MEAL Trial Question

[cashlessclay]

Taken from a post on Pseudoscience.

<< The best data we have is a trial where men on active surveillance were randomized to increase their vegetable intake. It made no difference in their rate of progression. I know that no proof of an effect (like my conflicting data on most dietary practices) is not the same as proof of no effect (like the MEAL trial.) >>

jamanetwork.com/journals/ja...

The MEAL trial is proof of no effect?

From the MEAL document above ...

<< Interventions

The telephone counseling intervention, provided through the UC San Diego Moores Comprehensive Cancer Center and previously described, used an approach adopted from social cognitive theory to achieve sustained behavior change.13,14A similar program had successfully affected behavior change in breast cancer survivors. (18) After randomization, each intervention participant was assigned to a counselor, who encouraged consumption of at least 7 daily vegetable-fruit servings (defined as a half-cup of raw or cooked vegetables or fruits or 100% vegetable juice), including at least 2 servings each of cruciferous vegetables and tomatoes.

Details of the intervention structure and content were previously reported (13) and are provided in the trial protocol (Supplement 1). Briefly, the intervention was divided into 4 phases. The first phase (6 counseling telephone calls over 1 month) focused on building self-efficacy; the second (4 calls over 2 months) on consolidating the new dietary pattern; the third (4 calls over 4 months) on relapse prevention; and the fourth (8 calls over 16 months) on providing positive feedback and monitoring for declining interest. To ensure fidelity and minimize bias, counselors completed an intensive 80-hour training program and used a computer-assisted coaching protocol.

Control participants did not receive counseling calls and were instead provided printed materials from the Prostate Cancer Foundation encouraging consumption of a vegetable-rich diet. The latest version of these materials is available online. (19) >>

The control group did not eat as usual, but rather given dietary advice by reading materials provided by the Prostate Cancer Foundation. So aren't we comparing two groups, both of whom changed their eating habits . . . one from live conversation with counselors, and the other from reading materials provided by the Prostate Cancer Foundation.? If so, the MEAL trial appears to be a test of mode of delivery rather than dietary effectiveness.

Comments Please.

[Tall_Allen]

It's certainly possible that the control group changed their eating habits too in response to the literature they received. But the comparison of the food diaries showed that the intervention group did eat markedly more vegetables than the control group. Were they lying? So blood was taken: "Fasting blood samples are collected at baseline, 12 and 24 months, and analysed for plasma carotenoids (total carotenoids, a-carotene, b-carotene, lutein, lycopene and cryptoxanthin) using high-performance liquid chromatography methodology" It affirmed they were not lying - they indeed ate more vegetables. And it made no difference.

[cashlessclay in reply to Tall_Allen]

I agree with you that the intervention group ate more vegetables. I'm not at all surprised that there was no difference in PCa progression. In my experience, more vegetables, by itself, doesn't move the needle.

If a clean, working anti-cancer diet has a 100 score, the average American diet would rate 10-20. A "health nut" diet would be 50-60. It would take a 70-80 score to slow cancer progression.

The MEAL study diet is perhaps a 40. My current diet is above 80, and my PSA has been going down for about 3 years. Last three PSAs were 0.197, 0.175, and 0.164 - - - down from above 0.5 three years ago.

[Tall_Allen in reply to cashlessclay]

I love to hear positive anecdotes!

[Steveo3312 in reply to cashlessclay]

Hello cashless,

Would it be possible if you could send me a list of foods you eat on a regular basis.

You can send me a message

If you like.

I have been eating broccoli sprouts and mushrooms on a regular basis.

I have a psa check on August 2nd.

Thanks.

[cashlessclay in reply to Steveo3312]

Steve, this older post may be helpful.

healthunlocked.com/advanced...

[Steveo3312 in reply to cashlessclay]

Thank you.

[Redigloo in reply to cashlessclay]

It's great that you have positive experiences with super healthy eating. But do you have any actual scientific data supporting your claim that "70/80" score of healthy eating can slow cancer progress? And have you ever gotten any mediale treatment for PCa?

Obviously it will not hurt anyone to eat healthier, but I am worried that posts like this will influence some people into choosing something like this OVER actual treatment.

[Stoneartist in reply to Redigloo]

Agree with that - but there is no better test that a healthy diet works than monitoring PSA after nadir and end of all treatments. If it goes up - then the natural approach is not enough. If it stays stable - and periodic scans show no worsening - then great.

But it should be noted that this is a test of one PCa occurrence - and relevant to the person who chooses to make this experiment on themselves. It is no less scientific for that - but just cannot be extrapolated to anyone else without them verifying that the same is true for them.

This must be the biggest attraction of an ADT "holiday". If PSA stays stable after ceasing treatment then maybe the diet is keeping the cancer at bay.

[Redigloo in reply to Stoneartist]

In scientific terms there are plenty of better ways to test this. The only thing we know in this situation is that this person self reports healthy eating, had a low start PSA, with a moderate decline over years. Nothing else. This does not fill the requirements of scientific testing at all. And at worst it can be dangerous to make claims like "vegetables can slow down cancer" in a forum for people with this diagnosis. Sure, eating healthy is always a good thing, but listen to your doctors for medical advice.

[Stoneartist in reply to Redigloo]

I dont know of any other ways we as individuals can test this - but if your aim is to keep your PCa at bay - and your PSA and scans continue to look good then you are on a winner. But you will never know if your progress is due to the diet or to how your body reacts to the change. Try going off a healthy diet and on to a typical American diet and see if the PSA starts increasing. Not sure there are many who would want to test that!!

But most of us start with real healthy anti cancer diets after we are diagnosed - we had one lifestyle which allowed the development of PCa - and if PCa does not return to progression with a different lifestyle/diet then the most obvious explanation is that the diet is important in keeping PCa at bay - though this is not proof.

But everybody is different, every cancer is different, and every diet is different - - too many variables. I think that was the problem with the MEAL trial.

[Redigloo in reply to Stoneartist]

As individuals, no, but we're not doing actual cancer research. And as long as we are not doing actual research using established scientific methods, I think we should be careful with our claims of treatments and/or cures.

I have fallen for these anecdotal experiences with treatments myself. I was so desparate to have a child a few years ago that I tried herbal remedies that some people swore had helped them. And then I got pregnant. Was it because of the herbs? Most likely they had absolutely nothing to do with it. There is no actual science behind it, only other people's stories.

My issue in this post is the bold claim that eating healthy at a 70/80 score will slow down cancer progression.

[Stoneartist in reply to Redigloo]

I dont think anybody has explicitly said that a healthy diet will slow down cancer progression regardless- Cashless, and myself have merely said for us as individuals it makes sense - given the state of research on the subject, for us to follow a healthy diet which maximises the content of foodstuffs which have been shown to have anti cancer activities. And so far things are looking good so it certainly doesnt seem to harm things. This has nothing to do with anecdotes - its a case study - interpret it as you wlll. This is the process of science - test and observe.

[cashlessclay in reply to Redigloo]

I had no additional treatment since SRT in Jan. 2011. I'm not here to advance science. This is a case study and I'm sharing the results.

You need some way to monitor progress, PSA, in my case, since I had a prostatectomy. If it's not working, by all means see your doctor.

[Schwah in reply to cashlessclay]

What other concurrent treatments have you been on as YOUR PSA went down. And what is your specific 80 + diet?

Schwah

[Stoneartist]

I agree with this. The control of diet needs to be much better. There have been problems before where researchers were good at focusing on the target foodstuff, but neglected to monitor the degree of consumption of other foodstuffs. Its difficult to do this right - and certainly almost impossible to keep to the track for 10 years.

I too am on a score of about 80 and things are progressing really well. I dont do supplements either.

[maley2711]

I had a PSA of 4.1 when I was 65, then a PSA of 7.6 when I was almost 70, then a PSA of 6.6 when I was 70 1/2, and then a 7.5 when almost 72, and now 7 months later PSA is 7.4. Do I have serious progressing PCa? My diet is not horrible, but I eat sweets and meat, and also lots of veggies heated. The recent biopsy showed 4+5 cancer..has my diet been working? I wouldn't claim so!!

[Magnus1964]

This is the stupidest trial I have ever heard being conducted. Vegetables are not curatives. The point of cancer with vegetables is that you stop eating meats that have antibiotics and growth hormones. Don't eat processed meats.

It does not matter if the control group fudged the trial or not, it's a stupid trial.

[pjoshea13]

Here is something I posted a year back:

"This was actually reported in a 2018 video interview with Kellogg "Kelly" Parsons:

urotoday.com/video-lectures...

"He is remarkably upbeat for someone who has been working on this from 2006 - the MEAL study actually kicked off in 2010-11. It seems that the study was not successful, but the methodology was. The ~500 men (from 91 sites) who were coached by the "call center", sustained their vegetable intake levels for 2+ years. So the methodology will probably be used in other studies.

"All the men who were under age 60 had Gleason scores of 3+3. If the intervention was ineffective for those men, it would hardly be expected to benefit men with metastatic disease.

"At one point in the interview, Kelly says that the men who ate more veg ate less fat - as though that was a desirable outcome - & less meat. Which suggests that those interventions might not show benefit either.

"When PCa is diagnosed, many things have already gone wrong in those cells. If micronutrients contained in vegetables has potential therapeutic value, perhaps they need to be applied at pharmaceutical levels, rather than physiological levels (which clearly has not worked)?

-Patrick"

[Teufelshunde]

To me this study is pretty specific to me. I am post RP and had rising PSA. Did SRT. Taking 60mg of the supplement (cant eat that much broccoli or sprouts) they used in this trial. Another study at 30mg also showed benefit. So lends, in my mind, some credibility that have to eat a lot (or concentrated supplement) to get the benefit. Thoughts? cancerpreventionresearch.aa...

[Kuanyin]

Awhile back I decided that entering these diet/cancer discussions are really not that useful. We keep repeating the same arguments and jumping from one study to another in an effort to bolster our positions. A few observations:

1 We all start from a different baseline. Some of us have had our prostates removed; others have had chemo; other have undergone radiation (different forms); ADT; immunotherapy and so on. The combinations are also mind-boggling.

2 There's the question of preparation: baked, broiled, fried.

3 What about total calories intake and eating times?

4 What about supplements and herbs?

5 What about Gleason composition: for example, are all Gleason 8's the same?

I could list other variables as well, but you get the idea. Just as medications aren't equally efficacious, it's probably more so with diet and supplements.

Lastly, I was at my oncologist's office a few weeks ago. He suggested that I take a Cologuard test, since it was more than ten years when I had had my last colonoscopy. I started squirming in my chair at the suggestion. He mentioned a patient, whom I knew, who had beaten PCa for twenty years. This guy once told me that when he had a scan he lit up like a Christmas tree, yet he didn't die of the PCa. Colon cancer got him because he refused to have his colon checked. I sent my stool sample in more than a week ago.

What I want to say is that many of us will die of colon cancer, heart disease, etc. I think that there is research to support a plant-based, low-fat, low -sodium and low-sugar diet to avoid these complications!