Your control over cancer

I have spent a lot of time arguing that diet, sleep, training, meditation, and targeted supplementation are the main levers for healthspan. The mechanism that pulls all of these together at the molecular level is epigenetics. The framework was central to the book I co-authored, The Immortality Edge, and it shows up in every recommendation I have made since.

The interest in epigenetics has caught up with the science. There is a lot of attention. Some good news, some bad news.

The bad news first

Epigenetic research is not going to reveal radically new behaviors that change your future. The behaviors that move epigenetic marks are the same behaviors that have always moved health outcomes. Eat well. Sleep. Train. Manage stress. Supplement intelligently. A reader once complained that this is not new. He wanted breakthroughs. There are no breakthroughs at this layer. There are durable inputs.

The second piece of bad news is that we know less about the epigenome than we do about the genome. The genome is largely mapped. The epigenome shifts with cell type, age, environment, and time of day. Mapping it is several orders of magnitude harder.

The third piece is that the marketing claims will outrun the data. Yoga for epigenetics, supplement protocols for epigenetics, diet pills for epigenetics. Most of these will be retreads of older claims rebadged with a fresher word.

The good news

Funding has poured into the field. Computational capacity has caught up. The next decade should produce real, testable maps of which epigenetic patterns correlate with which disease risks, and which interventions actually move those patterns in healthy people.

Cancer prevention is one of the most active areas. Colon cancer and breast cancer in particular have epigenetic predictors that are starting to outperform earlier risk models. One area I have followed is the work on Variant Enhancer Loci, regions of the epigenome where methylation changes appear to predict colon cancer risk before any visible polyp forms. If that work continues to replicate, we will have a pre-screening tool that lets us intervene at the epigenetic level rather than the surgical level.

The expected pattern is the same one we already saw in cardiovascular medicine. Identify the risk early. Apply lifestyle interventions first. Add pharmacology if needed.

Where telomeres fit

An increasing percentage of critically short telomeres is consistently found alongside the epigenetic patterns that predict cancer and other diseases of aging. The two systems share inputs. The cellular machinery that maintains telomeres also influences methylation patterns at relevant loci. Anything that supports telomere health, omega-3 status, vitamin D adequacy, regular exercise, sleep, meditation, and in some cases telomerase-supporting compounds, also supports a healthier epigenome.

What to actually do

The recommendations have not changed and probably will not change much over the next decade either.

• Eat a nutrient-dense, low-glycemic, anti-inflammatory pattern. Whatever specific name you put on it, those are the requirements.
• Sleep seven to nine hours on a regular schedule.
• Train consistently, mixing resistance and aerobic work.
• Manage stress with whatever practice you will actually do.
• Run an omega-3 index above 8 percent and a 25-hydroxy vitamin D between 50 and 75 ng/mL.
• Add a clinically dosed multivitamin with active B vitamins.

These are the same inputs I recommended a decade ago. The mechanism we now describe as epigenetic regulation is why they work. The mechanism does not change the recommendation.

— Doc