From Mutation to Metabolism: A Broader View of Cancer Development

Erik Peper, PhD, BCB1 and Richard Harvey, PhD2

1 Biofeedback Health, Berkeley, CA and 2 Institute for Holistic Health, San Francisco State University

My aunt died of breast cancer and my mother was an identical twin. She and her sister resembled each other so closely that family members often couldn’t tell them apart. For the first 26 years of their lives, they both lived in Amsterdam. After they married, they moved to different cities. At the age of 82, my mother’s twin was diagnosed with breast cancer with metastasis to the brain and died that year. For my mother, this was one of the most devastating experiences of her life. It was as if half of her had died. Even with this loss, my mother never developed cancer and lived to the age of 95. The situation became even more complicated when my cousin (the daughter of my mother’s twin) also died of breast cancer at the age of 53, while my mother’s two daughters remained cancer-free. -Erik Peper, PhD. Reproduced by permission from Peper, Gorter and Faass (2026).     

Cancer, with a capital ‘C’ along with each of the many kinds of malignant cellular processes is often understood primarily in terms of a disease driven by genetic mutations. This blog begins with observations from twin studies along with ongoing and emerging research suggests that genetics may represent susceptibility rather than destiny. In the case of identical twins, the experience of developing different cancer outcomes illustrates the importance of environmental exposures, lifestyle choices, specific metabolism interactions, immune functions, and particular cellular physiology.

The blog examines prevalent hypotheses about cancer processes which acknowledge interactions and functions such as immune, metabolic and evolutionary pressures. In particular, the paper argues in favor of revisiting the Warburg effect and the role of mitochondrial dysfunction in cancer development. The Warburg metabolic theory proposes that impaired mitochondrial energy production may drive cells toward an ancient survival pathway characterized by increased glucose fermentation, loss of specialized cellular function, and uncontrolled or unregulated proliferation. This perspective does not reject the strong role of genetics in cancer processes but rather places DNA and RNA within a broader biological context influenced by metabolism, epigenetics, and the environment. Understanding cancer as a systemic metabolic disorder may expand prevention strategies and complement existing treatments by emphasizing lifestyle, environmental, and metabolic interventions.

Twin Studies: Genetics as Predisposition, Not Destiny

For decades, research on cancer causes and treatments has been dominated by the Somatic Mutation Theory (SMT), which proposes that cancers arise through the accumulation of DNA mutations (Weinberg, 2023; Huang et al., 2025). This SMT framework has guided the “War on Cancer” and has led to remarkable advances in targeted therapies, chemotherapy, immunotherapy, and radiation treatments. These strategies have saved countless lives, yet they primarily focus on eliminating malignant cells rather than understanding why normal cells become malignant in the first place. While a variety of mutation-focused approaches has yielded remarkable therapeutic successes, one could expect that genetically identical individuals would develop the same or similar cancers.

Decades of twin research suggests otherwise. In the landmark Nordic Twin Study of Cancer, Lichtenstein and colleagues (2000) analyzed nearly 45,000 pairs of monozygotic (identical) and dizygotic (fraternal) twins from Sweden, Denmark, and Finland. If one identical twin developed cancer, the co-twin’s probability of developing the same cancer was about 10% which is much lower than expected if inherited genes alone determined cancer risk. Heritable factors accounted for only a portion of susceptibility (approximately 27% for breast cancer, 35% for colorectal cancer, and 42% for prostate cancer). The remaining risk was attributed largely to environmental influences, lifestyle, aging, and biological processes that occur during life (Lichtenstein et al., 2000; Mucci et al., 2016; Harris et al., 2019).

Both specific cancer investigations along with epidemiological findings across many places, people, and types of cancers suggest that genes create a predisposition, but they do not inevitably determine whether cancer develops. Instead, the cellular environment, metabolic health, environmental exposures, and epigenetic regulation strongly influence whether that predisposition is expressed. Simplistically stated, Genetics loads the gun and lifestyle and environment pulls the trigger (Peper et al., 2026).

The success of cancer treatments based on current oncology theories means that the Somatic Mutation Theory (SMT) provides a partial explanation of cancer processes. Extending the SMT of carcinogenesis to include Warburg-like theories has led to increasing evidence which suggests that metabolic dysfunction, mitochondrial injury, chronic inflammation, immune dysregulation, and environmental exposures all contribute to carcinogenesis. A useful framing of cancer risk related to inherent or heritable factors in comparison to non-intrinsic or non-genetic factors has been described by others (Brennan & Davey-Smith, 2022; Karras et al., 2024; Rahman et al., 2018; Wu et al., 2018). 

For example, Wu et al., (2018) suggest that it is not possible to modify ‘random errors in DNA replication’ as an intrinsic risk factor, it is possible to partially modify endogenous risk factors related to inflammation or hormone production or fully mediate or modify directly and indirectly moderate non-genetic exogenous risk factors associated with toxic carcinogenic exposures that include exposures to some products from carcinogenic interactions with bacterial, viral, fungal and parasitic products, tobacco products, ultra-processed food and beverage products and chemicals (e.g., preservatives, pesticides, contaminants, dyes, non-nutritive chemicals such as sweeteners), industrial pollutant and chemical products (e.g. endocrine disrupting ‘forever’ chemicals such as in plastics), and lifestyle moderators such as lack of sleep, exercise, relaxation from mental ruminations and strain. A simplified model pathway would be: Risk of cancer is based on intrinsic genetic factors plus non-intrinsic endogenous and exogenous ‘epigenetic’ factors moderated by individual adaptive capacity to reduce endogenous or mitigate exogenous non-intrinsic factors.

Rather than competing explanations, mechanisms of cancerous disease processes may interact to determine whether genetically susceptible cells remain healthy or progress toward malignancy. These factors may explain that the overall cancer mortality has declined substantially over the past several decades and is predominantly due to the decreased tobacco use, earlier detection, and improvements in treatment. At the same time, the incidence of several cancers, including colorectal and breast cancer, has increased among younger adults (Siegel et al., 2025; American Cancer Society, 2024; Ugai et al., 2022; Lee, 2026). These trends suggest that additional biological and environmental factors deserve closer examination. Beyond regulating exposure to lifestyle factors such as tobacco products as a mediator of reduced cancer mortality, theories by Warburg and colleagues have pointed to metabolic regulation, including regulation of sugars, as a mediator in cancer mortality.

The Metabolic Origin: Revisiting the Warburg Effect

An alternative framework proposes that cancer is fundamentally a disorder of cellular metabolism. This concept dates back to Otto Warburg, who received the 1931 Nobel Prize in Physiology or Medicine for discovering that cancer cells exhibit a distinctive pattern of energy metabolism (Bononi et al., 2022; Otto, 2016; Nobel Prize Outreach, 2026). He showed that cancer cells rely predominantly on glucose fermentation, an anerobic process for making energy without oxygen (e.g. glucose splits into pyruvate and makes two adenosine triphosphate molecules) which is much less efficient than making energy through oxidative phosphorylation, even when oxygen is abundant in a cancer cell. The vast majority of cancerous cell growth depends on a less efficient glucose metabolism form of energy (Kim, 2017; Warburg, Negelein & Posener, 1924). The Warburg effect has been recognized as a hallmark of cancer for nearly a century (Seyfried & Chinopoulos, 2021).

Non-cancerous healthy cells mainly generate energy by producing ATP through oxidative phosphorylation within the mitochondria. Healthy cells are metabolically flexible and can generate energy from both glucose and free fatty acid oxidation (FAO). During periods of fasting, exercise, or carbohydrate restriction, triglycerides stored in adipose tissue are broken down into free fatty acids and glycerol (Eberle, 2013). The liver also converts free fatty acids into ketone bodies, which provide an efficient alternative fuel for the brain and many other tissues when glucose availability is reduced (Wakil & Abu-Elheiga, 2009; Edwards & Mohiuddin, 2023).

When mitochondrial respiration is chronically impaired by environmental toxins, oxidative stress, metabolic dysfunction, or other factors associated with carcinogenesis, cells may shift from efficient oxidative phosphorylation to a more primitive, glycolytic mode of energy production that can generate ATP in the absence of oxygen. Mitochondrial function can decline as people age when accumulation of reactive oxygen species which can directly harm mitochondrial DNA (Bondy, 2024; Cui et al., 2012; Madamanchi & Runge, 2007). In addition, mitochondrial function can also decline due to the indirect moderating effects of lifestyle choices (Caturano et al., 2025; Lemos et al., 2023; San-Millán, 2023).

As described by Miwa et al., (2022), when mitochondrial function declines, mitochondrial dysfunction can contribute to cellular senescence which is the hallmarks of aging. As a response healthy cells can progressively relinquishes their specialized role within the tissue and adopts characteristics of a more ancestral, less differentiated state (Zhang et al., 2025).

Zhang et al. (2025) suggests a few mechanisms which explain the shift of healthy cells away from specialized states towards a less differentiated state, such as shifts in the tricarboxylic acid cycle (TCA) which rely on healthy mitochondria to produce cofactors such as acetyl-CoA and positively charged Nicotinamide Adenine Dinucleotide (NAD+), along with drops in chromatin, inhibiting DNA and histone demthylases (locking chromatin in a hyper-methylated state, and an upregulation of glycolysis. Additionally, cells ‘sense’ when mitochondria have low energy production such as a high ratio of adenosine mono-phosphate or di-phosphate (AMP/ADP) to adenosine tri-phosphate (ATP), which then leads to the AMP-activated protein kinase (AMP-K) pathway (Mihaylova & Shaw, 2011). Finally, hypoxia-inducing factor (HIF) signaling is how cells ‘sense’ and adapt to changes in available oxygen, and HIF binds to DNA, activating specific genes (Huang et al., 2023). The Warburg theory suggests that when mitochondrial dysfunction directly or indirectly reduces oxidative phosphorylation, the cells shift energy production from the mitochondria to cytoplasmic glycolysis which is a hallmark of unicellular ‘ancestral’ organisms or more embryonic or stem-like cellular activity (Suomalainen, & Nunnari, 2024; Zong et al., 2024).

It is as if your cells suddenly forget they’re part of a team. Instead of working together like citizens in a well-organized society, they revert to their most primitive programming; the “me first” mentality of our single-celled ancestors. This is what happens in cancer where sophisticated multicellular cooperation gets hijacked by an ancient survival script buried deep in our biological software. Sonnenschein and Soto (1999) describe this process in their book The Society of Cells (1999), “the default state of cells is proliferation.” In other words, multiplication isn’t some aberrant behavior; it’s actually the factory setting when single cells began. Every cell carries this “go forth and multiply” command like prehistoric programming code.

In healthy tissue, cells have learned to override this ancient impulse. They’ve evolved sophisticated “stop” signals, quality control mechanisms, and cooperative protocols that keep the peace. Cancer occurs when these civilized controls break down, and cells revert to their evolutionary factory settings—endless growth, damn the consequences.

It’s as if your cells suddenly decide to ignore millions of years of evolutionary teamwork and go back to playing by the rules that worked when life was just lone microbes floating in primordial soup.

Under Survival Threat, Organisms Revert to Their Oldest Survival Mechanisms

The same regression process can be observed in human beings. When children experience overwhelming stress, they often revert to earlier developmental behaviors, such as becoming incontinent or seeking protection by hiding behind a parent. Similarly, when adults perceive an immediate threat to survival, the stress response is not always fight or flight. Instead, the body may enter a freeze response characterized by profound immobilization.

This freeze response represents an ancient survival strategy that is activated when the nervous system perceives extreme, life-threatening danger. In this state, heart rate slows, metabolism is reduced, and movement is inhibited through activation of the dorsal vagal complex which is the evolutionarily older branch of the vagus nerve according to polyvagal theory, (Porges, 2023). For reptiles and other primitive vertebrates, this physiological strategy can increase the likelihood of survival until the danger has passed.

Metabolic Theory in Context

A ‘metabolic perspective’ related to carcinogenicity, or related to reversion to more primitive types of behaviors, does not dismiss the importance of genetics. Rather, a metabolic perspective places genetic mutations within a broader biological framework in which metabolism, mitochondrial integrity, immune surveillance, environmental exposures, and epigenetic regulation interact to determine whether a cell remains healthy, or progresses toward malignancy. From this perspective, cancer represents more than the accumulation of genetic mutations. It reflects a regression to an ancient cellular survival program in which energy production and reproduction, rather than specialized function and cooperation with neighboring cells, becomes the overriding priority. Genetic mutations may therefore be viewed not only as the initiating a set of complex interactions that reflect causes of cancer but also as downstream consequences of chronic metabolic dysfunction and mitochondrial damage.

If cancer represents the activation of an evolutionarily ancient cellular survival program triggered by metabolic dysfunction, then interventions that improve metabolic health can reduce risk associated with carcinogenesis which complement conventional treatment. As Dang (2012) points out, “excessive caloric intake is associated with an increased risk for cancers, while caloric restriction is protective, perhaps through clearance of mitochondria or mitophagy, thereby reducing oxidative stress.”

One practical implication is for people to follow often repeated advice: decrease the availability of rapidly absorbed carbohydrates by minimizing the consumption of sugar-sweetened beverages, refined starches, and ultra-processed foods while emphasizing whole, nutrient-dense foods. Broadly stated, such dietary changes in sugar intake can improve metabolic resilience, reduce chronic inflammation, and create a physiological environment that is less favorable for the metabolic adaptations observed in many cancers. Although additional clinical research continues to provide evidence supporting the effectiveness of ‘lifestyle’ and epigenetic strategies across different cancer types, the metabolic perspective offers a compelling framework for prevention and adjunctive therapy.

The metabolic theory of cancer based upon the Warburg effect offers hope in treatment by reducing glucose availability may help slow the growth of some cancers. The process is described clearly by Professor Thomas Seyfried of Boston College (Seyfried et al., 2014; Seyfried et al., 2021). His metabolic theory remains an active area of research, however is not the current consensus view on cancer biology. Consider watching the compelling overview of this metabolic theory presented by Professor Thomas Seyfried’s in his YouTube lecture, Cancer as a Metabolic Disease,

What can you do to reduce cancer risk and support healing

The metabolic theory of cancer presented in this paper suggests behavioral and lifestyle strategies to reduce cancer risk and slow or prevent cancer growth. Simply stated, reduce excessive glucose availability which becomes the main energy source for cancer cells. Clinical improvement may be possible if cancer cells are put on a diet (Stetka, 2016). Changing diet is one component to optimize what you can do to reduce cancer risk, support our immune system to promote healing and optimize health although the outcome is not totally in our hands.  Implement the following environmental and lifestyle behaviors promote health and healing.

Reduce and eliminate ultra-processed foods, simple carbohydrates and sugar. These increase the risk of cancers by 20 to 50 percent. Sadly, many patients undergoing chemo and radiation therapy and have difficulty with swallowing, are recommended to drink oral caloric rich supplements (such as Ensure Plus or Boost Very High Calorie) that are specially formulated to provide dense calories and protein in a small volume. They contain between 15 to 22 grams of sugar (1 to 2 tablespoons of sugar) in an 8 ounce serving– the sugar which paradoxically encourages  cancer growth.

Reduce and eliminate exposure to endocrine disruptors. These are chemicals that can mimic, block, or interfere with the body’s hormones, due to higher estrogen levels (in milk and beef, for example) and pesticides (some of which act as estrogen mimics). This means eliminating as much as possible all plastics and eat mainly organic foods that do not contain herbicides or pesticides. If possible, eat organic foods.

Reduce air and water pollution that are known factors to cause cancers.  This means use air and water filters at home since more than 50% of drinking water in the United States contain cariogenic substances and air pollution from car or fires are harmful.

Increase physical activity.  Movement/exercise is important because that reduces lymphatic circulation and blood flow, impacting the immune system in the long term.

For detailed information and recommendations what you can use to reduce cancer risk and optimize health, see our book, Cancer Reconsidered-Why Environment, Lifestyle and Immunity Matter more than we thought.

Additional relevant blogs

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Edited with the help of ChatGPT


Will the stock market bubble collapse? Will human fertility decrease to zero?

“Those who cannot remember the past are condemned to repeat it.” – George Santayana (Santayana, 1905)

These two questions may seem totally unrelated, yet they are deeply connected if one takes a long historic view and hypothesizes that present-day trends will continue.

When I drive or commute, I very much enjoy listening to podcasts. They offer an in-depth, nuanced discussions that are missing from today’s soundbite culture. These deep-dive podcasts offer a vital antidote, providing the nuanced, extended discussions necessary for true cognitive synthesis. One of my favorite podcasts is The Diary of a CEO with Steven Bartlett. I found the recent episode, “Billionaire’s WARNING: I’m SELLING. The Crash Is Already Here!”, very eye opening.

The interview was with billionaire investor Jeremy Grantham, the co-founder and long-term investment strategist of GMO. He is also the chairman of the Grantham Foundation for the Preservation of the Environment, and co-author of “The Making of a Permabear: The Perils of Long-term Investing in a Short-term World.”

While economics and financial markets fall outside my primary line of research, I deeply appreciated his long-term perspective—an analysis I find to be entirely spot-on. The actual content offered a masterclass in pattern recognition, forcing me to sit back and critically analyze the macroeconomic shifts happening around us rather than just reacting to the daily noise of the market. He persuaded me that the present AI-driven financial bubble will burst; we simply do not know exactly when. I concur with him that it will occur sooner rather than later. Personally, I would not be surprised if it occurred within the next two years. We must simply be prepared to deal with more challenging times.

The scientific data is clear: human fertility—both male and female—has been decreasing each decade. This is starkly indicated by a 50% drop in male sperm counts and a rising number of couples struggling to conceive (Ravitsky & Kimmins, 2019Mann et al., 2020; Inam, 2025). The culprits as for the increase in cancer rates? Ubiquitous modern disruptions like microplastics, pesticides, and pervasive environmental toxins (NIOSH, 2023; Doroftei et al., 2025; Brander et al., 2026).

Although the prognosis can look bleak, Grantham doesn’t just sound the alarm; he offers realistic strategies. He outlines how to protect yourself from the impending financial bubble collapse, as well as what you and your community can do to minimize toxic exposure and enhance fertility.

I smiled as I listened to the podcast, because his systemic analysis and practical recommendations are very similar to what we described in our just-published book, Cancer reconsidered-Why Environment, lifestyle, and immunity matter more than we thought (Peper et al., 2026).

To prepare yourself for the financial future and optimize your health and fertility, listen to Grantham’s insights on the podcast episode, “Billionaire’s WARNING: I’m SELLING. The Crash Is Already Here!”,

See the following blogs for more detailed information:

References

Brander, S.M., Swan, S.H., Mehinto, A.C., & et al. (2026). Impacts of environmental stressors on fertility and fecundity across taxa, with implications for planetary health. npj Emerging Contaminants, 2, Article 12. https://doi.org/10.1038/s44454-026-00032-6

Dilmaghani, D., Ainsworth, A. J., Nath, K. A., & Garovic, V. D. (2024). Decreasing fertility rate in the United States: Demographics, challenges, and consequences. Mayo Clinic Proceedings, 99(11), 1693–1697. https://doi.org/10.1016/j.mayocp.2024.09.004

Doroftei, B., Savuca, A., Cretu, A.-M., Maftei, R., Anton, N., Ilea, C., Doroftei, M., & Puha, B. (2025). Microplastics and human fertility: A comprehensive review of their presence in human samples and reproductive implication. Ecotoxicology and Environmental Safety, 303, Article 118939. https://doi.org/10.1016/j.ecoenv.2025.118939

Inam, Ö. (2025). Impact of microplastics on female reproductive health: Insights from animal and human experimental studies: A systematic review. Archives of Gynecology and Obstetrics, 312(1), 77–92. https://doi.org/10.1007/s00404-024-07929

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NIOSH. (2023, December 15). About pesticides and reproductive health. National Institute for Occupational Safety and Health Centers for Disease Control and Prevention. https://www.cdc.gov/niosh/reproductive-health/prevention/pesticides.html

Peper, E. Gorter, R. & Faass, N. (2026). Cancer Reconsidered: Why Environment, Lifestyle, and Immunity Matter More Than We Thought. BiofeedbackHealth/Regent Press. https://www.amazon.com/Cancer-Reconsidered-Environment-Lifestyle-Immunity/dp/1587907402/

Ravitsky, V. & Kimmins, S. (2019). The forgotten men: rising rates of male infertility urgently require new approaches for its prevention, diagnosis and treatment. Biol Reprod. 101(5), 872-874. https://doi.org/10.1093/biolre/ioz161

Santayana, G. (1905). The Life of Reason: Vol. 1. Reason in Common Sense. Charles Scribner’s Sons. p. 284. https://www.amazon.com/Reason-Phases-Progress-Introduction-Common/dp/B01DF937WU


Can Your Daily Choices Influence Cancer Risk and Recovery?

What if the way you eat, move, sleep, manage stress, and connect with others could influence your body’s ability to prevent disease and support healing?

Most of us have been taught to think of cancer primarily as a genetic disease. Yet an expanding body of scientific research tells a more hopeful story: while genes matter, they are only part of the picture. Our environment, lifestyle, immune system, and even the quality of our relationships can profoundly influence health.

These are the questions explored in the newly published book Cancer Reconsidered: Why Environment, Lifestyle, and Immunity Matter More than We Thought, by Erik Peper, Robert Gorter, and Nancy Faass.

Written for people living with cancer, their families, healthcare professionals, and anyone interested in optimizing health, the book translates decades of scientific research into practical, evidence-based strategies that readers can use in everyday life.

Rather than viewing cancer through a single lens, Cancer Reconsidered brings together insights from conventional medicine with evidence-based complementary approaches. The authors explore how nutrition, physical activity, stress, sleep, environmental exposures, immune function, and social support interact to influence both cancer risk and the body’s remarkable capacity for repair and resilience.

One of the book’s central messages is both simple and empowering: although we cannot change our genes, we can often change the conditions in which our genes are expressed. Daily choices matter. Healthy habits can strengthen the body’s natural defenses, reduce inflammation, support immune function, and improve quality of life.

A particularly practical chapter explores blood sugar regulation and metabolism. Using continuous glucose monitors (CGMs) together with smartphone apps, readers can observe in real time how different foods, exercise, stress, and sleep affect their glucose levels. Instead of following one-size-fits-all advice, they become active investigators of their own health, discovering what works best for their unique physiology.

Throughout the book, the emphasis is not on fear, but on possibility. Scientific evidence increasingly shows that hope, meaningful social connections, regular movement, nourishing food, restorative sleep, effective stress management, and resilience are not simply “nice ideas”—they are biological factors that can significantly influence health and well-being.

Cancer Reconsidered invites readers to move beyond the question, “What causes cancer?” and instead ask, “What can I do today to create the best possible conditions for health?” It offers a thoughtful, scientifically grounded roadmap for anyone seeking to answer that question.

Cancer Reconsidered: Why Environment, Lifestyle, and Immunity Matter More than We Thought is now available on Amazon in paperback and and affordable ebook Kindle editions. https://www.amazon.com/s?k=cancer+reconsidered


Managing Blood Sugar: Lifestyle Changes for Better Health

It was 4:45 p.m., and I was looking forward to swimming. I briskly walked the eight blocks from my house to the heated outdoor city pool. The pool is unusual—100 feet long instead of the standard 25 yards—and I enjoy the rhythm of swimming lap after lap.

I arrived just as the sign flipped from Closed to Open. I quickly changed into my bathing suit, locked my clothes in a metal locker, took a short shower, and jumped into the lane. The sun was still out, and only one other swimmer shared my lane. I felt energized and expected to complete my usual forty laps.

However, after about eighteen laps, my energy suddenly disappeared. There was nothing left in the tank. I swam to the side, pulled myself slowly onto the pool deck, and even slowly and unsteadily walked to the men’s locker room. I sat down on the bench feeling shaky, weak, and exhausted. This was not ordinary fatigue. After resting for several minutes, I slowly showered, dressed, and walked home with heavy, almost uncoordinated legs.

As I reflected on the experience, I remembered something similar that had happened two weeks earlier. Around 5 p.m, I had taken my son’s dog for a brisk walk. Again, I began energized, walking quickly, and then suddenly felt drained and sweaty. When I returned home, all I could do was sit down and recover.

What happened

Reflecting back, I realized that both cases I had eaten sweets—cake one time and a large chocolate chip cookie the other about two hours earlier Most likely, the rapidly absorbed sugars and refined carbohydrates caused a sharp increase in blood glucose, followed by a significant insulin response (Ludwig & Ebbeling, 2018). During exercise, my muscles then demanded additional glucose, and my blood sugar may have dropped rapidly enough to trigger symptoms of reactive hypoglycemia: shakiness, sweating, weakness, and fatigue (Morales-Brown, 2025, June 12).

The process is more complex than simply “sugar highs” and “crashes.” Carbohydrates are broken .break down into glucose during digestion, which begins in the mouth. Chewing breaks down food physically, while the enzyme amylase in saliva starts the chemical breakdown by splitting starches into sugars (Peyrot des Gachons & Breslin, 2016).  This raises blood glucose levels, which stimulates insulin release from the pancreas. Insulin helps move glucose from the bloodstream into cells. In some people—especially those developing insulin resistance or prediabetes—the insulin response may overshoot, leading to a later drop in blood glucose. Exercise can amplify this effect because active muscles rapidly consume glucose for energy (American Diabetes Association, 2024).

This experience was a wake-up call for me because my hemoglobin A1C is 5.7%, the lower threshold for prediabetes. Hemoglobin A1C reflects average blood glucose levels over approximately the previous three months (American Diabetes Association, 2026).

Like many people, I enjoy and am  even addicted to bread, potatoes, pastries, and sweets. Looking back, the subtle changes began during COVID. Before the pandemic, I spent much of the day teaching in person, walking across campus, moving, and interacting with students. During lockdown, I sat for hours teaching online. My physical activity during the day dramatically decreased while my eating habits did not significantly change.

When we are inactive, excess sugars and refined carbohydrates are less likely to be immediately used by muscles for fuel. Instead, repeated spikes in blood glucose and insulin can contribute over time to insulin resistance, weight gain, metabolic dysfunction, and increased inflammation (Ludwig & Ebbeling, 2018).

Although my episodes were minor, they reminded me that lifestyle patterns especially eating ultra-processed foods can increase the risk for chronic diseases such as type 2 diabetes, cardiovascular disease, obesity, and some cancers and dementia (Lane et al., 2024; Menegassi  & Vinciguerra, 2025). The scientific literature strongly links obesity, insulin resistance, and type 2 diabetes with increased risk for several cancers, including colorectal and postmenopausal breast cancer (Peper et al., 2026; Scully et al., 2021: Lauby-Secretan et al., 2016). Ultra-processed foods and sugar-sweetened beverages are also associated with increased risk for obesity and metabolic disease; moreover, cancer survivors who consume higher amounts of ultra processed foods face a significantly increased risk of both all-cause and cancer-specific mortality (Hall et al., 2019; Bonaccio et al., 2026). However, cancer is multifactorial, and no single food alone “causes” cancer. Rather, long-term dietary patterns, inactivity, obesity, chronic inflammation, genetics, environmental exposures, sleep, and stress all interact together ( Marino et al., 2024; Dalamaga et al., 2026; Peper et al., 2026).

What to do

The encouraging news is that these processes are often reversible.

Weight, hunger, blood sugar fluctuations, and even A1C are not fixed. They can improve significantly through lifestyle changes. Research consistently shows that reducing ultra-processed foods, lowering intake of refined carbohydrates and sugary beverages, increasing fiber-rich vegetables, improving sleep, reducing stress, and exercising regularly can improve insulin sensitivity and metabolic health (Bird & Hawley, 2017; Vaezi et al., 2025; American Diabetes Association, 2024; Peper et al., 2026).

For many people, continuous glucose monitors (CGMs) can provide powerful real-time feedback (Ehrhardt & Zaghal, 2020). Seeing how specific foods affect your glucose levels can increase awareness and motivate healthier choices. Often, we do not realize how dramatically a muffin, fruit juice, or bowl of white rice may affect blood sugar until we see the data on the screen.

The goal is not perfection or rigid dieting. Instead, it is learning to observe how your body responds and gradually shifting toward foods that support stable energy, satiety, and long-term health.

Before making major dietary changes, watch the superb interview with Dr. David Unwin, a British physician known for his work using lower-carbohydrate dietary approaches to help patients improve type 2 diabetes and metabolic health. His clinical work demonstrates that many patients can significantly improve blood sugar control and sometimes reduce medications through lifestyle changes (Unwin et al., 2020). The video, The Sugar Doctor’s Warning: The “Healthy” Foods Quietly Destroying Your Body! – Dr. David Unwin, is from the podcast, The Diary of a CEO with Steven Bartlett.

The Link Between Diet, Lifestyle, and Cancer Risk: Steps You Can Take

Read the new book, Cancer Reconsidered: Why Environment, Lifestyle, and Immunity Matter More than We Thought, by Erik Peper, Robert Gorter, and Nancy Faass. It explore the many of the lifestyle factors that can increase cancer risk—or help protect against it. The book brings together an extraordinary range of scientific research to illuminate how everyday habits and modern lifestyles influence cancer risk and healing. Drawing from both conventional medicine and integrative approaches, the authors thoughtfully examine the many factors involved in cancer causation while offering hopeful, evidence-based strategies for supporting recovery and restoring health.

What makes this book especially compelling is that it goes far beyond reviewing the science. It translates research into practical, everyday actions people can use to support healing and improve quality of life. At its heart is lifestyle medicine—the recognition that stress management, hope, physical activity, nourishing foods, supportive relationships, community, and resilience during times of crisis profoundly affect health and well-being. The book also offers a detailed and highly practical discussion of sugar metabolism and explains how continuous glucose monitoring sensors (CGMS) with the smartphone app can help people directly observe how specific foods and daily habits influence their blood sugar levels. Instead of relying on abstract nutrition advice, readers learn how to become active investigators of their own health.

Throughout the book, the message is empowering: our daily habits, social connections, attitudes, and environment may influence health as much as—if not more than—genetics alone. The book is available from Amazon: https://www.amazon.com/Cancer-Reconsidered-Environment-Lifestyle-Immunity/dp/1587907402

Listen to the in-depth discussion of this blog created with Google NotebookLM

Addition relevant blogs

References

American Diabetes Association. (2026). Blood glucose and exercise. American Diabetes Association. Retrieved May 24, 2026, from https://diabetes.org/health-wellness/fitness/blood-glucose-and-exercise

American Diabetes Association. (2024). Standards of care in diabetes—2024. Diabetes Care, 47(Suppl. 1). https://diabetesjournals.org/care/issue/47/Supplement_1

Bonaccio, M., Di Castelnuovo, A., Costanzo, S., Ruggiero, E., Esposito, S., Panzera, T., Di Costanzo, G., De Curtis, A., Magnacca, S., Cerletti, C., Donati, M. B., de Gaetano, G., & Iacoviello, L., for the Moli-sani Study Group. (2026). Ultra-processed food and mortality among long-term cancer survivors from the Moli-sani Study: Prospective findings and analysis of biological pathways. Cancer Epidemiology, Biomarkers & Prevention, 35(4), 664–674. https://doi.org/10.1158/1055-9965.EPI-25-0808

Dalamaga, M., Rozani, S., & Petropoulou, D. (2026). Why is colorectal cancer occurring earlier? Metabolic dysfunction, underrecognized carcinogens, and emerging controversies. Current Obesity Reports, 15(1), 24. https://doi.org/10.1007/s13679-026-00700-z

Ehrhardt, N., & Al Zaghal, E. (2020). Continuous glucose monitoring as a behavior modification tool. Clinical Diabetes, 38(2), 126–131. https://doi.org/10.2337/cd19-0037

Hall, K. D., Ayuketah, A., Brychta, R., Cai, H., Cassimatis, T., Chen, K. Y., Chung, S. T., Costa, E., Courville, A., Darcey, V., Fletcher, L. A., Forde, C. G., Gharib, A. M., Guo, J., Howard, R., Joseph, P. V., McGehee, S., Ouwerkerk, R., Raisinger, K., … Zhou, M. (2019). Ultra-processed diets cause excess calorie intake and weight gain: An inpatient randomized controlled trial. Cell Metabolism, 30(1), 67–77. https://doi.org/10.1016/j.cmet.2019.05.008

Lane, M. M., Gamage, E., Du, S., Ashtree, D. N., McGuinness, A. J., Gauci, S., Baker, P., Lawrence, M., Rebholz, C. M., Srour, B., Touvier, M., Jacka, F. N., O’Neil, A., Segasby, T., & Marx, W. (2024). Ultra-processed food exposure and adverse health outcomes: Umbrella review of epidemiological meta-analyses. BMJ, 384, e077310. https://doi.org/10.1136/bmj-2023-077310

Lauby-Secretan, B., Scoccianti, C., Loomis, D., Grosse, Y., Bianchini, F., & Straif, K. (2016). Body fatness and cancer—Viewpoint of the IARC Working Group. New England Journal of Medicine, 375(8), 794–798. https://doi.org/10.1056/NEJMsr1606602

Ludwig, D. S., & Ebbeling, C. B. (2018). The carbohydrate-insulin model of obesity: Beyond “calories in, calories out.” JAMA Internal Medicine, 178(8), 1098–1103. https://doi.org/10.1001/jamainternmed.2018.2933

Marino, P., Mininni, M., Deiana, G., Marino, G., Divella, R., Bochicchio, I., Giuliano, A., Lapadula, S., Lettini, A. R., & Sanseverino, F. (2024). Healthy lifestyle and cancer risk: Modifiable risk factors to prevent cancer. Nutrients, 16(6), 800. https://doi.org/10.3390/nu16060800

Menegassi, B., & Vinciguerra, M. (2025). Ultraprocessed food and risk of cancer: Mechanistic pathways and public health implications. Cancers, 17(13), 2064. https://doi.org/10.3390/cancers17132064

Morales-Brown, P. (2025, June 12). What is reactive hypglycemia. Medical News Today. Accessed May 24, 2026. https://www.medicalnewstoday.com/articles/reactive-hypoglycemia

Peper, E., Gorter, R., & Faass, N. (2026). Cancer reconsidered: Why environment, lifestyle, and immunity matter more than we thought. Biofeedback Health. https://www.amazon.com/Cancer-Reconsidered-Environment-Lifestyle-Immunity/dp/1587907402

Peyrot des Gachons, C., & Breslin, P. A. S. (2016). Salivary amylase: Digestion and metabolic syndrome. Current Diabetes Reports, 16, 102. https://doi.org/10.1007/s11892-016-0794-7

Scully, T., Ettela, A., LeRoith, D., & Gallagher, E. J. (2021). Obesity, type 2 diabetes, and cancer risk. Frontiers in Oncology, 10, 615375. https://doi.org/10.3389/fonc.2020.615375

Unwin, D., Khalid, A. A., Unwin, J., Crocombe, D., Delon, C., Martyn, K., Hasan, M., & Tobin, S. D. (2020). Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: A secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years. BMJ Nutrition, Prevention & Health, 3(2), 285–294. https://doi.org/10.1136/bmjnph-2020-000072

Vaezi, S., Freeling, J. L., de Vargas, B. O., Weidauer, L., Shoemaker, M. E., Sanders, W. M., & Dey, M. (2025). Impacts of minimally-processed omnivorous vs lacto-ovo-vegetarian diets on insulin sensitivity, lipid profile, and adiposity in older adults: Secondary findings from a randomized crossover feeding trial. Clinical Nutrition, 55, 90–103. https://doi.org/10.1016/j.clnu.2025.10.010


Improve fertility and decrease cancer risk: THE PLASTIC DETOX

In 1962, Rachel Carson published the seminal, groundbreaking book Silent Spring, which brought public awareness to the harmful effects of environmental pollution (Carson, 1962). In many cases, public awareness of environmental pollution has been driven by observations and research involving people living near or on toxic waste sites, such as the infamous Love Canal in Niagara Falls, New York. Residents living in this area experienced a significantly higher risk of developing bladder, kidney, and other cancers due to contaminated water and soil (Gensburg et al., 2009).

Equally important is the impact of environmental pollution, including ongoing exposure to plastics, on health and embryological development. Many studies report that downstream pollution from agriculture, chemical plants, and sewage causes significant harm, ranging from limb deformities in amphibians (Taylor et al., 2005) to disruptions in human reproductive health. For example, microplastics have been shown to impair ovarian function, decrease fertility rates, and disrupt hormone levels in female subjects and their offspring’s health (Inam, 2025).

Research findings suggest that many human-made chemicals reduce fertility and increase cancer risk. Many chemicals in plastics (e.g., bisphenols (BPA, BPS, BPF), phthalates, flame retardants, and nonylphenol) are endocrine disruptors contributing to reduced fertility and can act as carcinogenic initiators or promoters (NIH, 2026). Ongoing exposure to plastics is one of several factors that may contribute to declines in fertility and earlier onset of cancers such as breast and prostate cancer in younger populations.

The recently released Netflix documentary The Plastic Detox offers an eye-opening exploration of the hidden dangers of the chemicals in plastics in our homes and daily lives and how it may impact fertility. It highlights concerns ranging from hormone disruption—which may contribute to declining fertility worldwide—to increasing rates of cancer and earlier occurrences of heart attack and stroke.

In the documentary, Professor Shanna H. Swan, a research scientist at the Icahn School of Medicine at Mount Sinai in New York City, explains how microplastics and their associated chemicals may affect our health—and what steps we can take to reduce our exposure. Although the documentary is not a randomized controlled trial and it doesn’t disentangle the possible placebo effects that arise when people shift their beliefs about the cause of infertility (for example, “it’s not my fault; it’s the plastics”), its central message is valid. From a psychophysiological perspective, how we interpret the causes of our health challenges can shape both our stress responses and our sense of agency.

Even with its scientific limitations, the film points toward an important concern: that environmental exposures, including plastics, play an important role in reproductive health. I also wonder whether some of the sharp “scientific critiques” of the documentary reflect more than scientific caution alone. History reminds us that industries whose profits are threatened have often worked to amplify uncertainty and delay regulation as the tobacco industry famously did for decades despite mounting evidence of harm (Maani et al., 2022; Oreskes & Conway, 2010).

I strongly recommend watching the documentary and taking steps to reduce exposure to plastics and other environmental toxins (such as glyphosate and the chemicals in air and water pollution) to support your health and that of your children. Watch it on Netflix: https://www.netflix.com/title/82074244

Listen to the in-depth discussion of this blog created with Google NotebookLM

References

Carson, R. (1962). Silent Spring.  Houghton Mifflin Co. https://www.amazon.com/Silent-Spring-Rachel-Carson/dp/0395075068

Gensburg, L. J., Pantea, C., Fitzgerald, E., Stark, A., Hwang, S. A., & Kim, N. (2009). Mortality among former Love Canal residents. Environmental Health Perspectives, 117(2), 209–216. https://doi.org/10.1289/ehp.11350

Inam, Ö. (2025). Impact of microplastics on female reproductive health: Insights from animal and human experimental studies: A systematic review. Archives of Gynecology and Obstetrics, 312(1), 77–92. https://doi.org/10.1007/s00404-024-07929

Maani, N., van Schalkwyk, M. C. I., Filippidis, F. T., Knai, C., & Petticrew, M. (2022). Manufacturing doubt: Assessing the effects of independent vs. industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar-sweetened beverages. SSM – Population Health, 17, 101009. https://doi.org/10.1016/j.ssmph.2021.101009

NIH. (2026). Endocrine disruptors. National Institute of Environmental Health Sciences. Retrieved May 7, 2026, from https://www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm

Oreskes, N., & Conway, E. M. (2010). Merchants of doubt: How a handful of scientists obscured the truth on issues from tobacco smoke to global warming. Bloomsbury Press. https://www.amazon.com/Merchants-Doubt-Handful-Scientists-Obscured/dp/1608193942/

Taylor, B., Skelly, D., Demarchis, L. K., Slade, M. D., Galusha, D., & Rabinowitz, P. M. (2005). Proximity to pollution sources and risk of amphibian limb malformation. Environmental Health Perspectives, 113(11), 1497–1501. https://doi.org/10.1289/ehp.7585


Tell Me Where It Hurts

In my biofeedback practice, I’ve repeatedly seen that healing rarely comes from a single technique. It emerges from observation, integration and practicing and integrating skills in daily life.  When clients learn to combine biofeedback with other strategies to make it their own such as slower, more coherent breathing, guided imagery, shifts in internal dialogue, and practical lifestyle changes, something important happens: the body begins to reorganize itself toward health.

Again and again, clients report meaningful changes. Stress symptoms, headaches, eye problem, neck shoulder and back pain decrease or disappear. Gastrointestinal symptoms often fade out. Anxiety loosens its grip. Asthma improves.  Chronic neck, shoulder, and pelvic pain diminish.  These are not isolated outcomes; they reflect a pattern. When people gain the skills to regulate their physiology and reinterpret their internal experience, decrease in symptoms often follow (see the list of articles that describe successful outcomes).

Even though many of my clients benefit, I am continually searching for strategies and approaches that can improve their health and reduce suffering and for materials that I can recommend to them.

Now when I see a client who reports pain or who takes care of someone with pain, the first thing I do is to recommend the book, Tell Me Where It Hurts, by Rachel Zoffness, PhD, a leading pain expert and psychologist. The book offers a clear, science-based framework grounded in modern neuroscience, yet conveyed through compelling human stories. Her work aligns closely with what we observe in biofeedback: pain is not simply a signal from injured tissue. It is an experience shaped by the interaction of body, brain, emotions, beliefs, culture and context.

She makes a crucial point that pain may begin with injury or illness, but it is always modulated by factors such as physiological state, emotional meaning, cognitive interpretation, and social and cultural influences. In other words, pain is real, but it is also dynamic and changeable.

The first step she emphasizes is education. When people understand how pain actually works, fear often decreases. From there, the task becomes identifying what amplifies pain and what reduces it and then systematically strengthening the factors and behaviors and skills that support recovery.

One striking story captures this perfectly: a construction worker jumps from a plank onto what appears to be a 7” nail, which is driven through his boot. He experiences excruciating pain and is rushed to the emergency room. Yet when the boot is removed, the nail is found to have passed cleanly between his toes—there is no tissue damage. The pain was real, but it was driven by perception and expectation. This is not an anomaly; it is a powerful illustration of how the brain constructs pain.

Equally compelling are the recovery stories. Patients with severe chronic pain that continue and got worse after failed surgeries, long-term disability, or even amputation, find relief not through more invasive procedures or medication alone, but through learning how to retrain their nervous system. In many of these cases, even opioids had failed to provide meaningful relief. What made the difference was a shift in understanding, combined with evidence-based self-regulation strategies. They are no longer abstract ideas; they are lived experiences.

The larger message is both simple and profound: pain can change. And when people are given the right framework and tools, they can actively participate in that change. For anyone living with pain, or working professionally with those who do, this book is not just informative. It is practical, empowering, and, in many cases, transformative.

This is the book to read if you have pain or care for someone with pain. It is also the book every therapist who works with people with pain should read and recommend to their clients.

Zoffness, R. (2026). Tell me where it hurts. Grand Central. https://www.amazon.com/Tell-Me-Where-Hurts-Science/dp/1538758148/

I recommend listening to the excellent podcast generated with Google NotebookLM, which thoughtfully expands upon and clarifies the underlying research.isten to the expanded podcast based on this blog and created with Google Notebook LM.

The following blog has a link to a superb podcast featuring Rachel Zoffness.

Then listen to the podcast from Dolorology (PAIN) Encore with Dr. Rachel Zoffness. https://www.alieward.com/ologies/dolorologyencore

Examples of integrated biofeedback outcomes

Peper, E. (2015). Pain as a Contextual Experience. Townsend Letter-The Examiner of Alternative Medicine, 388, 63-66. https://townsendletter.com/peper-contextual-pain-09-11-15/

Peper, E., Booiman, A. & Harvey, R.  (2025a). Pain-There is Hope. Biofeedback, 53(1), 1-9. http://doi.org/10.5298/1081-5937-53.01.16 Also, republished in Townsend Letter-Innovative Health Perspectives. https://townsendletter.com/pain-there-is-hope/

Peper, E., Chen, S., Heinz, N. & Harvey, R. (2023). Hope for menstrual cramps (dysmenorrhea) with breathing.  Biofeedback,. 51(2), 44–51. https://doi.org/10.5298/1081-5937-51.2.04

Peper, E. & Cohen, T. (2017). Inhale to breathe away pelvic floor pain and enjoy intercourse. Biofeedback, 45(1), 21–24. https://doi.org/10.5298/1081-5937-45.1.04

Peper, E., Cosby, J., & Almendras, M. (2022a). Healing chronic back pain. NeuroRegulation, 9(3), 164–172. https://doi.org/10.15540/nr.9.3.164

Peper, E., Covell, A., & Matzembacker, N. (2021). How a chronic headache condition became resolved with one session of breathing and posture coaching. NeuroRegulation, 8(4), 194–197. https://doi.org/10.15540/nr.8.4.194

Peper, E. & Harvey, R. (2008). From technostress to technohealth.  Japanese Journal of Biofeedback Research, 35(2), 107-114. https://www.jstage.jst.go.jp/article/jjbf/35/2/35_KJ00005060045/_pdf

Peper, E., Harvey, R., Chen, S., & Heinz, N. (2025b). Practicing diaphragmatic breathing reduces menstrual symptoms both during in-person and synchronous online teaching. Applied Psychophysiology and Biofeedback. https://do.org/10.1007/s10484-025-09745-7   

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022b). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91 

Peper, E., Martinez Aranda, P., & Moss, E. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback. 43(2), 103-109. https://doi.org/10.5298/1081-5937-43.2.04

Peper, E., Mason, L., Harvey, R., Wolski, L, & Torres, J. (2020). Can acid reflux be reduced by breathing? Townsend Letters-The Examiner of Alternative Medicine, 445/446, 44-47. https://www.townsendletter.com/article/445-6-acid-reflux-reduced-by-breathing/

Peper, E., Oded, Y., & Harvey, R. (2024). Quick somatic rescue techniques when stressed. Biofeedback, 52(1), 18–26. https://doi.org/10.5298/982312

Peper, E. & Tibbitts, V.  (2003). Protocol for the treatment of asthma.  In:  Zheng, Y. (ed).  Clinical Practice of Biofeedback. Beijing:  High Education Press (HEP). 163-176. ISBN 7-04-011420-8 https://biofeedbackhealth.org/wp-content/uploads/2011/01/protocol-for-asthma-treatemtn2001-china.pdf

Peper, E. & Yirmiyahu, D. (2023). Transforming a “bad eye” to an “amazing eye”: a case report and protocol. Townsend Letters. The Examiner of Alternative Medicine, Saturday, July 29, 2023 https://townsendletter.com/transforming-a-bad-eye-to-an-amazing-eye-a-case-report-and-protocol/


Breathing for Health: Four Part Audio Series for Regeneration and Well-Being

Adapted from Peper, E. (1990). Breathing for Health with Biofeedback. Mont­real: Thought Technology Ltd and produced by Larry Klein.

Breathing is the most intimate rhythm of life. From the moment we are born until our last breath, our breath is always there—quietly sustaining us. And yet, most of the time, we are unaware of how we breathe or how profoundly it shapes our health. Learn how to use your breath to optimize your health and enhance your well-being.

Dysfunctional breathing patterns contribute significantly to a range of illnesses, ranging from chronic pain and anxiety to fatigue and stress-related disorders. For example, when anxious, breathing often becomes rapid and shallow; when calm, breathing tends to slow and deepen. Symptoms can often be reduced, and health, resilience, and a deep sense of well-being can be enhanced after mastering and implementing effortless breathing. Breathing affects the mind, body, emotions, and spirit; when you change your breathing, you change your state of being.

The audio series by Erik Peper was conceived and produced by Larry Klein co-founder of Thought Technology, Ltd in 1990 to make the science and practice of breathing with biofeedback accessible to everyone. Although it was recorded more than 35 years ago, the principles and instructions remain as relevant and evidence-based today as they were then.

It was designed to help you observe your own breathing patterns and cultivate the foundational skill of effortless diaphragmatic breathing. Even more importantly, it guides you in integrating this breathing pattern into daily activities so that it becomes your default—whether you are working, speaking, exercising, or resting.

The discussion and guided practices are both simple and profound. When you change how you breathe, you change how you regulate yourself. Breathing both reflects and influences your physiology, emotions, and cognitions—often outside of conscious awareness.

As you listen to and practice the techniques in this four-part audio series, you will develop greater awareness, appreciation, and mastery of effortless breathing. Enjoy applying these practices in everyday life until they become automatic. Like any skill, effortless breathing is learned through gentle, consistent practice—practice makes permanent.

Part 1: Background Information on Breathing
Listen once to understand the scientific foundations and underlying rationale

Part 2: Learning Slow Diaphragmatic Breathing
Listen repeatedly and practice consistently until the skill becomes natural, effortless, and reliable.

Part 3: Integrating Breathing in All Conditions
Alternate between Parts 2 and 3. Practice during everyday activities so the skill generalizes beyond formal sessions and becomes your default way of breathing.

Part 4: Integrating Breathing, Imagery and Meditation for Health
Experience how guided imagery and meditative awareness deepen and amplify the benefits of effortless breathing.

Additional Recommended Blogs to Support the Learning and Generalization of Effortless Breathing

Additional Recommended Blogs: How Breathing Can Help Relieve Pain


Hope for dry eyes and eye strain

Adapted from: Peper, E., Yoshino, A., & Harvey, R. (2026). Hope for dry eyes and eye strain: How breathing-blinking patterns Influence dry eye experience. Biofeedback. 54(1), 25-30. https://doi.org/10.5298/1081-5937-54.01.25

Many times during the day, I let my shoulders and face relax, and with each exhalation I feel the upper eyelids slightly dropping down at the same time as I am relaxing my jaw and mouth while sitting tall. I sense my tongue and throat sinking and feeling an increase in the space between my upper and lower molars. At the same time, I sense my eyes becoming soft and sinking down as my face muscle relax and are pulled down by gravity while sensing a gentle smile. My eyes are not trying to focus on anything. I continue to breathe slowly allowing a pause before inhaling and feel totally safe and at peace. While doing this, I sense moisture at the lower eyelids. After I have inhaled and as I exhale, I slowly open my eyes, and return to my work.  My eyes feel slightly moist and as I blink, the eyelids glide smoothly over the corneal surface.

Background

Dry eyes and eye strain are far more common than most people realize. More than 50% of adults in the United States and Europe experience irritated or burning eyes, dryness, eye strain, headaches, tired or heavy eyes, sensitivity to bright light, and general eye discomfort (Wozniak et al., 2025). The prevalence increases with age and is higher among people who smoke, wear contact lenses, or spend excessive time looking at screens—typically more than six hours per day (Uchino et al,, 2013).

Prolonged, intense screen use—often referred to as digital eye strain or computer vision syndrome—occurs when people focus and concentrate, and the muscles involved with near vision contract and do not relax (Chu et al., 2014). During near vision, the ciliary muscles tighten around the lens to allow near focus, and the medial rectus muscles contract to converge the eyes. These muscles stay contracted and only relax when looking into the distance.  This ongoing tension and increased sympathetic activation combined with reduced blinking decrease tearing, and contribute to dry eye symptoms because the tears are not able to provide adequate moisture.  As a result, the eyes may become irritated, red and inflamed, which increases eye discomfort (Sheppard & Wolffsohn, 2018Portello et al., 2012; Sheedy et al., 2003).

When someone is vigilant, fearful, or anticipates a threat, sympathetic activation increases (Ranti et al., 2020) and “eye blink are inhibited at precise moments in time so as to minimize the loss of visual information that occurs during a blink. The more important the visual information is to the viewer, the more likely he or she will be to inhibit blinking” (Ranti et al., 2020).  

Without being aware, many people are in a chronic state of vigilance and unknowingly are scanning the world for threats to which they must react.  Clinically, I often observe this when guiding clients in relaxation.  For example, when I give the instruction, “Let me lift your hand,” some clients immediately lift their hand towards me. This nonverbal response suggests that they are constantly vigilant and are monitoring the world around them—always ready to act instead of trusting that they do not have to act and that the world is safe. In most cases, their breathing pattern tends to be shallow and thoracic.

Would it be possible that this ongoing vigilance,which increases sympathetic arousal contributes to the experience of dry eye syndrome? It could be one factor explaining why women have a higher incidence of dry eye disease as well as anxiety than men since the world is often less safe for women, and they breathe more thoracically and less diaphragmatically (abdominally) than men. Shallow chest breathing is also associated with increased in anxiety (Fugl-Meyer, 1974; Mendes et al., 2020; Wilhelm et al., 2001; Banushi eat al., 2023; McLean et al., 2011; Jalnapurkar, et al., 2018).

Note: The risk of dry eye can also be further increased by a wide range of medical conditions and medications, such as diabetes; glaucoma and glaucoma medications; allergies; autoimmune diseases; arthritis; thyroid disease; high cholesterol; acne treatments; antihistamines; antidepressants; and a history of refractive surgery, conjunctival infections, or corneal abrasions. Dry eye also occurs more frequently in women (Mohamed et al., 2024).

What is usually recommended to resolve dry eyes

The primary and effective first-line treatment to reduce the symptoms of dry eye disease is the use of artificial tears (lubricating eye drops) to provide relief (Maity et al., 2025).  Another recommendation to reduce eye strain associated with computer use is to implement the 20/20/20 rule developed by the American Optometric Association–take a 20-second break every 20 minutes and look at something 20 feet away (AOA, 2026). Although the 20/20/20 practice can reduce eye strain and momentarily reduce some of the symptoms associated with dry eye disease especially if the eyes are closed, how we orient, breathe and look may contribute to the experience of dry eye discomfort.

Experience how to evoke dry eyes

Sit comfortably, look around, and observe how your eyes feel. Close your eyes. Now imagine there is a threat. Take a very quick gasp through an open mouth by inhaling into your upper chest and keep breathing very shallowly and irregularly. At the same time, open your eyes wide while being vigilant and looking for danger. Simultaneously, tense your body, inclining it slightly backward as if trying to avoid something.  Do not blink, as you may miss the potential threat approaching you (adapted from Lemeignan et al., 1990; Bloch, 2017). A sample physiological recording of this pattern is shown in Figure 1.

Figure 1. Breathing pattern in response to a threat; a rapid gasp into the chest and pulling the abdomen in to protect while breathing shallowly and rapidly.

Most participants report that almost immediately they feel their eyes getting cooler and after 15 seconds, drier. This facial, breathing, and posture pattern is an exaggeration of the somatic expression of fear that is evoked when we are vigilant and feel unsafe, and it increases sympathetic arousal (Kalawski, 2020).

In most cases, this pattern is automatic, and occurs without awareness, and increases sympathetic activity (Narkiewicz et al., 2006). On the other hand, slow diaphragmatic breathing tends to reduce sympathetic activity (Harada et al., 2014; Lehrer & Gevirtz, 2014). Clinically, the vigilance pattern can often be observed as a person slightly lifts and expands their chest during inhalation and drops and constricts it during exhalation, while breathing shallowly and rapidly without any abdomen expansion or constriction. It is often punctuated with brief breath holding and a reduced blinking rate during concentration.

To investigate these observations more systematically, we compared the practice of gasping while opening the eyes with gentle exhalation while opening the eyes—a pattern that may reduce sympathetic activation and alter the subjective sensation of eye dryness.

Participants: 13 males and 13 females; average age, 39 years

Procedure: While sitting comfortably with their eyes closed, participants were guided through the following two practices:

1.Gasp while opening the eyes

Sit comfortably and look around and observe how your eyes feel. Now close your eyes. Now imagine there is a threat. Take a very quick gasp through an open mouth by inhaling into your upper chest and keep breathing very shallowly and irregularly. At the same time, open your eyes wide while being vigilant and looking for danger. Simultaneously, tense your body, inclining it slightly backward as if trying to avoid something.  Do not blink, as you may miss the potential threat approaching you. Repeat three times.

2. Gentle exhalation while opening the eyes

Sit comfortably and look around and observe how your eyes feel. Now close your eyes. Breathe comfortably and inhale by allowing your abdomen to extend and widen while feeling your eyes sinking in their sockets and becoming softer as you gently start exhaling. While gently exhaling, begin to open your eyes very slowly, looking down through your eyelashes without caring what you see, allowing your jaw and face muscles to relax and feeling a slight smile. When you feel the urge to inhale, allow your eyes to close and let your abdomen expand as you inhale slowly. Repeat three times.

After these two practices, the participants filled out a short assessment questionnaire in which they rated how their eyes felt on a scale from -5 (dry), 0 (normal), to 5 (moist/tearing), and rated which eye-opening procedure allowed their eyes to be more relaxed and moist.

Results

92.3% of the participants reported that opening their eyes during exhalation significantly increased eye relaxation and moisture, as shown in Figure 2. A one-way analysis of variance (ANOVA) revealed a significant difference between the inhale condition (M = −0.19, n = 26) and the exhale condition (M = 1.00, n = 25), F(1, 49) = 9.65, p = .003. The experience of eye irritation was correlated (r = 0.64) with the self-rating of experiencing anxiety and fear during the last three months. 

Figure 2. Gently opening the eyes during exhalation increases the experience of moisture and relaxation in the eyes.

Discussion

The results suggest that increased moisture and eye relaxation could be evoked by changing breathing-blinking patterns. Nearly all participants experienced an increase in tearing and eye relaxation; however, long-term benefits most likely occur if the person implements this practice many times during the day. By changing the breathingg-blink pattern and peacefully looking at the world with a smile, one would decrease sympathetic arousal and increase parasympathetic activity.  This approach should be taught as the first self-care intervention to reduce eye irritation.

Recommendations to decrease dry eye and improve eye health

  1. Experience how the two different breathing and eye-opening practices described above affect your eye dryness or moistness. 
  2. When you sense the first onset of minimal eye discomfort or when looking at screens on your computer or cellphone, implement the following practice for about 10 to 15 seconds. Allow your eyelids to close.  Be aware of the sensations in your eyes, let your face and jaw relax as if they are being pulled down by gravity while sensing the eyes becoming soft and sinking into their sockets. Breathe diaphragmatically by allowing the abdomen to expand when you inhale. While gently exhaling, slowly open your eyes slightly while looking down with a gentle smile and sensing the moisture beginning to occur in the eyes. Repeat twice.
  3. During the day, implement the 20/20/20 vision-regeneration practice (every 20 minutes, take a 20-second break and look at something 20 feet away without caring what you see), as shown in Figure 3.
  4. Read and incorporated the many practices described in the superb book, Vision for Life; Ten Steps to Natural Eye Improvement, by Meir Schneider (2012).

Figure 3. The 20/20/20 rule poster to prevent eye strain (AOA, 2026).

Do these practices many times and be aware of the sensations in your eyes and face. This passive awareness, in conjunction with slower breathing, tends to reduce sympathetic arousal and increase parasympathetic activity, which facilitates increased tearing. As one participant reported when she practiced this:

What a surprise it was when I closed my eyes and breathed slowly and diaphragmatically, and then, as I began to exhale, I very slowly began to open my eyes while looking down and through my eyelashes, while feeling my eyes sink into their sockets. Tearing occurred spontaneously, and my eyes felt lubricated. What a relief. It provided hope that I could help myself instead of only depending on lubricating eye drops whenever my eyes felt dry and irritated.

Two books to maintain and improve vision and reduce techstress

Vision for Life: Ten Steps to Natural Eye Improvement by Meir Schneider (2016) offers many strategies you can immediately incorporate into your daily life to improve and restore your vision. It provides guidelines on how to reverse developing vision issues before they cause damage and how to remedy existing problems, including near- and far-sightedness, lazy eye, as well as more serious conditions such as cataracts, glaucoma, optic neuritis, detached retinas and retinal tears, macular degeneration, and retinitis pigmentosa.

TechStress: How Technology is Hijacking our Lives, Strategies for Coping, and Pragmatic Ergonomics by Erik Peper, Richard Harvey, and Nancy Faass (2020) offers practical tools to avoid the evolutionary traps that trip us up and address the problems associated with technological overuse. It includse effective strategies and practices that individuals can use to optimize their workspace, reduce physical strain, correct posture, and improve vision. It provides fresh insights on reducing stress and enhancing health.

Listen to the expanded podcast based on this blog produced with Google Notebook LM.

Additional blogs that offer strategies to improve vision

References

AOA. (2026). 20/20/20/ to prevent digital eyes strain. American Optometric Association. https://www.aoa.org/AOA/Images/Patients/Eye%20Conditions/20-20-20-rule.pdf

Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork interventions for adults with clinically diagnosed anxiety disorders: A scoping review. Brain Sciences, 13(2), 256. https://doi.org/10.3390/brainsci13020256

Bloch, S. (2017). Alba Emoting: A scientific method for emotional induction. Scotts Valley, CA: CreateSpace Independent Publishing Platform. https://www.amazon.com/Alba-Emoting-Scientific-Emotional-Induction/dp/154254884

Chu, C.A., Rosenfield, M., Portello, J.K. (2014).  Blink patterns: reading from a computer screen versus hard copy. Optom Vis Sci., 91(3),297-302. https://doi.org/10.1097/OPX.0000000000000157

Craig, J. P., Nichols, K. K., Akpek, E. K., et al. (2017). TFOS DEWS II definition and classification report. The Ocular Surface, 15(3), 276–283. https://doi.org/10.1016/j.jtos.2017.05.008

Dartt, D. A. (2009). Neural regulation of lacrimal gland secretory processes: Relevance in dry eye diseases. Progress in Retinal and Eye Research, 28(3), 155–177. https://doi.org/10.1016/j.preteyeres.2009.04.003

Fugi-Meyer, A.R. (1974). Relative respiratory contribution of the rib cage and the abdomen in males and females with special regard to posture. Respiration, 31(3), 240–251. https://doi.org/10.1159/000193113

Harada, D., Asanoi, H., Takagawa, J., Ishise, H., Ueno, H., Oda, Y., Goso, Y., Joho, S., & Inoue, H. (2014). Slow and deep respiration suppresses steady-state sympathetic nerve activity in patients with chronic heart failure: from modeling to clinical application. American Journal of Physiology-Heart and Circulatory Physiology, 307(8), H1159–H1168. https://doi.org/10.1152/ajpheart.00109.2014

Jalnapurkar, I., Allen, M., & Pigott, T. (2018). Sex differences in anxiety disorders: A review. Journal of Psychiatry, Depression & Anxiety, 4, 011. https://doi.org/10.24966/PDA-0150/100011

Kalawski, J.P. (2020) The Alba Method and the Science of Emotions. Integr. Psych. Behav. 54, 903–919. https://doi.org/10.1007/s12124-020-09525-4

Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5, Article 756. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104929/

Lemeignan, M., Guitart, L., & Bloch, S. (1990). Autonomic differentiation of emotional effector pattern of 6 basic emotions. Proceedings of the Fifth International Congress of Psychophysiology, Budapest, July 9–14, 199

Maity, M., Allay, M. B., Ali, M. H., Basu, S., & Singh, S. (2025). Effect of different artificial tears on tear film parameters in dry eye disease. Optometry and Vision Science, 102(1), 37–43. https://doi.org/10.1097/OPX.0000000000002206

McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. https://doi.org/10.1016/j.jpsychires.2011.03.006

Mendes, L. P. S., Vieira, D. S. R., Gabriel, L. S., Ribeiro-Samora, G. A., Dornelas de Andrade, A., Brandão, D. C., Goes, M. C., Fregonezi, G. A. F., Britto, R. R., & Parreira, V. F. (2020). Influence of posture, sex, and age on breathing pattern and chest wall motion in healthy subjects. Brazilian Journal of Physical Therapy, 24(3), 240–248. https://doi.org/10.1016/j.bjpt.2019.02.007

Mohamed, Z., Alrasheed, S., Abdu, M., & Allinjawi, K. (2024). Dry eye disease prevalence and associated risk factors among the Middle East population: A systematic review and meta-analysis. Cureus, 16(9), e70522. https://doi.org/10.7759/cureus.70522

Narkiewicz, K., van de Borne, P., Montano, N., Hering, D., Kara, T., & Somers, V. K. (2006). Sympathetic neural outflow and chemoreflex sensitivity are related to spontaneous breathing rate in normal men. Hypertension, 47(1), 51–55. https://doi.org/10.1161/01.HYP.0000197613.47649.0

Peper, E., Harvey, R., & Faass, N. (2020). TechStress: How Technology is Hijacking our Lives, Strategies for Coping, and Pragmatic Ergonomics, North Atlantic Books. https://www.amazon.com/Beyond-Ergonomics-Prevent-Fatigue-Burnout/dp/158394768X

Portello, J.K., Rosenfield, M., Bababekova, Y., et al. (2012). Computer-related visual symptoms in office workers. Ophthalmic and Physiological Optics, 32, 375–82. https://doi.org/10.1111/j.1475-1313.2012.00925.x

Ranti, C., Jones, W., Klin, A. et al. Blink Rate Patterns Provide a Reliable Measure of Individual Engagement with Scene Content. Sci Rep 10, 8267 (2020). https://doi.org/10.1038/s41598-020-64999-x

Schneider, M. (2016). Vision for Life: Ten Steps to Natural Eye Improvement. North Atlantic Books. https://www.amazon.com/Vision-Life-Revised-Eyesight-Improvement/dp/1623170087

Sheedy, J.E., Hayes, J.N., & Engle, J.(2003). Is all asthenopia the same? Optom Vis Sci, 80, 732–9. https://doi.org/10.1097/00006324-200311000-00008

Sheppard, A. L., & Wolffsohn, J. S. (2018). Digital eye strain: prevalence, measurement and amelioration. BMJ open Ophthalmology3(1), e000146. https://doi.org/10.1136/bmjophth-2018-000146

Stern, M. E., Gao, J., Siemasko, K. F., Beuerman, R. W., & Pflugfelder, S. C. (2004). The role of the lacrimal functional unit in the pathophysiology of dry eye. Experimental Eye Research, 78(3), 409–416. https://doi.org/10.1016/j.exer.2003.09.003

Swamynathan, S. K., & Wells, A. (2020). Conjunctival goblet cells: Ocular surface functions, disorders that affect them, and the potential for their regeneration. The Ocular Surface, 18(1), 19–26. https://doi.org/10.1016/j.jtos.2019.11.005

Uchino, M.,  Yokoi, N.,  Uchino, Y., Dogru, M., Kawashima, M.,  Komuro, A., Sonomura, Y.,  Kato, H., Kinoshita, S.,  Schaumberg, D.A., & Tsubota, K. (2013). Prevalence of Dry Eye Disease and its Risk Factors in Visual Display Terminal Users: The Osaka Study. American Journal of Ophthalmology, 156(4), 759-766.e1, https://doi.org/10.1016/j.ajo.2013.05.040

The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. , 5(2), 93-107. https://doi.org/10.1016/s1542-0124(12)70082-4

Wilhelm, F. H., Gevirtz, R., & Roth, W. T. (2001). Respiratory dysregulation in anxiety, functional cardiac, and pain disorders: Assessment, phenomenology, and treatment. Behavior Modification, 25(4), 513–545. https://doi.org/10.1177/0145445501254003

Wozniak, P., et al. (2025, September 12–16). Dry eye symptoms, severity, treatment and unmet needs: An analysis of the United States of America and a multinational snapshot (NESTS Study) [Poster presentation]. 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS), Copenhagen, Denmark. https://www.sciencedaily.com/releases/2025/09/250914205829.htm

Ziemssen, F., & Ruprecht, K. W. (2005).Autonomic dysfunction in dry eye syndrome. Ophthalmologe, 102(8), 744–749. https://doi.org/10.1007/s00347-005-1169-1


Corporations: The new(old) disease vectors as they choose profits over health

We can invest in preventing illness now by reducing our exposure to environmental toxins — or we can pay a far higher price later trying to treat the resulting  chronic and often debilitating diseases.”

Ever since the 1962 publication of Rachel Carson’s groundbreaking book, Silent Spring, which documented the harm environmental pollution caused, government has, often reluctantly,  set limits intended to protect Americans from exposure to harmful chemicals in our food, air and water (Carson, 1964). These regulations did not emerge easily. As the governmental regulations were being proposed and implemented, they were consistently challenged by the very  large corporations that manufactured and profited from these chemicals.

History reminds us how slowly public health protections can unfold. Consider how long it took for smoking to be prohibited in public spaces even though the harmful effects had been documented since the 1950s (Doll and Hill, 1954; Doll & Hill, 1964; Wynder & Graham,1985).  For decades, the science was clear, yet policy and governmental actions were delayed. Only in the early 2000s did many states began banning smoking in workplaces, restaurants, and bars. The shift in public policy saved many lives and the reduction in smoking has been the major reason for the decrease in cancer mortality over the last twenty-five years.

We are going backwards

The Trump administration  has rescinded the 2009 U.S. Environmental Protection Agency  endangerment finding on greenhouse gases, loosening vehicle emission standards, and weakening pollution controls on power plants and oil and gas operations (Tabuchi, 2026). The health consequences may not appear immediately; however, they are predictable. The increased exposure today will again contribute to increased rates of cancer, respiratory illness, cardiovascular disease, and developmental disorders tomorrow.

To understand how the government regulations have been revised so that once again Americans will be more exposed to toxins in their food, air, and water, read the superb investigative report published by U.S. Right to Know  whose mission is to pursuing truth and transparency for public health.

Their most recent report, Tracing Bayer’s ties to power in Trump’s Washington, describes in detail the hidden social connections, lobbying and political donations that lead “The White House to invokes the Defense Production Act to guarantee supplies of elemental phosphorus and glyphosate-based herbicides. Regulators reapprove dicamba, a Bayer herbicide twice blocked by federal courts, and clear the way for new pesticides containing toxic, persistent PFAS “forever” chemicals (Malkan, 2026).“ 

When regulatory safeguards weaken, corporations can once again function as disease vectors-not through infection, but through environmental exposure. By loosening the pollution standards, federal policy will negatively affect the health of both present and future generations. 

I encourage you to explore many superb investigative reports and practical  suggestions how to avoid these toxins exposure  that are available on U.S. Right to Know website:

One exposure. Twenty generations later, the damage is still unfolding

Glyphosate: Cancer, liver disease, endocrine disruption and other health concerns

Hormone-disrupting chemicals contaminate breast milk, global review shows; scientists say breastfeeding is still best

Big Food ‘transparency’ campaign seeks to block tough new food safety laws

Ultra-processed foods damage health in ways that calories don’t explain, new study says

Listen to the expanded podcast based upon this blog and created by Google Notebook LM.

See also the following blogs

References

Carson, R. (1962). Silent spring. Houghton Mifflin. https://www.amazon.com/Silent-Spring-Rachel-Carson/dp/B002E8JF6G/

Doll, R., & Hill, A. B. (1954). The mortality of doctors in relation to their smoking habits: A preliminary report. British Medical Journal, 1(4877), 1451–1455. https://doi.org/10.1136/bmj.1.4877.1451

Doll, R., & Hill, A. B. (1964). Mortality in relation to smoking: Ten years’ observations of British doctors. British Medical Journal, 1(5396), 1460–1467. https://doi.org/10.1136/bmj.1.5396.1460

Malkan, S. (2026). Tracing Bayer’s ties to power in Trump’s Washington. U.S. Right to Know. Accessed February 24, 2026. https://usrtk.org/pesticides/tracing-bayers-ties-to-power-in-trumps-washington/

Tabuchi, H. (2026). Historic Climate Rollback Makes U.S. a Global Outlier on Tailpipe Rules. The New York Times, February 16, 2026. Accessed February 24, 2026 https://www.nytimes.com/2026/02/16/climate/endangerment-finding-auto-emissions-regulations.html

Wynder, E.L., & Graham, A. (1985). JAMA, 253 (20), 2986-2994. https://doi.org/10.1001/jama.1985.03350440064033


Welcome the New Year with Inspiration

As the holiday season begins, I find myself looking back on all that has unfolded this year and looking forward with hope to the year ahead. My social media feed is full of touching, uplifting messages and videos—reminders of resilience, creativity, and the simple goodness in the world. Best wishes for the holidays and the New Year and I hope you will enjoy the two inspiring videos.

1. Nine life lessons from comedian Tim Minchin, presented at the University of Western Australia. His humor and wisdom offer a refreshing take on what truly matters.

2. A powerful story about transforming disaster into blessing.
If you ever feel stuck or unsure about the future, this video is a beautiful reminder that unexpected turns can lead to new possibilities.

Wishing you a healthy and inspiring New Year!

Erik