Extreme Diets.

[pjoshea13]

I define an extreme diet as one that flirts with deficiency of one or more essential nutrients. Sure, one can always take a pill to counter deficiency, but that would detract from the idea of an ideal diet meeting all of the needs of the body.

Is there a place for an extreme diet when cancer is present? I think so. Amino acid restriction can be used to inhibit the production of protein, which will in turn inhibit the production of growth factors, such as IGF-I (insulin-like growth factor I) which is implicated in PCa progression. Vitamin B12 insufficiency will prevent hypermethylation of tumor-suppressor gene DNA promoter regions. And so on.

But diets are often not chosen with such strategies in mind.

[A] Macrobiotics. [A1]

This diet perhaps appeals most to those interested in Buddhism. The diet emphasizes local grown foods, eaten in season, and meals designed to balance yin & yang elements. Nightshade plants are out, which means no potatoes, tomatoes, peppers, eggplants, etc. Hence no lycopene or capsaicin. But eat as much zucchini as you want. LOL

Occasional small amounts of fish are permitted, but this is not a core element. Without the fish, however, there would be no source of bioavailable B12, or of marine omega-3 fatty acids.

"Macrobiotic Diet No.7. Today this is the most popular of the original 10 diets. This consists of all cereal., which will serve as a panacea for all diseases known to man . . Elimination of all sugar, all meat, all animal products, severe restriction of water and fluid intake. The trick is to balance menus in a 5 to 1 ratio of Yin to Yang. Natural unpolished brown rice is the perfect food because it contains in itself the perfect balance of 5 to I ." [A2] Alas, one cannot live on brown rice alone, as some have discovered too late.

"The macrobiotic diet in chronic disease." [A3]

"The macrobiotic diet in cancer." [A4]

"Macrobiotics is one of the most popular alternative or complementary comprehensive lifestyle approaches to cancer. The centerpiece of macrobiotics is a predominantly vegetarian, whole-foods diet that has gained popularity because of remarkable case reports of individuals who attributed recoveries from cancers with poor prognoses to macrobiotics and the substantial evidence that the many dietary factors recommended by macrobiotics are associated with decreased cancer risk. Women consuming macrobiotic diets have modestly lower circulating estrogen levels, suggesting a lower risk of breast cancer. This may be due in part to the high phytoestrogen content of the macrobiotic diet. As with most aspects of diet in cancer therapy, there has been limited research evaluating the effectiveness of the macrobiotic diet in alleviating suffering or prolonging survival of cancer patients. The few studies have compared the experience of cancer patients who tried macrobiotics with expected survival rates or assembled series of cases that may justify more rigorous research. On the basis of available evidence and its similarity to dietary recommendations for chronic disease prevention, the macrobiotic diet probably carries a reduced cancer risk. However, at present, the empirical scientific basis for or against recommendations for use of macrobiotics for cancer therapy is limited. Any such recommendations are likely to reflect biases of the recommender. Because of its popularity and the compelling evidence that dietary factors are important in cancer etiology and survival, further research to clarify whether the macrobiotic diet or similar dietary patterns are effective in cancer prevention and treatment is warranted."

Unfortunately, the body of the paper begins with:

"Published in 1982, Recalled by Life: The Story of My Recovery from Cancer recounted the autobiographical story of a physician, Dr. Anthony Sattilaro, who was diagnosed at age 49 y with prostate cancer with multiple bone metastases. Given a poor prognosis and feeling that he had nothing to lose, Dr. Sattilaro adopted a macrobiotic, predominantly vegetarian, whole-foods diet soon after diagnosis. Follow-up examinations at 1 and 4 y after diagnosis revealed complete resolution of metastatic bone lesions."

Unfortunate, because Sattilaro was also on ADT. And when ADT failed ...

I saw one later review of his book, where the reviewer claimed he had died because he had returned to eating meat. If only he had continued on a macrobiotic diet. & so on. In other words, the apostate had only himself to blame.

Even so, [A4] is full text that may be of interest.

I am reminded of another book, "Confessions of a Kamikaze Cowboy" (Dirk Benedict), which is often cited.

He claimed to have cured PCa with macrobiotics. This was in the pre-PSA era. He seems to have had an enlarged prostate. He refused a biopsy, so I can't see how PCa could have been diagnosed. But his problems went away & he became a convert to the diet.

One has to look outside of the PCa literature if one is looking for evidence of an anti-cancer effect. (But I haven't looked.)

[B] John A. McDougall's Starch Diet.

If the concept seems crazy in this age of low-carb diets, McDougall can't be ignored IMO.

He has a number of books. His "The Starch Solution: Eat the Foods You Love, Regain Your Health, and Lose the Weight for Good!" [B1] has a basket of potatoes on the jacket. Will they be made into fries? No, because added fats are not part of his diet.

Sample recipes: [B2]. More info: [B3].

I must say he looks trim & healthy in his photos.

[C] Vegan Diet.

Michael Greger is a tireless spokesman for veganism. He "became a vegan after touring a stockyard as part of his work with Farm Sanctuary." [C1]

Like Greger, I think that many teenagers become vegans because of a concern for animals in the food system. One can only admire those who would undertake such a difficult lifestyle for ethical & compassionate reasons.

Dig into the many different takes on healthy diet & you will find foods that are excluded or included, but always for health reasons. With veganism, the excluded foods are absent for ideological reasons. Dr. Greger's self-appointed job is to prove that there are health reasons to back up their exclusion. i.e. it is not enough for eating meat to be "wrong", it also has to be unhealthy.

& he is very good at it. His 3 minute videos quote studies. Some complain about the cherry-picking, but he is like a good lawyer, making the best case he can. One can only respond by wading through the studies cited & not cited, & trying to add context & balance.

I was listening to his little talk on vitamin B12 yesterday.

First, from a recent paper [C2]:

"In a pooled analysis of 48 cases of infant deficiency, there was a remarkable similarity in clinical symptoms between maternal veganism and maternal pernicious anemia."

This is actually a bit scary, since symptoms of pernicious anemia do not always go away with vitamin B12 injections. The lifetime need of vitamin B12 is extraordinarily small and the body is good at conserving it. It can take years for deficiency to become apparent, & when symptoms appear, such as neuropathy, it's too late. "Maternal pernicious anemia" implies that the women were fairly young, with an elevated risk of early dementia &/or multiple sclerosis (B12 is a co-factor in myelin formation).

In Greger's B12 video [C4], he does several things:

a) he agrees that plants do not produce B12, but then says that animals don't make it either. Animal flesh has B12 because of bacteria in the gut. And humans have the same bacteria. To his credit, he does not insist that human B12 is bioavailable (as some sites do).

b) for some reason, he gets bogged down with eggs as a poor B12 choice. "200 to 400 eggs a day" "Think about how much cholesterol that would be?" Who would eat 200 eggs? So why does cholesterol come into it. He's hitting on a favorite bugaboo to bolster his case.

c) he mentions the Framington study, where one in six meat eaters were deficient. Yes, but unlike vegans, five out of six meat eaters were B12-sufficient. The one in six probably lacked intrinsic factor, due of age, or didn't eat enough meat. Meat is a good source of B12 for men who produce adequate intrinsic factor.

d) he goes on to point out that those with the best B12 status were those who ate a fortified breakfast cereal or used a supplement.

Well, he did the best he could. He trashed eggs, created doubt amongst meat eaters & increased sales of Total breakfast cereal (no milk).

From a 2016 meta-analysis [C5]:

"... with few exceptions, the reviewed studies documented relatively high deficiency prevalence among vegetarians. Vegans who do not ingest vitamin B12 supplements were found to be at especially high risk. Vegetarians, especially vegans, should give strong consideration to the use of vitamin B12 supplements to ensure adequate vitamin B12 intake."

A vegan diet is not a complete diet, & one should monitor B12, zinc, iron, iodine, etc, etc. status. The fact that studies find deficiencies is indicatative of a lack of awareness of the difficulties.

In Greger's 2016 video "How Not to Die from Cancer" [C6], he mentions the Dean Ornish PCa study. I don't recall anyone getting excited by that study. It involved men with Gleason 3+3 or less. The diet was "near-vegan" (that drove some vegans bananas) because it included fish oil. It was 10% fat. The study included stress management.

In effect, it was a calorie-restriction diet for those men & there was an improvement in lipid profiles - with the notable exception of triglycerides. Baseline number were closer to 150 than 100, & were >2 HDL-cholesterol. The numbers were higher at the end of the study - consistent with a low-fat high-carb diet. HDL-C actually decreased, as I recall (full text is no longer free), so the triglyceride:HDL-C ratio, a surrogate for insulin resistance worsened appreciably.

I remember from early findings, that there was a slight drop in average PSA, but not enough to excite men with Gleason 7-10. However, "No significant differences were found between the untreated experimental and untreated control patients in PSA change or velocity at the end of 2 years." [C7] [Giant collective yawn.]

What was impressive was the effect of drawn blood on LNCaP cells in a petri dish, & Greger makes the most of that [C6]. What does it mean when vegan blood can kill LNCaP cells in a dish, but there is no significant change in the PSA of a Gleason 3+3?

Greger is not abashed to hype the one finding & bury the other.

Google <youtube greger> to see what he is about.

Here's McDougall: youtube.com/watch?v=MSKG496...(Not working as expected?)

Interesting take on macrobiotics: youtube.com/watch?v=oy-Ex2_...(Not working as expected?)

-Patrick

[A1] en.wikipedia.org/wiki/Macro...

[A2] onlinelibrary.wiley.com/doi...

[A3] ncbi.nlm.nih.gov/pubmed/211...

[A4] jn.nutrition.org/content/13...

[B1] amazon.com/Starch-Solution-...

[B2] drmcdougall.com/wp/wp-conte...

[B3] en.wikipedia.org/wiki/John_...

[C1] en.wikipedia.org/wiki/Micha...

[C2] ncbi.nlm.nih.gov/pmc/articl...

[C3] en.wikipedia.org/wiki/Vitam...

[C4] nutritionfacts.org/video/sa...

[C5] ncbi.nlm.nih.gov/pubmed/246...

[C6] nutritionfacts.org/video/ho...

[C7] ncbi.nlm.nih.gov/pubmed/186...

[Jayg57]

Ornish paper available in full free - prostate-cancer-today.org/f...

Can't get papers free from the journal? Frequently they are available from other sources. Try searching scholar.google.com/

[Hidden]

Thanks very much, Patrick, for what seems to in part be a manner of replying to my recent post.

I consider myself to be quite the skeptic and certainly not tending to be gullible. I pay attention to what Michael Gregor says, but I don't at all think I am manipulated by him. I have never considered his manner or his means of conveying information as anything resembling manipulative (cherry picked either, for that matter). That includes a good period of time when I was a long way from consideration of adopting a WFPB diet for my own needs. I realize my impressions don't prove anything, but neither do yours.

The lacking naturally occurring B12 in the plant-based diet has been debated over and again and long put to bed in my mind. As you and Gregor point out, neither our plant food products nor our animal food products make their own Vitamin B12. I simply supplement and because it is an essential vitamin, I have only a modest concern about the possible connection B12 may have to prostate cancer. I could be wrong not to have more concern, but choices we make in life almost never have all absolute evidence that supports them. Despite this supposed B12 conundrum, I'm convinced that a conscientious WFPB diet is much more complete than the standard American diet (which I assume you would say is the least extreme one) begins to be. I further believe that a WFPB diet may in many cases be the optimal adult human diet. I believe that to be backed by sound evidence, but since you and I both know I'm not a master of the actual scientific literature, I won't pretend to be by throwing in a reference to one now...haha.

Maybe I'm wrong about Gregor's major motivator and it honestly doesn't matter a great deal to me. However, I thought sure I had read something different from what you referenced that had spurred him to his self-appointment, as I think you termed it. I thought it was more based on his research after a terminal status was given for his grandmother's heart disease and the subsequent apparent reversal of it and her quality life that extended for decades longer. That's of course a case study of one, but the motivation for many and possibly most people's life work is laden with emotional factors. I listen to and read Gregor regularly and have not noticed him espouse much in the way of a heavy animal welfare agenda. As for me, I honestly have embraced a bit of the animal welfare aspect, but that happened well after I adopted a plant-based diet. I and many others who are on board with the WFPB school of dietary thought don't easily identify with the label "vegan." That's because of connotations of a lifestyle that's almost religiously fervent in its mission to convert the world to its tenets. That's not me in the least and I frankly don't think it's the essence of Gregor either. While I may sometimes encourage others to make what I see as good choices, I never want to be guilty of behaving like I am infallible or that I have all the answers because I am not and I do not. I fully honor the right for people to make their own dietary choices based on their unique desires, circumstance, needs and values. Many people (me included) embrace a WFPB diet predominantly because of the evidence of its health benefits rather the desire to be compassionate to animals.

[pjoshea13 in reply to Hidden]

Manatee,

I had heard the grandmother story too, but she was cured by the Pritikin diet, which is not vegetarian:

nutritionfacts.org/video/th...

Would I say that the standard American diet is the least extreme? In my post, I define "extreme" in terms of resulting in deficiency. Of course, there are deficiencies even with diets that have no restrictions. Americans who choose not to eat bread might have very low intakes of selenium. Americans who avoid salt, or rather, the iodized versions, might end up with iodine deficiency, if they also avoid seafood, or other source of iodine. Apparently, choline insufficiency is common.

A potential problem with the American diet, to my mind, is excess nutrients. Meat eaters generally get too much meat when they eat out, & a steak from the supermarket will typically feed two, if you use Barry Sears Zone diet as a guide. For men with PCa, the phosphorus in a hefty serving of meat will interfere with vitamin D.

IMO, the American food pyramid diet is a disaster, with grain at the bottom & fats at the top. We have an epidemic of non-alcohol-related fatty liver disease. We also have a big problem with diabetes & a huge hidden problem of the metabolic syndrome [MetS]:

"Nearly 35 percent of all U.S. adults and 50 percent of those 60 years of age or older were estimated to have the metabolic syndrome in 2011-2012, according to a study. " [1]

The charts in [2] show the prevalence of MetS:

- white men age >70: 1988-94 = 44%, 1999-2006 = 50%, 2007-12 = 58%.

- white men all ages: 1988-94 = 27%, 1999-2006 = 28%, 2007-12 = 35%.

It's a rapidly worsening situation & I blame the pyramid. People are avoiding fat. In 2016, when my wife was very ill, I spent a lot of time shopping. One day, I was looking for full-fat yogurt for her. The supermarket selection had to have taken up 12 feet - different brands, plain & flavored. All were 2% or zero fat. Crazy.

For a voice of reason, I would point to Joel Fuhrman:

drfuhrman.com/content-image...

I could quibble a little, but I wish it were better known.

-Patrick

[1] sciencedaily.com/releases/2...

[2] cdc.gov/pcd/issues/2017/16_...

[Hidden]

Hi Patrick,

A few followup comments that are mostly only my opinions:

A Pritikin diet seems to be a fairly close match to a WFPB diet in many ways. So much so that the Pritikin Institute invited Gregor to speak to their organization. My opinion is that the biggest flaw in the Pritikin diet is not its use of small amounts of animal based foods, but its ultra low fat premise. Gregor may encourage more in the way of low fat than is my current viewpoint as well.

As far as adding some animal products into a predominantly plant-based diet, many WFPB experts, including Gregor, agree that it's not entirely an all or nothing proposition. If I were to add anything, it might be a small amount of fish, but for a couple of major reasons, I don't. I've certainly been known to "cheat" now and then and that doesn't cause me a bit of guilt.

I consider my diet to be a constant work in progress. Whether our dietary goals change or not, most of us will probably never be perfect at meeting them. The exception would perhaps be those who choose to eat whatever they want. With the concept of moderation used, I can honestly see at least a small degree of merit to the "whatever you like" dietary approach that so many physicians endorse. It may serve some people well enough, but except in a few specific short term circumstances, I am far from convinced of that.

I certainly agree that the American government hasn't done a good job of promoting good nutrition. Obesity statistics alone are evidence of the failures. Obesity is of course one of the components of metabolic syndrome, the incidence rate of which is indeed quite disturbing.

I'm a paid subscriber to Joel Fuhrman's website and have a great deal of respect for him. I currently also use some of his rather pricey supplements. He is a proponent of a low fat and either wholly or almost wholly plant-based diet. Even though I support Fuhrman by buying from him, I have concerns about his absolute objectivity in that, unlike Gregor, he promotes and sells a sizable number of products for profit. I take some comfort in believing that many of his supplement and food products were developed in an earnest attempt to fill various voids in the marketplace. I am not so comforted that he sells very expensive health retreat type vacation packages that are way beyond the financial reach of probably the vast majority of consumers.

My belief is that the biggest problem with the low fat trend that became such a craze in the 1990s was what people and manufacturers tended to replace the fat with. That often was (and still is) refined sugar and other low quality or refined carbohydrates. It also seems that not enough attention was paid to how fat in the diet is an important mechanism for triggering satiety. It is fairly clear that we as a nation have facilitated the obesity epidemic much more than we have warded it off. Some of the reasons seem fairly clear; others not entirely just yet.

Gregor and Fuhrman both subscribe to the benefits of a low fat diet. They both believe vegetable and seed oils are not healthful foods used in any quantity. I do get the logic of that advice, but I'm a bit on the fence with it and continue to use small amounts of high quality olive oil.