Transcript NUTRITION FOR PROSTATE HEALTH

NUTRITION
FOR PROSTATE
HEALTH
Colleen Takagishi RD, CSO, LDN
Characteristics of Men with PC
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Very motivated to learn about nutrition
and prostate cancer
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Many have made diet changes based
common knowledge general cancer diet
guidelines
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High use of nutrient supplements with or
without diet changes
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Understanding Nutrition and Cancer: How
Recommendations are Formed
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Applying Research to Practice
Prostate Cancer as a Chronic Disease
Primary Risk Factors for
Prostate Cancer
Age
Family history/genetics
 Ethnicity
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Ongoing research suggests that certain nutrition
and lifestyle variables play a role in initiation and
progression of prostate cancer
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You cannot change age, genetics but you can
modify risk with diet and movement
How We Know What We Know
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Epidemiological/Population Studies
 Observations of diet/lifestyle
and disease patterns
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Controlled trials
 SELECT : Selenium and Vitamin E Cancer Prevention Trial, a
prevention clinical trial to see if one or both of these dietary
supplements prevent prostate cancer - NO
WCRF/AICR : leading US/World cancer organization that fosters, supports and summarizes research on diet,
weight, physical activity and cancer
www.dietandcancerreport.org
Challenges of Nutrition Research
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Expensive ; not profitable
Complex and Evolving Science
Confounding Variables
Subjective : Tell me what you think I want to hear
 Non-nutrition variables: stress, smoking, alcohol,
exercise, gene variants
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Compounded food-nutrients or Food Synergy
What Do We Know?
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Do not prove cause/effect but suggests an
association.
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Identify a relationship between food and cancer
but cannot prove that this food directly causes a
lower cancer risk
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People who consume a plant based diet appear to
have less incidence of all cancers
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Men who consume foods high in lycopene appear to
have less prostate cancer
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NOT lycopene prevents prostate cancer
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When a consistent pattern of studies show an
association between a diet/lifestyle behavior and
cancer then it suggests that a causal relationship
exists
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Science has demonstrated an association
between diet and risk of primary cancers
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Source: AICR/WCRF 30-60% of cancer associated with diet, physical
activity and weight control
Scientists suspect that foods/diet patterns that
prevent cancer may also
May prevent second cancers from developing
 Prevent your cancer from returning
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Important Facts
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Most cancer research done with natural foods
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Difficult to study which foods or components
of a food offer protection
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Identified nutrient may be a “marker”
Increasingly we find that foods eaten in their
natural state confer the most protection.
Importance of Natural Foods
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Consumption of natural carotene rich foods appear protective in
cancer but use of supplement negates protection
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Use of supplemental beta carotene in smokers linked to incidence of
and progression of lung cancer (and prostate)
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Whole tomato products offer better protection from PC than
lycopene supplements alone
Source: Tomatoes or lycopene versus prostate cancer: is evolution anti-reductionist? J Natl Caner Inst. 2003 Nov 5;95(21):1563-5
FOOD SYNERGY
The process by which identified and
unidentified nutrients within a particular
food or between foods work in
combination
Examples of Synergy in PC
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Broccoli and tomato alone clearly beneficial
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Combination of broccoli and tomato appear to more effectively fight
prostate cancer than either food alone.
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Whole tomato products offer better protection from PC than
lycopene supplements alone
Source: Tomatoes or lycopene versus prostate cancer: is evolution anti-reductionist? J Natl Caner Inst. 2003
Nov 5;95(21):1563-5
Digging Deeper
Nutrient Specificity
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Lycopene and prostate cancer
Beta carotene and lung cancer
Calcium and breast/prostate cancer
Selenium protective in certain gene
variant while not in another
WCRF/AICR General Guidelines
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Choose mostly plant foods
Limit red meat
Avoid processed meats
Be physically active 30 min or more/day
Aim to be a healthy weight throughout
life
Do not smoke or chew tobacco
Characteristics of men with PC

Many have made diet changes based
common knowledge general cancer diet
guidelines

Very motivated to learn about nutrition
and prostate cancer

High use of nutrient supplements with or
without diet changes
+Association
Plant Based Diet
9-11
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Men who consumed more vegetables per
week associated with 50% lower risk of PC
(1)
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Men who increased vegetables 35
significant reduction in rate of PSA rise (2)
(1) Lifestyle and health-related quality of life of men with prostate cancer managed with
active surveillance. Urology.2006 Jan;67(1):125-30
.
(2) Adoption of a plant-based diet by patients with recurrent prostate cancer. Integr Cancer
Ther. 2006 Sep;5(3):214-23
Sample 9 vegetable and fruit plan
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Whole grain cereal; Milk/Soy ; Seasonal
berries
V8 juice
 Edemame
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Chicken ; Whole grain bread ; Vegetable
soup
Fresh pear
 Carrots/hummus
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Pan seared scallops ; Sautéed sesame
spinach ; Garden salad ;Rice
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Pomegranate juice; Greek yogurt
Lycopene
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PC progression slowed in men consuming
lycopene rich foods 2 or more times per
week
A diet rich in both broccoli and tomato
based foods appeared to fight PC more
effectively than either food consumed
alone
Source: Chan et al, 2006. Diet after diagnosis and the risk of prostate cancer progression,
recurrence and death (United States). Cancer Causes and Control.Mar;17(2):199-208
Source: Canene-Adams et al, 2007. Combinations of tomato and broccoli enhance antitumor
activity in dunning r3327-h prostate adenocarcinomas. Cancer Res. Jan15;67(2):836-43
Knowledge Deficit
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Lycopene : probable modifying factor
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25% identified properly ; 75% did not
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One person knew where to find the most
potent sources of lycopene in diet
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No one knew the quantity of lycopene that
has been demonstrated to slow progression of
PC
Lycopene Food Sources
30 mg
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Tomato paste
Marinara sauce
Tomato soup
Tomato juice
Raw tomato
1cup
1cup
1 cup
1cup
1 cup
Source: USDA National Nutrient Database for Standard Reference
75 mg
40 mg
26 mg
22 mg
4.6 mg
-Association : Calcium
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Dose response relationship between
advanced/aggressive PC and milk intake (a marker for
calcium intake)
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Association between all prostate cancer risk and milk
and dairy products
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Milk and calcium: difficult to sort out which variable
(the milk or the calcium) is the culprit either + or –
because they are so intertwined
Source: Food, nutrition and the prevention of cancer: a global perspective. Washington (D.C.): The
Institute 2007. Chapter 7, Cancers; p. 305-309
Milk/Calcium Theories
IGF-1: milk increases blood levels of
IGF-1, which has been associated with
PC in some studies
Not conclusive A does not = C
 Synergy : high intake of calcium may
down-regulate the formation of
vitamin D which in turn increases cell
proliferation in the prostate
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Calcium Table
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Milk (all)
Yogurt
Mozzarella
Ice Cream
Cottage Chez
Almonds
Carrots (cooked)
1 cup
1 cup
1 oz
1 cup
4 oz
1 oz
1 cup
~400 mg
~400 mg
~200 mg
~200-300 mg
~80 mg
~75 mg
~50 mg
RDI: 1000 mg/day 19-50 yrs; 1200 mg/day >50yrs
- Body Weight
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A study of 2,000 men revealed that men who
maintained healthy weight were less likely to
have recurrence of PC.
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Obese men 30-69% increased risk of recurrence
when compared to healthy weight men.
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The greater body weight = higher risk of PC
Source: Impact of obesity on prostate cancer recurrence after radical prostatectomy: data from
CaPSURE. Urology. 2005 Nov;66(5):1060-5.
How Much Does Weight Matter?
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The mortality rate from PC for overweight
men was found to be 25% greater than
healthy weight men. The risk of death was
found to be twice as high for obese men
when compared to healthy weight men
Source: Wright ME, et al, 2007. Prospective study of adiposity and weight change in
relation to prostate cancer incidence and mortality. Cancer 2007 Feb 15;109(4):675-84
Targeted Nutrition Therapy
Research  Practice
Target Nutrients for PC Health
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Eat a varied plant-based diet
 lycopene ***
 Selenium ***
 Legumes **
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Limit Calcium intake *** and get adequate Vitamin D
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Low fat diet * with emphasis on healthy fats
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Avoid processed meats **
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Limit processed foods such as refined grains/sugars *
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Achieve and maintain IBW *
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Avoid inappropriate nutrient supplementation
What Will It Cost?
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Commit to hard work
A change in American paradigm from
treat with a drug (supplement) to doing
the hard work required
Supplement truly means “supplement”
not supplant
Stay educated – be curious but discerning
Keep your eye on emerging research in PC
Value Added?
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Prevention : you and your family
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Reduced risk of recurrence
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Reduce risk of second cancers
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Diet for all chronic disease : most men die
with rather from PC
Quality of Life
Vitality
 Strength ; Stamina
 Increased energy
 Mental clarity
 Sense of control
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Eat Well!
Colleen M Takagishi RD, CSO, LDN
Oncology Nutritionist
Kellogg/Prostate Cancer Center of Excellence
[email protected]
847.328.4802