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NUTRITION FOR PROSTATE HEALTH Colleen Takagishi RD, CSO, LDN Characteristics of Men with PC Very motivated to learn about nutrition and prostate cancer Many have made diet changes based common knowledge general cancer diet guidelines High use of nutrient supplements with or without diet changes Understanding Nutrition and Cancer: How Recommendations are Formed Applying Research to Practice Prostate Cancer as a Chronic Disease Primary Risk Factors for Prostate Cancer Age Family history/genetics Ethnicity Ongoing research suggests that certain nutrition and lifestyle variables play a role in initiation and progression of prostate cancer You cannot change age, genetics but you can modify risk with diet and movement How We Know What We Know Epidemiological/Population Studies Observations of diet/lifestyle and disease patterns 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 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 Compounded food-nutrients or Food Synergy What Do We Know? Do not prove cause/effect but suggests an association. Identify a relationship between food and cancer but cannot prove that this food directly causes a lower cancer risk People who consume a plant based diet appear to have less incidence of all cancers Men who consume foods high in lycopene appear to have less prostate cancer NOT lycopene prevents prostate cancer When a consistent pattern of studies show an association between a diet/lifestyle behavior and cancer then it suggests that a causal relationship exists Science has demonstrated an association between diet and risk of primary cancers 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 Important Facts Most cancer research done with natural foods Difficult to study which foods or components of a food offer protection Identified nutrient may be a “marker” Increasingly we find that foods eaten in their natural state confer the most protection. Importance of Natural Foods Consumption of natural carotene rich foods appear protective in cancer but use of supplement negates protection Use of supplemental beta carotene in smokers linked to incidence of and progression of lung cancer (and prostate) 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 Broccoli and tomato alone clearly beneficial Combination of broccoli and tomato appear to more effectively fight prostate cancer than either food alone. 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 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 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 Men who consumed more vegetables per week associated with 50% lower risk of PC (1) Men who increased vegetables 35 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 Whole grain cereal; Milk/Soy ; Seasonal berries V8 juice Edemame Chicken ; Whole grain bread ; Vegetable soup Fresh pear Carrots/hummus Pan seared scallops ; Sautéed sesame spinach ; Garden salad ;Rice Pomegranate juice; Greek yogurt Lycopene 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 Lycopene : probable modifying factor 25% identified properly ; 75% did not One person knew where to find the most potent sources of lycopene in diet No one knew the quantity of lycopene that has been demonstrated to slow progression of PC Lycopene Food Sources 30 mg 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 Dose response relationship between advanced/aggressive PC and milk intake (a marker for calcium intake) Association between all prostate cancer risk and milk and dairy products 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 Calcium Table 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 A study of 2,000 men revealed that men who maintained healthy weight were less likely to have recurrence of PC. Obese men 30-69% increased risk of recurrence when compared to healthy weight men. 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? 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 Eat a varied plant-based diet lycopene *** Selenium *** Legumes ** Limit Calcium intake *** and get adequate Vitamin D Low fat diet * with emphasis on healthy fats Avoid processed meats ** Limit processed foods such as refined grains/sugars * Achieve and maintain IBW * Avoid inappropriate nutrient supplementation What Will It Cost? 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? Prevention : you and your family Reduced risk of recurrence Reduce risk of second cancers 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 Eat Well! Colleen M Takagishi RD, CSO, LDN Oncology Nutritionist Kellogg/Prostate Cancer Center of Excellence [email protected] 847.328.4802