Transcript "Nutrition & Prostate Cancer" Greta Macaire, RD

Nutrition & Prostate Cancer:
Exploring the role of diet
Presented by
Greta Macaire, MA, RD, CSO
UCSF Helen Diller Family Comprehensive
Cancer Center
Nutrition & Prostate Cancer
• Improved nutrition may reduce the incidence of
prostate cancer & the risk of prostate cancer
progression (J Urol. 2005 Sep;174(3):1065-9).
• “Scientific evidence suggests that differences in diet
& lifestyle may account in large part for the variability
of prostate cancer rates in different countries”
(CaPCure).
• “The increase in prostate cancer deaths in Asian and
Eastern European countries has been thought to
reflect westernization, including increased
consumption of animal fat, obesity, and physical
inactivity” (ACS. Global Cancer Facts & Figures, 2nd Edition, 2008).
Prostate Cancer Lifestyle Trial (PCLT)
Ornish D, et al., J Urol. 2005 Sep;174(3):1065-70
• Randomized controlled trial:
– 93 men (non-smoking) on active surveillance for prostate cancer.
– Intervention (low-fat, vegan diet, w/soy and antioxidants, omega-3
fatty acid, moderate aerobic exercise, stress management, and
group support) vs. Control (usual care)
• Results:
– After 1 year, PSA ↓4% in the intervention group & ↑6% in the
control group.
– Prostate cancer cell growth was inhibited ~8 times more by blood
from the intervention vs. control group.
• Conclusion:
– Intensive changes in diet and lifestyle may affect the progression
of early stage prostate cancer and improve quality of life.
– Further studies and longer term follow-up are warranted
PCLT - Two year follow up
Frattaroli, et al. Urology. 2008 Dec;72(6):1319-23
• 27% of control patients vs. 5% of intervention
patients underwent conventional treatment.
• Intervention group also had significant
decreases in total cholesterol and LDL.
• 95% adherence to lifestyle program in the
intervention group.
GEMINAL Study
• Gene Expression Modulation by
Intervention with Nutrition & Lifestyle Study
– Single arm, pilot study - 30 men, active
surveillance, biopsy at baseline and after 3 mos
intensive lifestyle change.
– Gene expression in > 500 genes was affected:
• Significant modulation of biological processes that
have critical roles in tumorigenesis.
– Total PSA did not significantly change, % free
PSA, CV risk factors, & some measures of QoL
improved.
Ornish, et al., Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-74)
Guidelines for a Healthy Diet
• Plant-based diet
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Plethora of colorful fruits, vegetables, herbs & spices
High fiber – whole grains and beans/legumes
Limit processed & refined foods  avoid WHITE
Limit meats & dairy
• Low fat diet with emphasis on healthy fats
• Drink plenty of fluids
• Stop smoking if you smoke
• Limit alcohol consumption
• Be physically active to help achieve and maintain a
healthy weight
Benefits of Eating a Plant Based Diet.
• Meat Based
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• Plant Based
High in cholesterol
High in saturated fats
High in oxidants
Low in antioxidants
Pro-inflammatory
Low in fiber
• High in pathogenic
substances
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No cholesterol
Low saturated fats
Low in oxidants
High in antioxidants
Anti-inflammatory
High in fiber
• High in protective
substances
Dewell A, et al. Am Diet Assoc. 2008;108:347-356.
Phytochemicals: Protective
Compounds in the Food We Eat
Food sources of phytochemicals with
anti prostate cancer activity
• Indole-3-Carbinol:
– Cruciferous vegetables – broccoli, Brussels sprouts,
cabbage, cauliflower, collard greens, kale, kohlrabi,
mustard greens, radish, rutabaga, and turnips.
• Lycopene/Other Carotenoids:
– Cooked tomato products, raw tomatoes, watermelon
– Carrots, sweet potatoes, peppers, mangos,
cantaloupe
• Organosulphur compounds:
– Garlic, leeks, onions, shallots
• Ellagitannin:
– Pomegranate
Food sources of phytochemicals with
anti prostate cancer activity
• Isoflavones:
– Soy foods
• EGCG:
– Green and white tea
• Resveratrol:
– Grape skins, peanuts, mulberries, cranberries, soy
• Curcumin:
– Turmeric
• Quercetin:
– Teas, onions, apples, berries, buckwheat,
cruciferous vegetables
Insulin, Glycemic Control, & Cancer
• A Western lifestyle -- characterized by low physical
activity, & high dietary intake, animal protein,
saturated fats, trans fats, & rapidly digestible
carbohydrates -- is associated with ↑ risks of many
cancers.
– May be mediated by alterations in the metabolism of the
hormones insulin and insulin-like growth factors (IGFs).
– Insulin & IGF-I may promote tumor development by
inhibiting apoptosis, stimulating cell proliferation,
stimulating synthesis of sex steroids, changing gene
expression, and inhibiting the synthesis of sex hormonebinding globulin (SHBG).
Insulin, Glycemic Control, & Cancer
• Recent studies indicate that high insulin & IGF-1
levels, & greater abdominal fat are associated with
increased risk for various cancers.
• Additionally, hyperinsulinemia is associated with
increased risk of heart disease, type 2 diabetes, ↓
immune system, & weight gain (obesity).
• Obesity & fasting hyperinsulinemia have also been
associated with a poorer prognosis in cancer
patients.
Dietary Strategies to Improve
Glycemic Control
• Aim for 30-45 gm fiber daily
– ↑vegetables, beans/legumes, whole grains
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Limit portions of starchy carbohydrates
Avoid ‘white’ foods
Limit caloric beverages (avoid HFCS)
Avoid eating starches alone; combine with
protein & healthy fats
• Avoid evening snacking; ↓evening meal size
Healthy Plate = Energy & Balance
VEGETABLES
& FRUITS
LEAN OR PLANT
PROTEIN
SOURCE
Healthy Fats
WHOLE GRAINS/
STARCHY
VEGETABLES
Reading the Nutrition Facts Label
The 10:1 Rule
For every 10 gm of
total carbohydrate listed on
the label, you want ≥1 gm of
dietary fiber
Note that for most breads and
cereals, look for 3 or more
grams of dietary fiber/serving
Finding Whole Grains
Inflammation & Cancer
Obesity and Inflammation
Fat cells especially
visceral fat (the kind
around the waistline) are
active cells 
secreting chemicals
(TNF-alpha, IL-6, CRP,
leptin) that promote
chronic inflammation.
Essential Fatty Acids
Omega-6 fatty acids
Decrease Omega-6 Fatty
Acids:
Meats (especially grain-fed),
butter, whole milk, egg yolks,
sunflower oil, safflower oil,
cottonseed oil, corn oil, &
processed foods made with
these oils.
Both types of fat are essential.
Imbalance of omega-6 to
omega-3 oils can have
negative affects on the
metabolism of eicosanoids.
Omega-3 fatty acids
Increase Omega-3 Fatty
Acids:
Cold-water fish (i.e., salmon,
trout, sardines, herring,
sablefish), DHA enriched
eggs, flaxseeds, chia seeds,
walnuts & pumpkin seeds.
Standard American
Diet (SAD)
Pro-Inflammatory
Compounds:
Promote inflammation,
tumor growth, progression
& angiogenesis
Suppress immune function
Ratio of Omega-6 to
Omega-3 intake: 20:1
Traditional/Ideal ratio:
~2:1
Anti-Inflammatory
Compounds:
Inhibit tumor growth &
angiogenesis
Immune enhancing
Healthy Fat Recommendations
• Keep saturated fats to 7% total kcals from fat.
– Limit or avoid fatty meats, whole milk dairy products,
cheese, mayonnaise, butter, & baked goods.
• Avoid trans fat, AKA partially hydrogenated oils
• Aim for 1:1 to 4:1 omega-6:omega-3
– Limit processed foods
– If eating out often, inquire about type of oil used at
restaurants
– Use olive oil, avocado, almond, macadamia nut or
canola oil for cooking/salads
– Increase sources of omega-3’s daily
• Fish, chia seeds, flaxseeds, walnuts, pumpkin
seeds
• EPA/DHA supplement if appropriate
Body Weight & Physical Activity
• Obesity & inactivity = ↑ risk of prostate cancer & prostate
cancer progression.
– A cohort study reported an ↑ risk of death from prostate
cancer:
• Obese men ↑ risk by 20 %/ Severely obese ↑ risk by 34%
– A UCSF study of over 2,000 men found that maintaining
a healthy body weight ↓ the risk of recurrence.
• Obese men  recurrence by 30%
• Very obese men  recurrence by 69%
– Men with prostate cancer who walked briskly for ≥3
h/wk had a 57% lower rate of progression than men
walking at an easy pace for <3 h/wk (Cancer Res; 71(11); 1–7.
2011 AACR).
Physical Activity
• Physical activity IN ANY FORM helps ↓
risk of cancer.
– Influences hormone levels, ↑ immune
function, improves digestion, helps control
body weight
• Any steps taken are beneficial.
– Aim for 30-60 minutes of exercise most days.
– Everything counts: All types/Cumulative
Dairy & Prostate Cancer
• A meta-analysis on 8 cohort studies found a
6% increase in prostate cancer risk per
serving of dairy per day (AICR/WCRF - 2nd Expert Report.
November 2007).
• In a 7.5 year prospective study of 43,435
Japanese men, those consuming the highest
amount of dairy (=12 oz of milk/day) had a
63% ↑ risk of prostate cancer compared to
men consuming the lowest (=2 oz of milk/day).
(Kurahashi, et al. Cancer Epidemiol Biomarkers Prev. 2008 Apr;17(4):930-7).
Vitamin D
• Vitamin D is known to inhibit prostate cancer in animals
& appears to have a similar effect in humans.
• Non-dairy sources of vitamin D include cold-water fish,
fortified products (i.e., soy milk, cereals), & sunlight.
• A supplement of vitamin D3 (cholecaciferol) may be
beneficial (1000 IU or more if needed).
• It is suggested to test serum 25-OH vitamin D level,
especially if undergoing ADT &/or have darker
pigmented skin.
– Appears to be optimal at >40 ng/ml (AJCN 2006).
Lifestyle factors for benign prostatic
hyperplasia (BPH) and lower urinary tract
symptoms
Parsons, JK Current Opinion in Urology.
21(1):1-4, January 2011. DOI:
10.1097/MOU.0b013e32834100c9
Supplements & BPH
• Saw Palmetto:
– Studies conflicting about benefits for improving
symptoms. Dosage: 160 mg, 2 x day
• Beta-sitosterol:
– Improves urinary symptoms. Dosage: 20 mg, 3 x day
– Food sources: vegetables, fruits, nuts/seeds,
avocados, vegetable oils
• Pygeum:
– Decreases nocturia, increases peak urine flow, and
reduces residual urine volume. Dosage: 50 mg, 2 x
day or 100 mg, 1 x day
What can a healthy diet do for me?
• May help to inhibit prostate cancer growth
• Reduce risk of chronic diseases
• Enhance immune system
• Increase energy levels
• Facilitate recovery   toxicities of
treatment
Healthy Prostate Cancer Diet
Plant-Based
• 8-10 COLORFUL fruit & vegetable servings daily
– Eat 1 cup or more vegetables with at least 2 meals
– Herbs & spices daily
– Lycopene (30 mg) from food  6 ½ tbsp tomato paste, ¾ C
tomato sauce, or 12 fl oz tomato juice
– Pomegranate  1 oz concentrate or 8 oz juice
• Beans/legumes, whole grains & other high fiber foods
– 30-45 grams of fiber daily
– 2 T ground flaxseed
• Limit or avoid meats & dairy
• Limit or avoid processed & refined foods  avoid WHITE
Healthy Prostate Cancer Diet
Limit alcohol consumption
Fats
• Low in fat (20-25% of calories)
• Healthy fats  cold-water fish, flaxseeds, chia seeds,
walnuts, soybeans, olive oil, avocados
Green Tea  1-4 cups daily
Vitamin D (1000 IU or more if needed)
– Consider serum 25-OH test  Recommend > 35 ng/ml
Regular physical activity and avoid excess calories
to achieve or maintain a healthy body weight.
Resources
Cookbooks
• Cancer Lifeline Cookbook – written by Kimberly Mathai, 2004
• Eat to Beat Prostate Cancer – written by David Ricketts, 2006
• One Bite at a Time – written by Rebecca Katz, 2004
• The Cancer Fighting Kitchen – written by Rebecca Katz, 2009
Websites
• http://www.aicr.org
• http://www.caring4cancer.com
• http://cancer.ucsf.edu/crc
• http://www.consumerlab.com
• http://www.cancerproject.org
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf
Thank you