Latest Consensus on Omega-3, Aspirin & Curcumin?

[jazj]

So in finishing up my deep dive into supplements, these were the three I had the most trouble making any definitive personal conclusions about so I wanted to do a review before putting them to bed to get any last input. My general feeling is without well-designed long-term studies (not retrospective observational), not even the scientists can give us reliably conclusive evidence. It's mainly about good overall diet and exercise. Most information seems to be referencing in-vitro and in-vivo mice studies. I've seen posts that claim Dr. Sartor says no on Omega-3, Snuffy Myers says yes, for example. Go figure.

With that said, it basically boils down to one should probably take the stance, "when in doubt, leave it out" -- that admittedly could probably eliminate about 90% of what people here are taking. So in the least, I'd follow the minimum rule, if there's any evidence of it potentially being negative, leave it out.

Omega-3 Supplements - My conclusion: "Neutral - but probably wise to avoid mega doses of Omega 3 Fish Oil > 4g a day"

For general health, it seems widely accepted that a lower ratio of Omega-6 to Omega-3 is better than a high ratio. The average American diet with our pizza, cheeseburgers, steaks, and chicken sandwiches appears to put a lot of people up near the 20:1 ratio. A general health go-to ratio I've seen referenced the most is to shoot for 4:1. I eat fish 2-3 times a week and am otherwise mainly vegan, and I can tell you from my diet log app, that ratio is virtually impossible without ingesting a bunch of ALA Omega-3 which is supposedly potentially a negative for PCa. (Note that I have hyperlipidemia and high blood pressure so I take low-dose Simvastatin and Losartan, combined with exercise and diet keeps my numbers in a good range.)

Regarding the data, I've read quite a few large studies that basically have confirmed that taking large quantities of fish oil supplements don't have as significant of cardiovascular benefit as they may be hyped up to provide. Considering I eat very little animal protein other than fish, I'm definitely not a good candidate to be needing large doses of Omega-3 supps in general I think.

The controversy appears to have been mainly fueled by a study done at Fred Hutchinson Cancer Center (in my backyard) in 2011

fredhutch.org/en/news/relea...

Mayo clinic later responded:

mayoclinicproceedings.org/a...

This article I think summed it up well:

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

"Taken together, there are inadequate data to determine if fish-derived omega-3 fatty acids are associated with PrCa incidence and progression and how to advise PrCa patients who are considering fish oil supplementation. Preliminary research suggests that an association between higher omega-3 intake and decrease PrCa mortality may be present but more research is needed."

2015, 21 studies: pubmed.ncbi.nlm.nih.gov/258...

"In general, most summary associations for the dietary intake studies were in the inverse direction, whereas the majority of summary associations for the biomarker studies were in the positive direction, but all were weak in magnitude. The results from this meta-analysis do not support an association between LCω-3PUFAs and PC."

2017, 44 studies: pubmed.ncbi.nlm.nih.gov/273...

"Current evidence is insufficient to suggest a relationship between fish-derived omega-3 fatty acid and risk of PrCa. An association between higher omega-3 intake and decreased PrCa mortality may be present but more research is needed."

2021, 5607 men: pubmed.ncbi.nlm.nih.gov/335...

"We find no evidence in this study nor in a meta-analysis of similar studies that consuming n-3 PUFA-rich fish or using fish oil supplements affects the risk of PC."

Aspirin - My personal conclusion "take it or leave it" (possibly depending on if you're using Curcumin instead or if you have CVD risks you are trying to mitigate.)

It has a benefit of reducing Thromboxane A2 (TXA2), good for prevention of PCa metastasis, but even at the baby aspirin doses of 81mg/day, it also reduces PGI2 to a lesser degree (not good.) While at the same time increases risk of bleeding issues (moderately.) Taking 81mg every third day or 40mg every other day may strike a better balance between risk/reward. Disregarding the moderate bleeding risk issue, there's definitely more positive data out there regarding PCa (and recent regarding Breat Cancer) compared to Omega-3. It seems doing 40-80mg every other day or every third day if you are concerned about pre-existing cardiovascular risks seems logical? I honestly can't make up my mind on this one. If I had a rising PSA, I'd probably be inclined to go for it to hopefully help delay metastasis.

Curcumin - My personal conclusion "Possibly beneficial but be aware of interactions with your prescriptions."

Seems to be the least studied (as far as human studies) of the three for PCa. It appears to have strong evidence as a NSAID for people with arthritis and that's about it. Unlike Omega-3 though, I have not seen any negative data on it related to PCa, only positive, but it appears to be mostly all dishes or mice in a lab. Appears to have some of the same anti-platelet (TXA2 reduction) effects same as baby aspirin but weaker. Main benefit is its anti-inflammatory effect related to PCa progression. But again, where's the cold hard human data showing significant benefit? Apparently it can increase PGI2 which would help mitigate the GI tract negatives of aspirin so I've seen one study advocating both could be taken together. The dosage for a given form of Curcumin to have a significant benefit for PCa is anyone's guess if there is such a benefit. It apparently affects P450 so can make drugs that are metabolized through P450 have a more potent effect (especially avoid if taking something like Warfarin sounds like.)

Am I way off on any of these general conclusions?

[Adlon57]

I have terminal epilepsy, but for the last nine months, after Hunter recommended Turmeric, I have gone through a lot of these Omega supplements, maybe with turmeric, did not really help, I was told to use Aspirin after my epilepsy diagnosis, irreputable brain damage, my GP and indeed Hunter thought it might react to my other medications. Turmeric/Curcumin have easily been the most effective, the joy of actually running to catch my sister's car in Dec. last year, and the realisation!I have NF3 with schwannomas on my prostate, unfortunately all the classic symptoms, since first diagnosed in March 2020, the subsequent biopsy last month taking a long time😣😣

Meanwhile, I've found the likes of supermarket versions are not to be trusted, usually with the minimum amount of the so called Curcumin/Turmeric included. Due to lack of choice I took a months version of these horrors, balance headaches, returned with vengeance. I would recommend Turmeric with black pepper anyone in my particular condition.

None of these medications have had any effects on my prostate [I think] I have a colouful collection of medical conditions, so have to keep a VERY tight rein on side effects? I am in the process of diagnosis for prostate cancer, so there ALWAYS the chance I might not have it🤞but I thought my experience with Omega, aspirin and curcumin might be relevant?

[Mascouche in reply to Adlon57]

Have you tried a ketogenic diet? Though people are now using it for all kinds of metabolic diseases, it was originally invented as a treatment for epileptic seizures

[Adlon57 in reply to Mascouche]

No I have not? I have diabetes 2, epilepsy and genetic osteoarthritis to add to my case! Sounds interesting?

[Mascouche in reply to Adlon57]

The keto diet has shown itself able to reverse type 2 diabetes in a matter of weeks for many people so you might kill two birds with one stone. Prolonged faster (over 3 days) is even more efficient but I understand that it is harder to do for most people. But between shooting myself with insulin and avoiding carbs, the choice it clear to me. Best of luck to you.

[Adlon57 in reply to Mascouche]

My specialist friend is currently on holiday, lucky girl, but your suggestion is now in her "interesting file" thanks again!

[jazj]

Yes, I agree on the Aspirin. I failed to mention, when I did a deep dive on it, the positive evidence was weak AND only pertaining to metastasis (and primarily theoretical.) The observational studies done regarding preventing recurrence (which most here are already past that point) has shown no benefit.

[jazj]

Oh not to muddy the waters but it appears Pomegranate Extract has largely most of the same properties as Curcumin and it's a hell of a lot less expensive and doesn't have the gazillion different proprietary forms claiming a gazillion percent better bioavailability. Might be best to just pick Pomegranate over Curc for an anti-oxidant/anti-inflammatory in your "stack" and save your money. These two supposedly have anti-platelet properties to a degree like Aspirin but I can find virtually no comparison as to how big the difference is between taking either of them compared to Baby Aspirin. I assume Aspirin is way more potent due to the much stronger COX-1 inhibition. The other two are primarily COX-2 inhibitors. Frankly I don't want a GI or Brain Bleed because I took too many things that lower your blood clotting ability together.

[kreg001]

I’ve stoped aspirin 81mg daily. As 74 approaches skin has become frail and easily scratched or bruised and the aspirin exacerbates bleeding and bruising. Curcumin really helps with my osteo arthritis. Nice to be able to walk pain free. Aleve with quarterly cortisone is not adequate without the curcumin. I worried the curcumin was interfering with PSA assays but three months without curcumin and PSA numbers same as with curcumin. Painful experiment and within days after resuming curcumin knee stoped hurting.

[MateoBeach in reply to kreg001]

Whether or not Curcumin actually interferes with lab measurement of PSA or not, as has been proposed, to me is not certain. Perhaps it is just lowering actual PSA secretion a bit. Not a bad thing.I have decided it is not important to me. If I am on my Curcumin supplement all of the time, then I am not interested if the actual PSA lab value is a bit higher or not. I am only interested in whether it is higher, the same or lower compared to previous values, also while on Curcumin.

[MrG68 in reply to MateoBeach]

Yup, watch your psa with a time series and not fret about the absolute value. The reduction in psa measurement, if is what happens, will not be cumulative between measurements. Ie it will not compound for each measurement due to equipment failing to measure due to some chemical interference.

[Teufelshunde in reply to MateoBeach]

Finally, someone who figured out with tests that we are primarily looking for rate of change, not always just absolute number. Like stepping on a scale. I dont care if scale is super accurate, as i care about gaining or losing weight on the same scale.

[Justfor_ in reply to MateoBeach]

Curcumin did NOT influence my PSA as my recent experiment showed. To be 100% accurate in said statement, if any influence at all is less than -18%. The possibility of an increase vs a reduction of my PSA will be ruled out after my next monthly test.

[lcfcpolo]

Good analysis Jazj. As I get DVTs I'm on a anticoagulant, Apixaban. I cannot take Aspirin due to the increased bleeding risk. Good luck with your final decision.

[Grandpa4]

There is a placebo controlled trial of curcumin in PCA ongoing now. Who knows when it might give us useful info.

[jazj in reply to Grandpa4]

Ya, this 2021 article pretty much sums up the state of evidence on Curcumin:

pubmed.ncbi.nlm.nih.gov/343...

"This study demonstrated that turmeric or curcumin supplementation might have beneficial effects on some parameters related to prostate diseases, but it should be noted that some studies showed no effect. Therefore, further studies using curcumin-related compounds, particularly in highly bioavailable forms, are needed to assess the impact of curcumin on prostate conditions."

Regarding the positive studies, pjoshea13 (Patrick) has shown some evidence that the "beneficial" effect regarding PCa may just be masking PSA and not actually significantly affecting disease progression.

So will be interested to see future study results.

[Explorer08]

Almost all fish oil Omega 3 supplements contain Vitamin E as a preservative. Vitamin E has been show to exacerbate recurrent prostate cancer. My docs agree with this finding and suggest not taking anything containing Vitamin E.

[Currumpaw in reply to Explorer08]

Nordic Naturals oils only have rosemary and some lemon flavor other than the oils.

Fish oil should be fish oil --in my opinion--and not in a capsule.

A synthetic type of fish oil, Vascepa, very expensive, prescribed by doctors. Poor old fish oils. When I embalmed bodies the funeral director that owned the home said that the rather large Swedish population usually outlived the rest of the locals. He attributed it to their consumption of fish.

A link to Vascepa--

Is Vascepa the same as fish oil? - Drugs.com

drugs.com/medical-answers/v...

Currumpaw

[MateoBeach]

Good analysis jazj. Personally, I take Omega 3 supplement as I eat more meat (beef and chicken) than fish in a typical week on my keto oriented diet.

Agree with the aspirin: I take 80 mg enteric 3X per week. And celecoxib 400 mg daily. Lowering inflammation burden is one of my primary targets to reduce cancer progression (Review Hallmarks of Cancer), which is a different tier of therapy than fighting the present state of the cancer.

Curcumin is a winner in my book.

I do not know why “diet” is ranked so high or which elements of the diet are favored. Those without metabolic syndrome or diabetes and have normal body composition ( no excess fat and maintaining muscle mass) and have lipids and CV risk factors in check, have diverse options in their choice of diet. And none have been shown to be measurably better than others with respect to APC outcomes. (Not speaking about primary prevention, which does not apply to those of us here.)

Thanks for all your research and thoughtful consideration. Paul

[jazj in reply to MateoBeach]

Many of the positive mechanisms of actions stipulated in various supplements (such as anti-inflammatory) are also achieved through diet (mainly increasing fruits and vegetables and lowering high fat animal protein.) In addition, many foods have various complimentary phytonutrients the isolated supplements don't include. There has been debate on whether or not these additional phytonutrients in the foods are key to maximizing beneficial effects compared to a supplement.

None of the Integrative Medicine Doctors I talked to advocated any one specific type of diet. In fact they said trying to adhere to a strict certain type of diet was probably counterproductive mentally. Basically they said use common sense and strike a balance you are comfortable with that isn't obviously unhealthy (in short, whatever you do, eat some fruits and vegetables and some oily fish once in a while (Salmon, Mackerel, Sardines, etc.) Don't restrict your diet to the point it's making you stressed/depressed that you can't eat some of the things you enjoy that aren't the most healthy, at least once in a while.

[Purple-Bike in reply to MateoBeach]

Paul, how low inflammation do you aim for? I measure mine with CRP, latest 0.46. It used to be be below 0.2, but eased up on my diet, am making it stricter again. / Ulf

[MateoBeach in reply to Purple-Bike]

I try to keep it as low as poss but not obsessively so. My local Lab only reports down to <0.30 so I’m satisfied with that. But if there are some strong stresses going on or any kind of infection or wound healing then inflammation is expected and part of the healing process.

[MrG68]

If people try to find a specific compound as a panacea, it’s unlikely to yield anything special IMO. No harm in trying though.There’s a million different variables at play from genetics, epigentics, an environment that changes, viruses, different sun exposure, allergic reactions, inconsistency of supplements, varying information and a multitude of others. These all interact with each other and everyone will show a variety of results. Even if you were able to get some RCT there are shortcomings with the results.

I would try to have a certain holistic approach and see what results come out if it. Exercise, diet, sleep, sun exposure etc. if the results don’t yield what you want, try a different holistic approach.

I try to target inflammation . I think it’s prudent to understand that having a psa value which is constant is also a win scenario. People seem totally transfixed on the absolute value.

Just my opinion.

[jazj in reply to MrG68]

I agree that the key is taking a holistic approach: diet, exercise, stress reduction, and maybe a select few supplements based on data showing some positive evidence with no potential harm (except to your pocket book.)

[MrG68 in reply to jazj]

Yeah, that pocketbook is quite an expense eh?

[jazj]

This analysis out of University of Thessaly published in October 2020 I think realistically sums up the level of evidence as of 2019 on natural supplements pertaining to Prostate Cancer. Unfortunately it's not going to leave anyone who is a "supplement believer" feeling good.

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

Also a side note: Dr. Snuffy Myers advocating Curcumin (in 2016) appears to have been based on studies related to Pancreatic Cancer at MD Anderson U of Texas, not Prostate Cancer. He was extrapolating it could also be effective with Prostate Cancer. I've seen both studies contending it potentially masks PSA and others (including in the above article) it has no effect but none that it poses any harm.

Interestingly, the University of Cal San Francisco, renowned for its Prostate Cancer research has a very comprehensive guide to Nutrition and Prostate Cancer. However it was published in 2009, 10 years prior to the article from University of Thessaly so in my opinion much of the information in this guide has since been debunked and shown to have no clinical proof of effectiveness so their conclusions at that point may have been based on mostly in-vitro/in-vivo mice and/or underpowered or poorly designed studies. But, for anyone that has personally decided to include nutritional supplements (thinking it can only possibly help), this UCSF guide seems excellent in presenting recommendations from what a I consider the "pro supplement" biased view, countering the apparent "anti supplement" stance in the guide from U of Thessaly.

urology.ucsf.edu/sites/urol...

I've made my final decision. This is what I'm going with:

1. Flexatarian diet (80% vegan, 15% pescatarian, 5% non-fish animal - got to treat myself to a hamburger once in a while!)

2. Aerobic and strength training exercise minimum 3 hours a week (3-4 session)

3. Continue my 20mg Simvastatin for my high cholesterol

4. Rhodiola Rosea once a day (3% Salirsodes) as it keeps my cold sores at bay and has anti-cancer properties. (was using this before PCa diagnosis)

5. Vitamin D-3 5000 IU once a day adjusted as needed to maintain 45-65ng blood level.

6. Calcium/Mag/Zinc supp (low dose - 333 mg cal, 125 mg mag, 8mg zinc) to top off levels as I show consistent moderate deficiency since I drastically cut down on animal protein and eat virtually no dairy.

7. Vitamin K2 100mcg (MK7 long chain form) due to primarily Vegan Diet and moderately high CVD risk

8. Pomegranate Extract - Mainly for liver protection for the evenings I indulge in a glass or two of wine but also for its general anti-oxidant and anti-cancer properties a kin to Curcumin but about 1/4th the cost of taking Curcumin and bit less potential for interaction with prescription drug metabolism.

Things I may add in the future depending on how things go from here:

9. Avodart/Dustateride at appropriate times and dosage to keep DHT <= 3

10. Modified Citrus Pectin

11. Low Dose Aspirin (40 mg every other day or 81 mg every 3 days)

[Hidden]

Hey jazz! This is why I follow a naturalpathic onco in his nutrient routine . I’m not smart enough to go it on my own limited knowledge .

[j-o-h-n]

Something to remember regarding supplements, Don't let anyone Con your sensus......

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 07/06/2022 7:02 PM DST

[jazj]

Note that I updated the Omega-3 section of my original post as I did some final research on Fish Oil. My initial stance is that it provided no benefit and possibly a negative association but a more broader review of studies from 2015 on shows no indication Omega-3 Fish Oil Supplements should be avoided although I still believe there can be "too much of a good thing." The main research that set off alarm bells was a study done way back in 2011 at Fred Hutchinson. I could not find significant data since then that backed up the contention EPA/EHA Omega-3 promotes Prostate Cancer. So I think keeping a low Omega 6 to Omega 3 ratio will personally continue to be my goal while trying to have a healthy balance of Omega 3 sources being a mix that isn't overly lopsided of ALA, EPA, and DHA. This may require some MODERATE fish oil supplementation during weeks my diet was largely devoid of it.

Here by the way is the Mayo Clinics response to the Fred Hutch study that associated Omega-3 with a higher risk of PCa.

mayoclinicproceedings.org/a...

[thethinman]

For those who are using curcumin do you have a preferred form(meriva, bcm-95, etc.) Also how much are you using? Just the amount suggested on the label or are you going with a higher dose? Is anyone aware of any data regarding boswellia and PC?