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Advanced Prostate Cancer
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Antioxidants

I replied in the original "Antioxidant and Metastasis" post, but got no replies. So at the risk of looking too pushy, I'd like to pose it here again:

"I'm still unclear about this. Could we revive the post please.

- Are all antioxidants evil? Res/fruits/Pomegranade/etc? are there any scientific fact/anecdotal evidence to back it up?

- Second, in regard to Alpha Lipoic acid, a lot of sources point to its benefits. But it seems to have BOTH effects [1]

"As a result of application of alpha lipoic acid, which acts as

both pro-oxidant and natural antioxidant,.."

what are your thoughts?

[1] journalcmpr.com/sites/defau...

"

27 Replies
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Reactive oxygen species (ROS) is the mechanism your immune system uses to kill cancer cells. Antioxidants/free radical absorbers may interfere with ROS generation. Foods, in normal amounts, are generally safe because your body can decide what it needs and excretes the rest. Supplements may overwhelm your body's regulatory capabilities. Stick to food sources and you should be OK.

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Thank you - curious, do you have any strong opinions on alpha Lipoic acid?

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As a supplement? Based on what I just wrote, it would certainly be one to avoid. You may be interested in Jim Watson's essay on the harm done by antioxidant supplementation (he is a fan of metformin and broccoli) - particularly sections 16-18 and 22:

rsob.royalsocietypublishing...

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That’s the confusing part - ALA is claimed to have both pro- and antioxidation effects (at least based on that one report).

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It's not confusing to me. It is a powerful antioxidant and if there is no good evidence of benefit (and there isn't) and a real risk of harm (which there is), supplementation should be avoided. Your body makes all it needs and it's ubiquitous in foods - I really don't understand why anyone with cancer would supplement it.

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If I understood you correctly, you’re against any and all supplements. Correct?

I’d be curious why you’d be against citrus pectin, for example, with reasonable anecdotal evidence in its favor?

Also, the reason I was confused, is because ALA is categorized as BOTH.

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To me, supplements (unlike foods) are drugs. They can overwhelm the body's natural feedback mechanisms for regulating absorption and upset homeostasis in biochemical systems. Some unbalance the natural microbiome needed to maintain good health and an active immune system. Just like any other drug, they have to have proven benefit and no proven harm. Proof is only obtained from an RCT - and there are only a few for supplements, mostly negative (except sulforaphane).

Your body balances antioxidants and pro-oxidants (perhaps including ALA on both sides). Upsetting the balance artificially can be harmful. Your body knows its biochemistry and how to regulate it a lot better than you do (or even than I do - and I have a degree in biochemistry).

"Reasonable anecdotal evidence" is an oxymoron. If it is anecdotal, it's not evidence of any kind, and is certainly an unreasonable foundation on which to base treatment decisions for such a serious disease.

If you actually read the essay by Jim Watson, you will get a better appreciation of the complex biochemistry involved and how attempts to interfere with them can unwittingly and tragically backfire. What you don't know CAN kill you.

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Hi TA,

Your replies are always based on scientific facts and also straight to the point which I like very much. I have been in remission for nearly 3 years since my DX in March 2015 followed by an aggressive treatment regimen : RRP + IMRT + ADT2 ( 2 years ). My PCa is GS9 - T2NoMx. Being interested in a proper diet I stopped eating red meat and dairy products. More vegetables and fruits. But with the recent controversy over Antioxidants and PCa, quite reluctantly I gave up the following items which are supposed to be rich in antioxidants ( I was taking them for almost 3 years ).

- Green Tea ( 3 cups daily )

- Cooked Tomatoes with my breakfast ( Lycopene )

- Broccoli and Cauliflower

Do you think my decision is wrong?

Sisira

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First, diet is different from supplements. Your body can self-regulate how much of any micronutrient it will absorb and keep vs what it will excrete. My feeling is that foods should be varied with lots of highly colored vegetables and fruits, and plenty of fiber. I think eating lots of cruciferous vegetables is just about the best dietary change a man with PC can make. One of the ingredients in them (sulforaphane) has actually been proven to slow down recurrent PC. (In the Jim Watson article, he talks about the anti-cancer effects of another ingredient, diindolylmethane.) In fact, sulforaphane is the one supplement I really approve of - but one has to eat some raw broccoli with it to get an enzyme that makes it bioavailable.

cancerpreventionresearch.aa...

Lycopene and EGCG have had equivocal findings, but there's nothing wrong with eating tomato sauce/paste/ketchup/etc., or drinking a few cups of green tea.

Dividing supplements into one category or another - antioxidant or pro-oxidant - is a very simplistic approach. Different substances have different biochemical effects and should be judged on whether they are clinically effective against PC, not on the broad category they fall into. One would never take such a simplistic approach to drug use - we wouldn't, for example, think of declaring ALL steroidal hormones (eg, cortisol, testosterone, estrogen, progesterone, Vitamin D, etc.) good or bad. Each is good or bad in specific situations, at specific times, and in specific amounts.

Remember too that cardiovascular disease is 20 times the killer in older men than PC is. Any diet should be judged first on how good it is for the heart and blood vessels.

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TA -

to me the line between supplements and non-supplements are sometimes blurred. I like tumeric with my food, but curcumin quickly becomes a supplement. Similarly between garlic and garlic supplements. I'm not suggesting that the two variant are chemically identical, but - and here is where the blurred line is - they are similar enough in cases.

In other cases, your body cannot generate/obtain enough on its own. D3 would be an example.

And third, I'd imagine a body harboring cancer can get all the help it can, especially given al the typical medications that constantly depleting it from one nutrient or another.

My argument if not a scientific one, I agree. But common sense tells me it would be ok to pick up supplements, but only selectively, and intelligently to the extent possible. To me it's sort of like an arcane legal system: supplements are guilty until proven innocent.

I'm 100% with your on diet and exercise.

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The distinctions between dietary intake and supplements are really quite simple. A supplement is extracted and concentrated from its food source to achieve some hoped for health effect. Adding turmeric (ground roots) to my curry is not a supplement, but taking a pill of extracted curcumin is. Eating fish is not a supplement, but taking a pill of concentrated omega-3 fatty acid is.

When one has a deficiency in a micronutrient, like Vitamin D3, it may be necessary to take a drug/supplement to correct that deficiency. Sometimes it isn't at all clear that supplementing will correct the deficiency, But that is another story. At any rate, the deficiency has to be diagnosed first. Some studies suggest that getting one's serum Vitamin D too high may make the prostate cancer MORE virulent. I think we all learned a lesson from the landmark SELECT RCT that in spite of the fact that we think something is beneficial, it may, in fact, be harmful.

Giving one's body "all the help it can get" implies that one knows exactly how to do that. How would anyone know without medical evidence? I agree that supplements, like any other drug, are guilty until proven innocent. They have to prove that they have a favorable risk/benefit ratio. Only one way to do that - an RCT.

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points well taken AT.

RCT, despite all of its limitations, would clearly be the best measure. But as you said, there may not be an RCT for every variation of the supplements. Absent an RCT, your advice is abstinence, regardless of cohort/population studies (what I call anecdotal evidence). For me, a well constructed population/cohort study carries "some" weight, which gets re-enforced with additional, supporting studies. Yes it's subjective, but it is rational. I suppose we can agree to disagree on this.

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I agree that when the weight of all the evidence is in one direction AND there is laboratory analysis that consistently backs up the plausibility AND there is no known reason it might be harmful that one can decide based on lower levels of evidence. But supplement studies are almost always equivocal, unless one relies on Life Extensions or similar websites that give a one-sided view in order to sell product.

BTW - anecdotal evidence has quite a different meaning from cohort/population studies. An anecdote would be me giving my personal testimonial about something. Cohort studies often have large sample sizes and are not anecdotal at all. They can show an association, but never causation.

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Thanks a lot TA. Excellent reply. Everything is very clear. I got the point. Besides, you are a specialist in Biochemistry. The three items I have mentioned are all in the natural form falling into the category of food. Though they have antioxidant properties, they are also said to possess anti cancerous properties too. All in all I have now decided to continue with them. Appreciate your clarification.

Sisira

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Well, I am very pro anti-oxidant--and I have written enough on it--that I just give them a thumbs up-- they work for me! I take over a dozen of them. Guess according to some who responded to you I should be dead. I have taken them for 27 straight months

As to ALA--you are only getting half of the dose when taking---as a chemist I am aware that ALA, comes in a 50/50 mixture of R and S forms. The S form is inactive in the body---so if you are going to use--> buy R-Alpha Lipoic Acid---then you will get 100% activity.

Nalakrats

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Nal,

I did read your write ups on the R-ALA. again, I’m not trying to scientifically settle the issue here once and for all, but I’m curious about your reaction to what’s been posted here by Patrick and others about the negative effects of antioxidants. I know you’re a living example of it working. But anything beyond that? Biochemically speaking?

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Not going down that road--we have people who read research papers and report on them and we have people who follow exacting Chemistry of electrical bonding opportunity of free radicals and scavenging in the body. I will not advance any further on this subject. As this is a no win situation---Where I say--if you are going to supplement[CHOOSE WISELY].

Nalakrats

P.S. maybe someone can tell YOU why the body is loaded with Glutathione, our most powerful anti-oxidant, whose production pathway comes thru metabolic reactions of N-Acetyl Cysteine. Is GOD trying to KILL US with anti-oxidants?

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Nal - this is not a competition with winners and losers. We are all trying to learn more from the collective wisdom of the forum. Sorry you feel that way.

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I will tell you what, on 2nd thought snoraste, I will attempt to address this tomorrow on the Sabbath---as a reply would be quite long. I said attempt!!!

Nalakrats

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I do not feel basically any particular way. There are two different sides on this subject--those for and those against anti-oxidants. Yes exactly my point: it is not a competition. I have already made my argument. I am not trying to win over converts. I just report, either what I have researched, or that which I know from my educational experience, and by playing Doctor at home. I am finished on the subject unless I find more unknown information on the subject.

Nalakrats

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And I rest my self oops case.

Good Luck and Good Health.

j-o-h-n Saturday 03/10/2018 1:26 PM EST

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John - I have to admit sometimes I have no idea what you’re talking about. But keep them coming anyways!

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That's exactly what my wife keeps telling me.

Good Luck and Good Health.

j-o-h-n Saturday 03/10/2018 8:13 PM EST

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No, it doesn't make sense to me. Hydrogen peroxide erodes the mucosa in the esophagus, stomach and intestines. A single small dose of a 3% solution won't harm you, but long term use may ulcerate your digestive tract. Your mucosa are there for precisely the reason to protect you from the toxicity of such chemicals. There is an enzyme ubiquitous in every cell called peroxidase that will destroy the peroxide if there isn't too much.

Your poor body is going through enough without your upsetting its homeostatic mechanisms with your alternating overdosing. Have some respect for the biochemistry of your body - it is smarter than you are.

The best way to ensure the right amount of ROS is with exercise. The increased oxygenation supports healthy cells and helps kill cancerous and precancerous cells.

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"Have some respect for the biochemistry of your body - it is smarter than you are" Love to read this kind of stuff! We need more people like you to educate us in the right manner.

Many thanks

Sisira

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I hope you and others did not infer from anything I wrote that diet and exercise combined with anything will cure metastatic prostate cancer. That is certainly not anything close to what I believe.

I don't think your dilute peroxide will hurt you, and if it makes you feel better, why not? I doubt that any ROS gets into your body because it, however. The only way to do that would be to inhibit peroxidase, which would be fatal.

Exercise is certainly the best tool we have to increase oxygenation inside our bodies. your intake of antioxidants may be interfering with that mechanism. Because of homeostasis, you may be achieving the opposite effect by overloading with antioxidants.

"Loading cancer cells with antioxidants blunts the positive effects of exercise training and interferes with important reactive oxygen species-mediated physiological processes such as antioxidant adaptations."

sciencedirect.com/science/a...

While I think the benefits of exercise on survival are small, the greater impact may be on quality of life among men taking ADT. Why take anything that might interfere?

cancernetwork.com/survivors...

ncbi.nlm.nih.gov/pmc/articl...

nature.com/articles/pcan20159

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Reading this post gave me a headache. Tall Allen, how do you know so much about this stuff? When I was diagnosed 2 years ago, I started taking a bunch of supplements, that seemed to have good evidence behind them, but I'm not so sure now. Given that I have large bone lesions, with high fracture risk, I feel that Vitamin D3, K2 and calcium (supporting Xgeva injections) are very necessary to strengthen my bones, but I can't work out if any of the other supplements I have taken make any difference.

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