Summary of Dr. Stephen J. Freedlander's Talk on Diet: “Nutrition and Prostate Cancer: What We Think We Know and What We Actually Know”

[Kuanyin]

“Nutrition and Prostate Cancer: What We Think We Know and What We Actually Know”

The following is a summary of the major points made by Dr. Stephen J. Freedland in his, talk “Nutrition and Prostate Cancer: What We Think We Know and What We Actually Know” at the 22nd Annual Scottsdale Prostate Cancer Symposium on Thursday, March 16, 2017.

Summary

--Low: calories, carbs (glycemic index

--High: Break-a-sweat exercise, vegetables and fruits, nuts, legumes (beans and peanuts)

--OK—Meat (as long as animals eat a natural diet [grass vs grain] (my words)

--Achieve and maintain a normal body weight

--Heart healthy=prostate healthy

--“Genes load the gun, but lifestyle pulls the trigger.”

Notice that there is nothing on this list about fats. The Dr. does discuss this in somewhat detail in his talk, but has left them out in his summary. I think the reason is that he is currently running a test using the Atkins Diet to see whether or not it affects PSA-one way or another, and is waiting to for the findings of the study. Actually, there are numerous research papers already out in the scientific literature supporting as well as attacking a Ketogenic diet, but he must feel that the information is inconclusive.

The talk is only 25 minutes or so. Most of you should hear it for yourselves to draw your own conclusions.

One important issue Dr. Freedland neglected to include in his talk is hormones. It does not make much of a difference with beef or dairy products whether the hormone is added or “natural,” you are still getting hormones from another species that are many times more concentrated than the very low amount (comparatively) you received in breast milk for a relatively limited period of time. Nor does he talk about how dead animals (hogs, for example) are returned as feed for their brethren. Nor does he discuss how the increase in Alzheimer's Disease may be attributed to Pion-based diseases (Mad Cow, etc) that have been misdiagnosed.

My own addition to this diet discussion is what I refer to as the "Nothing Burger Diet," (to borrow a term from the political realm) to which I use to refer to CR (Caloric Restriction) Diet. This is only anecdotal, but all of the cases of people who have managed to slow down their disease, appreciatively, are those who practice caloric restriction. This is a hard row to hoe, since most people can't even adhere to a low-carb diet. We have seen photos of people on CR diets: they appear gaunt, hollow cheeked, almost wasted. Supposedly, they claim to have " a lot of energy." I suppose if someone posed the following question to you: If you could be guaranteed that you would never have to go on chemo, would you follow a CR diet? Answer that one.

[Hidden]

Woody Allen said "You can live to be a hundred if you give up all the things that make you want to live to be a hundred."

I think we should all try to eat reasonably healthy and you can do that without sacrificing quality of life.

But some of these extreme diets start to reduce your quality of life if you can't eat a lot of the foods you enjoy. I've definitely given up some things, probably for the better, but I'm not willing to make extreme changes to my diet. What's the point of giving up too much of what you like eat for the theoretical possibility of living longer?

You ask if we would go on a CR diet if someone could guarantee us we'd never go on chemo. Of course that's exactly the problem, there are no guarantees either way. But even if there were, you always have to consider the reduction in quality of life when considering any treatment, including major changes in diet.

I prefer what I would call the "common sense" diet. We know in general which foods are healthy and which are not. I think we should all make an effort to eat healthy whether we have cancer or not. But as they say "everything in moderation".

[Kuanyin in reply to Hidden]

I won't even attempt to define "common sense" whatever it is. Often, so-called common sense (e.g.,the world is flat and the many religious beliefs about the world, man's place in it, evolution, you get the message) depend upon many variables and cultural assumptions. Listen to Dr. Freedman's talk, as I have suggested. My thought is, if you want to move the dial, so to speak, through diet, and you have a serious illness that is killing you, the only choice you may have is to go strongly in one direction--Keto, Vegan, CR). Yes, no guarantees, but that's what it may come down to. Middle-position often represents an inability to commit by covering one's bets.

[Hidden in reply to Kuanyin]

I think nutrition and cancer is a fascinating subject and I would like to see more scientific research on it. But I am "moving the dial" on the treatment of the "serious illness that is killing me". I am moving the dial by using treatments that have been proven through scientifically-based studies. I've had people tell me I could cure my cancer with everything from soy products to yoga. It's easy for them, because their life isn't on the line. The problem I have with a lot alternative and diet-based treatment solutions is the lack of scientific research. There are probably millions of diets that all claim to be the best, most healthy, etc., but there is little consensus, except for those "common sense" (sorry to use that again) things like eating raw, organic fruits and vegetables, staying away from additives, hormone fed meats, trans-fats, limiting or eliminating alcohol, and I could go on and on. The problem I see is that many diets have become like religions, each with their own followers, preachers, dogma, products to buy, etc.

I like the link you provided in another post to Prostate Cancer Foundation. Along with their recommendations on diet, they point out:

"1. Factors that have gained popular attention but lack sufficient data to base sensible recommendations...

The recommendations of diet are each given a star rating from 1 to 4 stars based on the scientific evidence to support them. Many are 1 star and none more than 2 star. Still there was a lot of good guidelines on eating healthy. But I have to say, I didn't see much there that wasn't common sense to me.

That said, if you can point us to some scientifically based studies on nutrition and cancer, similar to those that have been done for ADT, chemo, androgen blockers, immunotherapy, etc., I would love to read them. There are new breakthroughs all the time in cancer research.

[Kuanyin in reply to Hidden]

I agree. This business of diet is confusing and made worse when drs and researchers on one side (Vegans, for example) bad-mouth the research and diets of the other side (Ketogenic, Paleo, Atkins, etc.). As far as the "research" is concerned, there is certainly no evidence of so-called "proof" on either side to support their conclusions. As far as accepted "science"--based treatment. One thing we can be certain about, none of them kills stem cells (undifferentiated cancer cells). They are the ones that survive and go on to to spread the disease. The treatments buy us some time...at a price. There is probably no one in the cancer community who isn't hedging his (her) bets by taking supplements, retooling diet, going to Mexico or the Bahamas for treatment, eating fat and protein or drinking four glasses of carrot juice everyday, ad nauseam. Yes, as you have said, it's a matter of "control" over what, essentially, is uncontrollable. That said, each of us does what he or she hopes will, at best, help our condition at least a little and not make it worse.

[Scruffybut1 in reply to Hidden]

Good morning Gregg. Generally I agree with you. What is the point of eating something you know you don't like? Because you might live an extra unhappy week? We've all been diagnosed and live with a real bastard of a disease. My dietary change is to eat and drunk a little less of what I enjoy. Always enjoyed vegetables and pulses. Love red meats, chicken, fish. Chocolate - very dark. Actually lived in Greece for 5 years so enjoyed the Mediterranean diet. Went back to visit my Greek friends a few years back, saw most in the village cemetery. So much for Mediterranean diet! I love life and following my brothers and sisters on this site. So helpful. Enervating. Wish I could be more helpful. David

[Hidden in reply to Scruffybut1]

It's funny how people tout this so-called Mediterranean diet when in fact there are so many different diets in that region. I've been reading about it and some of them are pretty bad by what we would consider healthy. What I would like is not their diet, but there genes. That's probably 90 percent of it right there.

[Scruffybut1 in reply to Hidden]

Other than serious business owners all the Greek friends would begin the day with a visit to the Kafeneion for powerful black coffee and brandy. It worked for them. Interestingly a recent published work showed that drinking strong coffee (northern Italy) seemed to provide a resistance to PCa. Equally Nordic coffee. Differing production methods but both 'better' than other coffees. 6 cups black coffee recommended for diabetic control. (I have used this for 30 years).

[Hidden in reply to Scruffybut1]

I'm having a cup right now and I appreciate it so much. Coffee is one of those things I just don't want to live without, even if it could give me an extra 4 days to live.

[Sisira]

I agree with the views of gregg57.

Sisira

[TommyTV]

Alcohol is a well known testosterone suppressant.

Discuss?

[Scruffybut1 in reply to TommyTV]

I will have a pint first to freshen my thoughts!

[Hidden in reply to Scruffybut1]

I'll drink to that!

[pjoshea13]

As you say, Dr Steve Freedland does talk about fats. He says there are problems with old studies that suggested that fat promoted PCa. He cited 3 papers where fat was not implicated, so it's clear where he stands, IMO:

1] Park (2007):

ncbi.nlm.nih.gov/pubmed/174...

"Dietary fat and meat as potential risk factors for prostate cancer have been the focus of many epidemiologic investigations, and findings from recent studies in particular have been inconsistent. Therefore, we examined the association between these exposures and prostate cancer risk in the Multiethnic Cohort Study. The analyses included 82,483 men in Hawaii and Los Angeles ..."

"we found little evidence of any relation of fat and meat intake with prostate cancer risk within any of the 4 racial/ethnic groups (African Americans, Japanese Americans, Latinos and Whites)."

2] Crowe (2008)

ncbi.nlm.nih.gov/pubmed/184...

"Findings from early observational studies have suggested that the intake of dietary fat might be a contributing factor in the etiology of prostate cancer. However, the results from more recent prospective studies do not support this hypothesis ..."

"This was a multicenter prospective study of 142,520 men in the European Prospective Investigation into Cancer and Nutrition (EPIC)."

"After a median follow-up time of 8.7 y, prostate cancer was diagnosed in 2,727 men. There was no significant association between dietary fat (total, saturated, monounsaturated, and polyunsaturated fat and the ratio of polyunsaturated to saturated fat) and risk of prostate cancer. The hazard ratio for prostate cancer for the highest versus the lowest quintile of total fat intake was 0.96 ... There were no significant associations between prostate cancer risk and fat from red meat, dairy products, and fish."

3] Dagnelie (2004)

ncbi.nlm.nih.gov/pubmed/151...

Older study: "reviewed 37 prospective cohort and four intervention studies on potential dietary risk factors for prostate cancer, published between 1966 and September 2003."

"Studies are inconclusive on the role of meat, dairy products, fat, vegetables, fruits, alcohol and anthropometric measures, whereas a very high calcium intake appears to be positively associated with prostate cancer risk."

-Patrick

[Kuanyin in reply to pjoshea13]

No, it's not really clear to me. He still wants to do the Atkins Diet study he mentions in the talk. If there is so much evidence in the research literature supporting a link beteen diertary fat and Pca, why not come out and include fat in his recommendations? Also, the foods associated with high fat content, mainly meat, carry a high hormone content which further complicates the entire issue of meat, chicken, fish (seriously, does anyone believe that those fish off the coast of northern Japan don't show up in the total count of so-called caught "wild" salmon or all the estrogen containing medications dumped into our water supply isn't affecting us) And what about a heart-healthy diet. The good Doctor says that what's good for the heart is also good for the prostate? If you have Netflix, take a look at the documentary "What the Health" to see how really confusing the issue remains. There are many sources cited in this documentary and several physicians who come down on the other side against any meat consumption at all. Example, a farm-raised tilapia has more fat content than a donut!

[pjoshea13 in reply to Kuanyin]

You mention the Atkins diet, but Freedland isn't doing a trial of the whole diet. He says that the men will be in the Induction phase (Phase 1) of Atkins for 6 months. Induction lasts for at least two weeks, but can last longer. "You'll stay in this phase until you're 15 pounds from goal weight." [1] A Freedland inclusion criterion is "BMI >=24 kg/m2".

Freedland: It is "5% carb" - "95% protein+fat". He does not break down the 95%, but here is what the Atkins site has to say about fats & oils:

"There are no carbs here, but keep in mind that the serving size is approximately 1 tablespoon." [2]

So most of the fat will come from the protein sources. The fish & fowl lists contain lean & fatty options, but this phase is clearly extremely high in protein.

The Freedland study focus is: "Carbohydrate Restriction and Prostate Cancer Growth" [3] It isn't about fat.

"A Randomized Controlled Clinical Trial of Carbohydrate Restriction Among Men With A Rising PSA After Failed Primary Therapy for Prostate Cancer"

"This study is currently recruiting participants." It's been going on for 5 years, with a target of 60 men & an end date of February 2018. Poor accrual - lack of interest?

Farm-raised tilapia - horrible stuff - is notable because of the omega-6:3 ratio (11:1?). That might be due in part to the diet - an issue with any farmed fish. The fat content itself was not an issue, as I recall. I doubt that Freedland would object to a herring - a fatty fish high in omega-3.

In fact, according to the USDA, tilapia is low in fat - 1.7% [4].

-Patrick

[1] atkins.com/how-it-works/atk...

[2] atkins.com/how-it-works/atk...

[3] clinicaltrials.gov/ct2/show...

[4] ndb.nal.usda.gov/ndb/foods/...