Disease Proof : Disease Proof : Health & Nutrition News & Commentary : Dr. Joel Fuhrman

       Prostate cancer is the second most common cancer in men (second to skin cancer). It is well established that the death rate from prostate cancer is quite low:

• Men in the U.S. have a 16% lifetime chance of being diagnosed with prostate cancer, but only a 3% chance of dying from it.[1]
• The five-year and ten-year relative survival rates for prostate cancer are over 99% and 91%, respectively. [2]
• The primary causes of death of men with prostate cancer are cardiovascular disease and other cancers.[3]

After treatment for prostate cancer (either radiation or prostatectomy), prostate-specific antigen (PSA) levels continue to be monitored. If PSA begins to increase, this is called “biochemical recurrence” (BCR) of prostate cancer.

Biochemical recurrence and mortality

A study in U.S. veterans attempted to figure out how biochemical recurrence affected risk of dying from prostate cancer. Six hundred twenty three men were followed for 15 years after being treated for prostate cancer. In this study, 37% of men who were treated with prostatectomy and 48% of men who were treated with radiation experienced BCR.

Overall, a total of 387 men had died within 15 years – 48 of these men died of prostate cancer, representing 12% of total deaths. For men who underwent prostatectomy and experienced BCR, the total rate of death within five years was 34%, and the rate of prostate cancer death was 3%. For radiation and BCR, death rate within five years was 35%, and prostate cancer death rate was 11%.[4, 5]

In short, the researchers came to the conclusion that the probability of dying from prostate cancer, even after biochemical recurrence, is relatively small. They mention that their findings are in agreement with the often quoted phrase “most men die with prostate cancer, not of it.”

Since BCR is defined as an increase in PSA following treatment, this data also suggests that PSA levels may not be an accurate predictor of risk after treatment. Further studies will likely examine this issue.

Routine PSA screening

Routine PSA screening is known by the scientific community not to be as accurate or valuable as the public is led to believe. About 70% of men with elevated PSA do not actually have cancer, and PSA screening is not thought by scientists to reduce prostate cancer-related deaths.[6-8] Richard J. Ablin, who originally discovered PSA in 1970, recently called PSA screening a “hugely expensive public health disaster” in a New York Times editorial. Dr. Ablin supports his assertion with these facts:

• FDA approval of PSA tests occurred largely in response to a study that found that PSA screening was only able to detect 3.8% of cancers, and that blood PSA levels may be elevated due to a number of factors, such as drug use, infections, and benign prostatic hyperplasia (BPH).
• The U.S. Preventive Services Task Force, the American College of Preventive Medicine, and the American Cancer Society do not recommend routine PSA screening. However, PSA screening is still routinely used.[1]

Men should not rely on PSA screening as a method of “early detection” to prevent prostate cancer. Rather they should avoid the cause of prostate cancer. Diets high in vegetables (especially cruciferous vegetables and tomato products) and fruit, and low in dairy products, meat, and processed foods, are known to be protective.[9-11] Living and eating healthfully protects against prostate cancer, as well as the other chronic diseases common to Americans (such as heart disease, strokes, and colon cancer) – the same diseases that kill most men with prostate cancer. For those who already have prostate cancer, a healthy, plant-based diet is effective at halting progression of the disease.[12-15]

References:

1. Ablin, R.J., The Great Prostate Mistake, in New York Times. 2010. p. 27.
2. American Cancer Society. What are the key statistics about prostate cancer? 06/30/2010 09/02/2010]; Available from: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-key-statistics.
3. Ketchandji, M., et al., Cause of death in older men after the diagnosis of prostate cancer. J Am Geriatr Soc, 2009. 57(1): p. 24-30.
4. Uchio, E.M., et al., Impact of biochemical recurrence in prostate cancer among US veterans. Arch Intern Med, 2010. 170(15): p. 1390-5.
5. Harding, A. Even when prostate cancer returns, most survive. Reuters Health 08/25/10; Available from: http://www.reuters.com/article/idUSTRE67O4RR20100825?feedType=nl&feedName=ushealth1100.
6. Esserman, L., Y. Shieh, and I. Thompson, Rethinking Screening for Breast Cancer and Prostate Cancer. JAMA: The Journal of the American Medical Association, 2009. 302(15): p. 1685-1692.
7. Coldman, A.J., N. Phillips, and T.A. Pickles, Trends in prostate cancer incidence and mortality: an analysis of mortality change by screening intensity. CMAJ, 2003. 168(1): p. 31-5.
8. Andriole, G.L., et al., Mortality results from a randomized prostate-cancer screening trial. N Engl J Med, 2009. 360(13): p. 1310-9.
9. Steinbrecher, A., et al., Dietary glucosinolate intake and risk of prostate cancer in the EPIC-Heidelberg cohort study. Int J Cancer, 2009. 125(9): p. 2179-86.
10. van Breemen, R.B. and N. Pajkovic, Multitargeted therapy of cancer by lycopene. Cancer Lett, 2008. 269(2): p. 339-51.
11. Ma, R.W. and K. Chapman, A systematic review of the effect of diet in prostate cancer prevention and treatment. J Hum Nutr Diet, 2009. 22(3): p. 187-99; quiz 200-2.
12. Frattaroli, J., et al., Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology, 2008. 72(6): p. 1319-23.
13. Ornish, D., et al., Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A, 2008. 105(24): p. 8369-74.
14. Ornish, D., et al., Intensive lifestyle changes may affect the progression of prostate cancer. J Urol, 2005. 174(3): p. 1065-9; discussion 1069-70.
15. Fuhrman, J., Dr. Joel Fuhrman Case Study Series: Prostate Cancer.

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A study in Sweden examining the effects of zinc and the omega-3 fatty acid DHA on mortality in prostate cancer patients was presented at the American Association for Cancer Research annual meeting in April. Five-hundred twenty-five men with prostate cancer were followed for twenty years after being diagnosed with prostate cancer.  Baseline dietary habits, stage of cancer at diagnosis, and deaths over the twenty years were recorded and analyzed.¹

The authors chose to investigate these two nutrients because zinc and omega-3s share the common action of attenuating the inflammatory response, and chronic systemic inflammation may fuel prostate cancer progression. Importantly, zinc and DHA are both difficult to obtain on a plant-based diet.

Zinc is especially concentrated in the prostate, but zinc levels become depleted in cancerous cells. Addition of zinc to cultured prostate cancer cells leads to cell death, possibly by suppressing the activity of inflammatory molecules. A previous study found that long-term zinc supplementation was associated with reduced risk of advanced prostate cancer.²

In the current study, the researchers organized the study participants into quartiles according to their intakes of zinc and DHA. In men who were diagnosed at with early stage cancers, the highest quartile of zinc intake (15.7 mg zinc daily or more) was associated with a 74% reduction in risk of death from prostate cancer compared to the lowest quartile (12.8 mg zinc daily or less). Absorption of zinc tends to be low on a vegan diet – beans, whole grains, nuts, and seeds have high zinc content, however these foods also contain substances that inhibit the aborption of zinc.³ A 2009 study of vegetarians found a high prevalence of zinc deficiency.⁴ To correct for bioavailability, the zinc requirement for vegans may be as much as 50% higher than that of omnivores.⁵

I recommend zinc supplementation with a multivitamin and mineral to ensure sufficient zinc intake in vegans or those who minimize animal foods.

The connection between omega-3 intake and prostate cancer is somewhat complex. For example, flaxseed oil was found to increase prostate cancer risk, whereas whole flaxseed, EPA, and DHA were found to be protective.^6,7,8 EPA and DHA are known to have anti-cancer and anti-inflammatory properties.⁹ In this study, the highest quartile of DHA intake was associated with 30% reduced risk of overall prostate cancer mortality, and a 45% risk reduction in men diagnosed at early stages, supporting the idea that DHA is protective against prostate cancer. Plant foods contain ALA, which can be elongated to DHA, but the major food source of DHA is fish, which often contains pollutants and is not acceptable for vegetarians and vegans. For these reasons, I recommend a laboratory cultivated DHA supplement made from micro-algae, which is also a more environmentally sustainable option than fish or fish oil.

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Approximately 1300 men who had been diagnosed with prostate cancer were followed for two years to document their dietary patterns and recurrence or progression of their disease. In this study, two specific animal foods were found to be risky - the men that ate the most eggs or poultry with skin were twice as likely to have their disease recur or progress.¹

This study makes three important points.

1. Diet does matter, even after a prostate cancer diagnosis.
2. There is something in chicken, specifically in the crispy outer portion and skin that is powerfully cancer-inducing. Heterocyclic amines, carcinogenic compounds that are formed when meat is cooked at high temperatures, are a probable culprit. A November 2009 study of 175,000 men showed an increase in prostate cancer risk with consumption of barbequed and grilled meat.²
3. Consumption of eggs and egg whites is not without risk. Eggs are high in animal protein, which has been linked to cancers. Our populations’ idea that more protein is favorable and that egg (whites) are the perfect food does not hold up to scrutiny. Eggs also could affect prostate cancer due to their high choline content – egg consumption increases the amount of choline in the plasma, and high plasma choline increases prostate cancer risk.³ 

Four previous studies implementing a plant-based diet and exercise following prostate cancer diagnosis found a decrease in prostate cancer progression rates.⁴ 

Dietary strategy for prostate health 

References:

1. Richman EL et al. Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression. Am J Clin Nutr. 2009 Dec 30. [Epub ahead of print]

2. Sinha R et al. Meat and meat-related compounds and risk of prostate cancer in a large prospective cohort study in the United States. Am J Epidemiol. 2009 Nov 1;170(9):1165-77. Epub 2009 Oct 6.

3. http://www.foodnavigator.com/Science-Nutrition/Meat-not-linked-to-prostate-cancer-recurrence-risk

4. R. W.-L. Ma, K. Chapman. A systematic review of the effect of diet in prostate cancer prevention and treatment. J Hum Nutr Diet, 22, pp. 187–199 

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Folic acid supplementation is dangerous – especially for pregnant women

In a 10-year study,^1,2 scientists found that women who take multivitamins containing folic acid increase their breast cancer risk by 20-30%.

Even more alarming are the associations between supplemental folic acid during pregnancy and death from breast cancer,⁸ and asthma and respiratory tract infections in children.^5-6

Read full article

Folic acid is the synthetic form of folate, a B vitamin, which is abundant in green vegetables. Folate protects against birth defects known as neural tube defects (NTDs). Pregnant women could safely increase their folate status and prevent NTDs by eating green vegetables, but instead they are instructed to take folic acid supplements, putting them and their children at risk. Folic acid supplements are not a substitute for folate-containing green vegetables – there are inverse associations between maternal vegetable intake and childhood cancers.^12-13

Unlike synthetic folic acid, folate obtained from food sources – especially green vegetables – protects against breast and prostate cancer.

There is inverse relationship between dietary folate intake and breast and prostate cancer.^14,3 Chemical differences between folate and folic acid translate into differences in uptake and processing of these two substances by the cells in the intestinal wall – excess folic acid in the circulation can occur. Luckily, folate from food comes naturally packaged in balance with other micronutrients and the body regulates its absorption.⁹

Rich sources of food folate

As a reference point, the U.S. RDA for folate is 400μg. Below is the approximate folate content for a 100-calorie serving.⁸

Additional foods listed in full article

Clearly, we do not need synthetic folic acid supplements to meet our daily folate requirements.

Dr. Fuhrman’s Gentle Care Formula Multivitamin does not contain folic acid

Supplemental folic acid has also been linked to prostate cancer³, colorectal cancer⁴, and overall cancer mortality.⁷ Because folate is abundant in the nutritarian diet, and synthetic folic acid is so potentially dangerous, folic acid is not included in Dr. Fuhrman’s Gentle Care multivitamin.

Dr. Fuhrman does not recommend prenatal vitamins because of the potentially harmful ingredients, such as folic acid.

Dr. Fuhrman’s special recommendations for pregnant women:

• Gentle Care Formula
• Osteo-Sun
• Iron supplementation (approx. 30 mg/day when needed)
• DHA Purity
• A nutrient dense diet, rich in green vegetables (and folate)

(See full article for references)

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If breast and prostate cancer were detected early, via mammograms and PSA tests, treatment could begin earlier, and lives would be saved – right?

Wrong, according to a recent article in the Journal of the American Medical Association that examined incidence and mortality rates for breast and prostate cancer over the past 20 years.¹

Why? The authors think that we are in a state of “overdiagnosis” – that many slow-growing, non-threatening tumors are being detected and treated; at the same time, the more dangerous and aggressive cancers may be missed because they can grow and become lethal in the time interval between screenings, and by then treatment will not work. Overall, the mortality rates of breast and prostate cancer have not decreased significantly in the past 20 years.

Still, are there sound reasons to skip these screenings altogether? You decide…

Mammograms: Following detection of a tumor, 80% of biopsies are negative, and the risk of false positives is very high in women under 50.² This equates to thousands and thousands of unnecessary surgical procedures are performed on women after they have had a suspicious mammogram result. In a recent review, it was estimated that for every 2000 women screened, one will benefit, more than 200 will have a false positive result, and 10 healthy women will be treated unnecessarily.³ And those women who are treated for cancers earn many chemotherapy-related deaths counterbalancing any life-span enhancements in those treated.⁴ PSA tests: About 70% of men who have elevated PSA levels do not actually have cancer.¹ And the side effects of the associated treatments include bowel, urinary, and sexual dysfunction.⁵ Additionally, a 9-year study in Sweden showed that men who had undergone endocrine treatment for prostate cancer were at a 20-30% increased risk of cardiovascular diseases and death from myocardial infarction.⁶ 

With both of these tests, detection of low-risk cancers also causes much undue emotional trauma to patients and their families.

(image credit: Samat Jain @Flickr)

The American Cancer Society now advises:

“There are some cancers for which we don’t currently recommend screening, such as prostate cancer, because the benefits are unclear or unproven.”⁷ 

The authors of the JAMA article offer strategies for the scientific and medical communities: to find specific biomarkers that can differentiate high-risk from low-risk cancers, and to target high-risk individuals with preventive treatments.

I offer a strategy to you: Be proactive – reduce your risk of breast and prostate cancer. Practice prevention by maintaining a healthy weight and eating an anti-cancer diet - a high-nutrient diet rich in protective phytochemicals from cruciferous vegetables, leafy greens, and berries, and minimizing or eliminating browned foods, animal products, and refined flour and sugar. Taking sufficient Vitamin D is also important. You can read more about the strong connections between diet and cancer in my article “Eat for Health – the Anti-Cancer Diet."

References:

1. Esserman L, Shieh Y, Thompson I. JAMA. 2009 Oct 21;302(15):1685-92. Rethinking screening for breast cancer and prostate cancer.

2. Wright CJ, Mueller CB. Screening mammography and public health policy: the need for perspective. Lancet 1995;346(8966(:29-32.

3. Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001877.

4. Rock E, De Michele. A Nutritional approaches to late toxicities of adjuvant chemotherapy in breast cancer survivors. J Nutr 2003 Nov;133(11 Suppl 1):3785S-3793S.  

5. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 2005;293 (17):2095-2101

6. M. Van Hemelrijck et al. 1BA Increased cardiovascular morbidity and mortality following endocrine treatment for prostate cancer: an analysis in 30,642 men in PCBaSe Sweden. EJC Supplements - September 2009 (Vol. 7, Issue 3, Page 1, DOI: 10.1016/S1359-6349(09)72024-5)

7.http://www.cancer.org/docroot/MED/content/MED_2_1x_A_Special_Message_from_CEO_John_Seffrin_PhD_on_Cancer_Screening.asp)

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People are getting unnecessary medicals test that cost a ton of money? No, you don’t say! A new study in the Journal of the National Cancer Institute reveals large-scale screening for prostate cancer using the prostate-specific antigen, or PSA, test has resulted in mass over-diagnosis and over-treatment:

The death rate from prostate cancer has fallen in the United States, but not necessarily because of mass screening, study co-author Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Medical School's Institute for Health Policy and Clinical Practice contended. "There are a number of reasons why mortality might fall, but the most obvious is that we have better treatment," he said. "Even without early detection, I expect mortality would fall."

Results of a European study reported earlier this year indicated that "to save the life of one man, 50 must be over-diagnosed," he said.

Guidelines for screening for blood levels of PSA -- a protein produced by the prostate gland -- differ widely. The American Cancer Society does not recommend PSA screening. But, the society says a PSA test can be offered to men, starting at age 50, during a discussion with their physician. That discussion should also include an explanation of the potential benefits and limitations of such screening.

It all comes down to money! I asked Dr. Fuhrman about it and he said, “It’s true. Prostate cancer screening in general is flawed, but it is big business and the business of medicine trumps science because of the money to be made.” And Dr. Fuhrman insists the PSA test does not accurately detect cancer anyway.

An important thing to remember is prevention, prevention, prevention! Reports come out all the time highlighting the benefits of plant foods on prostate cancer prevention:

• Less Meat, More Veggies Prevents Prostate Cancer
  

• Pomegranates Slow Prostate Cancer
  

• Vitamin K Battles Prostate Cancer!

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A good half hour in the gym is a great way to blow off some steam and according to a new study in the journal Cancer, exercise also helps improve life after cancer, specifically breast, prostate and colorectal cancer.

They interviewed 753 men and women, all at least 65 years old, who had survived 5 or more years after a breast, prostate, or colorectal cancer diagnosis. All were overweight to some degree, but none was morbidly obese.

When the interviewers asked about exercise, diet, weight status, and quality of life, they found that half the group got no more than 10 minutes of moderate-to-vigorous exercise per week, and only 7% had healthful eating habits…

…However, those who exercised more and had better diet quality also had better physical quality of life outcomes (e.g., better vitality and physical functioning) than those who exercised less and ate poorly. Also, the greater the body weight, the poorer the physical quality of life.

In general, conclude [researchers], the results point to "the potential negative impact of obesity and the positive impact of physical activity and a healthy diet on physical quality of life in cancer survivors.

In related news, doing moderate to high-intensity exercise for 30 minutes a day cuts cancer risk in men by 50%. Regular exercise helps strengthen bones too.

Via Reuters.

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Omega-3 fatty acids, the good fats recently found to improve heart health and help prevent prostate cancer, are now being associated with lower bodyweight.

Published in the British Journal of Nutrition, scientists observed that overweight or obese people had blood levels of omega-3s roughly 1% lower than healthy people.

For the study, 124 people of varying bodyweights—21 were classified as healthy weight, 40 overweight and 63 obese—had blood samples taken, with results showing an inverse relationship between omega-3 levels and participants’ waist size and hip circumference.

Obese people had omega-3 levels of 4.53%, but healthy people had levels of 5.25%.

Sure, it’s only a small difference, but healthy bodyweight is just one perk of omega-3s. Other reports have shown omega-3 fatty acids offer protection from stroke, depression linked to pregnancy and help lower young children’s risk of type-1diabetes.

Good sources of omega-3 include flaxseed, walnuts and micro algae-derived supplements.

Via Food Navigator.

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A night at the pub might land you a night in the emergency room. No surprise really. Reports have shown drinking alcohol increases the risk of bowel cancer and aggressive prostate cancer.

And now, a new findings in the Journal of Epidemiology and Community Health claim even as little as four pints of beer each week can raise a man's chances of needing hospital treatment.

For the study, researchers studied 5,772 Scottish men, ages 35 to 64, and discovered those participants who drank the equivalent of four pints of beer, eight shots of liquor or eight small glasses of wine, were more likely to be admitted to the hospital.

Experts observed the risk grew as the amount of alcohol consumed increased and heavy drinkers stayed longer in hospitals than people who abstained.

Reminds be of that episode of Scrubs when J.D., Turk and their college buddy are hung over from the night before and hook themselves up to IVs to sober up. Too funny!

Now, boozing might be a good time, but it’s iffy. Other studies have even associated alcohol consumption with erectile dysfunction and brain shrinkage. Eek!

Via the BBC.

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The days of the film noir private dick taking a slick drag off a cigarette and sipping a shot of stiff whiskey are long gone. He died from lung cancer and cirrhosis of the liver.

Now, booze might look cool up on the big screen, but it doesn’t do your health any favors. In the past, reports have linked alcohol to cardiovascular disease and erectile dysfunction. Eek!

Go on and add prostate cancer to the list. A new study in the journal Cancer found heavy drinkers—men who drank 1.7 ounces of pure alcohol each day, the equivalent of four shots of hard liquor, four or five times a week—had a higher risk of aggressive prostate cancer.

That’s a lot of drinking! The typical beer has 4% to 6% alcohol by volume, wine 12.5% to 14.5% and around 40% for vodka.

The study aimed to test alcohol’s effect on finasteride—found in popular prostate cancer medications—showing that alcohol reduces the drugs benefits. Clearly, drugs aren’t the be-all-end-all of for prostate cancer. That’s why the researchers recommend men limit their intake of alcohol.

In related news, experts determined eating less meat and more vegetables helps prevent prostate cancer.

Via HealthDay News.

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