I try to educate in that it can be that easy, and as you practice, it gets easier for longer periods of time.

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