In this video (see link below) Dr. Freedland, Director of the Centre for Integrated Research in Cancer and Lifestyle at Cedar Sinai, joins Alicia Morgans, Associate Professor of Medicine at Northwestern University to discuss the Carbohydrate and Prostate Study 2 (CAPS2) - a randomised controlled trial of a 6 month low carbohydrate intervention on disease progression in men with recurrent prostate cancer
This study, part of a series, involved taking men with rising PSA after failed surgery or radiation and randomising them to a low carb diet of less than 20 grams of carbs a day for six months. The primary outcome was to track PSA doubling times, as based on data from Hopkins and other places, ‘the rate at which PSA rises…. will predict the development of metastasis and ultimately death from prostate cancer’. If the rate of the doubling time can be slowed this may potentially have significant benefits.
In addition to looking at the doubling time the study tracked and measured metabolic effects on participants to ensure that any negative outcomes of the diet were identified. The video discussion raises some interesting points for consideration about the benefits of a low carb diet, including significant weight loss and improved cardiovascular health.
Dr Freedland’s study suggests that unlike most treatments, that are potentially heart harmful, this diet ‘might actually be heart beneficial and have anticancer activity’. These two important health topics of obesity and cardiovascular health were raised in recent posts from cujoe confirming the long-term implications of why it is so important to pay attention to the emerging data that lifestyle, diet and exercise do matter.
In summary Dr Freedland made the following comment
‘I don't think there is one single dietary approach that is the answer for everything and certainly our data I think support low carb as an option. But that's not to say a vegan diet is not also good or some other diet is not also good. It's just like treatments for prostate cancer. There's no one single treatment. It's what does it make sense to you? …Similarly here, there are multiple diets that are probably helpful. We happen to study one and there’s a lot of bias out there against low carb diets but again, our data support that it’s certainly not bad for the cancer and may have some other benefits.’
Thanks Marnie, interesting presentation. Most studies of keto-type; i.e., low carb/ high fat diets universally show short-term weight loss and the benefits that go with that weight loss. The bigger question is: Are those short-term benefits sustained over the long haul. As Dr. Feedland clearly states at the end of the interview, individual metabolisms lead to varying responses to diet (and lifestyle); i.e., one shoe does not fit all.
Some time back a PCa patient posted (on another HU forum) about his experience monitoring his glucose levels over several weeks or more. He wore one of the electronic monitors that sampled his glucose every 15 mins or so. He was able to download the data and compare his glucose response to particular foods he ate. He was surprised to find that his glucose often spiked for foods commonly not expected to cause a glucose increase (w/ low glycemic index) and the opposite was often true for foods expected to cause a spike (w/ high GI). And while he was only reporting his own experience, it served as an example of the diverse nature of our individual metabolism; i.e. OSDNFA.
With that qualification, I do find the results of this dietary research (as limited and qualified as they are) to be quite valuable to PCa patients - as we all struggle to find ways to slow the progress of our mostly incurable disease. In the end all "diets" involve some sort of trade off. Low carbs at the expense of some or all fruits and whole grains, both of which have also been shown in epidemiological studies to be beneficial in preventing cancer. Meats are usually welcomed onto all keto menus, but have also been shown to have risks for the development of cancer. That that may be due to the way industrialized meat is "produced" is a bit of a canard in a world where most of us get our food at the local supermarket. The same is true for most all other "processed" foods. Chemical fertilizers, toxic pesticides, processing agents, and genetically modified seed crops all add considerable risk to the foods we consume. The supermarket is more like a mine-field these days than the trust-worthy source of mostly natural, locally grown food of my early childhood. As in all things related to our health and general well-being, caveat emptor still rules the day.
Indeed, who knows what is really in our food short of doing electron spectroscopy for chemical composition. Fertilizers, pesticides, insect parts...a veritable smorgasbord...None the less, we must choose something to eat. A while back, Patrick did a post regarding meats and the charred variety are the worst, but poultry and fish seemed to be safe. Caveat emptor rules our lives these days. Now isn't that just sad....
Dave. Yes we have to eat and there are so many theories about what's good and what's not and what is in favour one day is out the window the next day. One thing I think is critical for all of us.... but especially those with cancer of any type.... and I know you are also conscious of this ....is weight management.
I recall the time we had our first meeting with Ron's PC specialist after the biopsy results were back and he looked at Ron, who at the time weighted 120kg, and he very bluntly said while pointing 'You have to lose that weight. This cancer feeds off fat especially fat around the middle'
I'm a great fan of Dr Michael Mosley's theories about the importance of weight control for overall health and the benefits of interval fasting. By encouraging Ron to implement Mosely's principles he's now under 100kg and finds it very easy to stick with IF. For the long term this is also an important point....not just losing the weight... but what cujoe picked up earlier...it has to be sustainable.
In relation to Patrick's post that you mentioned.... I recall research many years ago that strongly suggested that 'burnt' parts of meat, toast etc had the potential to be carcinogenic.
What is encouraging is the ongoing search for solutions for all stages of this affliction and like you say often....the science is coming ...and this will be the answer.
Yes I agree cujoe. I found it encouraging to know that money is being provided for trials like this one that aren't dependent on pharmaceuticals but just lifestyle changes. I think it is fairly well established that obesity is a real problem for men with prostate cancer for a number of reasons and a low carb diet is known for promoting significant weight loss... so it would seem, for those with disease progression, if there are no cardiovascular negative outcomes ...no harm done and perhaps some benefits in slowing the doubling PSA rate. Be interesting to see the outcomes of the next series in the study . You too BW & SW
I do enjoy Alicia Morgans podcasts. Due to information on the Warburg effect and studies on diet, we are getting fine tuned on what helps and what hurts in PCa. I am watching SM-88, a drug aimed at tumor metabolism.
The evolution of cancer treatment from knowledge gained of epigenetics, tumor metabolism, and the tumor itself have come such a distance in such a short time...I know some people pooh pooh my statements of hope, but when you look at treatment 15 years ago and treatments today, the changes are amazing...
Thanks as always for having you scientific ear to the ground and sharing what you hear with all of us here at FPC (& hopefully beyond?).
#1SM-88 sounds pretty interesting to me. As have outlined before, in the case of my "other cancer", Chronic lymphocytic leukemia (CLL), tyrosine inhibition (in that case, Bruton Tyrosine Kinase inhibitors - en.wikipedia.org/wiki/Bruto... , has changed the entire frontline treatment landscape for the disease - and has in the process turned an incurable and often deadly disease into one that for most is now a controllable chronic one.
To get to that level of efficacy for PCa, esp. without the many side effects of ADT, would would be close to a silver-bullet for many of us patients.
PS Ditto re: Alicia's great interview videos & podcasts
Yes Dave I find Alicia's interviews easy to listen to and she has such superb skills in asking questions that draw out the issue and also following through with questions that you hope she'll ask.
Most people following closely all the developments in the research into prostate cancer and it's progression will agree with you that the changes are indeed amazing and you'd have to believe that they will continue.
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Fish consumption and PCa Mortality. A meta-analysis.
