Conversations With Prostate Cancer Experts

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Carbohydrates + Prostate Cancer

Dr. Stephen Freedland is a urologist at Cedars-Sinai in Los Angeles, California, and the Director of the Center for Integrated Research in Cancer and Lifestyle, Co-Director of the Cancer Genetics and Prevention Program and Associate Director for Faculty Development at the Samuel Oschin Comprehensive Cancer Institute.

Dr. Freedland treats the whole patient and not just a man’s prostate cancer.

Prostatepedia spoke with him about diet and prostate cancer.

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What do you tell your patients about prostate cancer and diet?

Dr. Freedland: Given the link between obesity and prostate cancer, I focus on getting my patients to lose weight. The easiest way to lose weight is to cut out all the extra sugar in your diet: cookies, cake, candy, all of that. A meta-analysis published in the Journal of the American Medical Association of all the popular diets found that the best diet for weight loss was a low-carb diet. That was the best diet. They’re all decent, but low carb is the best.

Is that true primarily for American patients or for everyone?

Dr. Freedland: I think it’s true for everyone. A recent study published in the Lancet followed over 135,000 people in 18 different countries on over five continents. They found that the more carbs you eat, the more likely you are to die earlier. Eat fewer carbs, live longer. Fewer carbs and more fat make you live longer.

This is a landmark study that supports what an increasingly loud minority of us has been saying. Fat is not the problem. Carbs are the problem.

I focus my patients on their carb intake. Let’s focus on the carbohydrates in the diet and see which of those we can get rid of. If you’re having whole-grain oatmeal for breakfast, maybe that can stay. But most people are having pancakes with butter and syrup. We can get rid of that.

While you’re giving up the sugars, cakes, and candies, we focus on what we can put in their place: fruits and vegetables.

Yes, fruits have sugar, but it’s a natural source. As long as patients aren’t juicing, natural fruits contain a lot of fiber that will slow the absorption of sugar in the intestine. Nuts, beans, and those types of things are also good replacements.

I worry that because we’ve been advocating that people cut out fat and tell them to eat lots of fruits and vegetables, people are going to go to the store, buy fat-free ice cream and say, “I had a salad with my dinner so I can eat all the ice cream I want now. I’m being healthy!”

Remember the old food pyramid from the 1980s? Carbs were at the bottom of the pyramid, the largest food group.

Dr. Freedland: Right. Lots of bread. Our entire way of thinking has been very carb-centric. Let’s eat carbs and avoid fat. And the result has been that the obesity rates have almost tripled in the United States in the last 30 years.

What do you say to people who argue that you should have carbs in balance with fat and protein?

Dr. Freedland: Your body doesn’t need carbs. There are animals and people raised without eating a single carb. You can’t survive without eating fat. You can’t survive without eating protein. You can survive without eating carbs.

What protein sources do you recommend?

Dr. Freedland: People get in this mindset that red meat is bad and fish is good. Fish (we think) is good because it contains fish oil, an omega-3 fatty acid. But I found an article that looked at tilapia. It turns out that tilapia doesn’t have much fish oil. If you want fish oil, you know what are better sources than tilapia? Doughnuts and bacon.


Dr. Freedland: Doughnuts and bacon have more fish oil than tilapia per gram.

I guess not all fish are created equal.

Dr. Freedland: Correct. And not all meat is created equal. A nice grass-fed steak probably has as much omega-3 fatty acid as many kinds of fish. The worst protein for prostate cancer is charred meat. Those black lines you get on your steak in charring form heterocyclic amines that can cause cancer. This is true mostly for meat because that’s what you tend to char, but it’s also true for chicken and potentially fish.

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Dr. Mark Moyad: Diet, Lifestyle + Prostate Cancer

Moyad Headshot-2Dr. Mark A. Moyad, the Jenkins/Pokempner Director of Complementary and Alternative Medicine in the Department of Urology at the University of Michigan Medical Center, has published over 150 medical journal articles and 12 books, including The Supplement Handbook: A Trusted Expert’s Guide to What Works & What’s Worthless For More Than 100 Conditions.

Dr. Moyad frames this month’s conversations on diet and lifestyle for prostate cancer.

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First, I’d like to say that I find it incredibly wonderful that we’re now talking about diet and exercise for prostate cancer. In the old days, it was unusual to even talk about it, but now you stick out if your institution doesn’t cover diet and exercise. What a wonderful and diverse collection of experts in this issue—such a pleasure to read and learn from some of the best in this field now and in the future.

I always say that heart-healthy is prostate-healthy. Heart-healthy is all healthy. Reducing your cardiac risk as close to zero as possible is the smartest thing you can do as a prostate patient. That’s the top of the pyramid when it comes to diet and exercise for prostate cancer. Maintaining a health weight is the first step in becoming heart-healthy.

Every few years, we realize that more and more cancers are associated with obesity. Now we know that obesity is associated with up to at least 13 types of cancer, not to mention the ongoing, ravaging obesity epidemic.

That said, I don’t believe that we have neither the power nor the right to tell people what diet to follow. It doesn’t matter if you want to go vegan, high fat, or low carb: there’s nothing more important than maintaining a healthy weight and having the heart-healthy numbers to support that healthy weight loss.

The new elephant in the room is alcohol. Alcohol often becomes self-medication in elderly people, but it is one of the largest sabotages to a heart-healthy and prostate-healthy lifestyle.

First, the caloric content of alcohol is high: seven calories per gram. Second, the data clearly show a relationship between excessive insulin production and excessive alcohol exposure. This makes it so easy to gain weight when you drink alcohol. Some of the greatest weight loss I’ve seen in the past 12-months has come when a patient eliminates alcohol. There is also a correlation between alcohol and potentially aggressive prostate cancer. So alcohol makes you gain weight, encourages prostate tumor growth, encourages cardiac risk, and encourages risk of other cancers.

Exercise is important, but we have to be careful as we age. We become very delicate machines. That’s why I agree with Dr. Rob Newton that finding an exercise physiologist is a great idea. We have to be smart about exercise: if you don’t preserve yourself, you won’t be able to stay active and get the benefits of exercise for your prostate cancer.

I’ll also add that the biggest benefit to exercise is a mental health benefit. I love the cardio/metabolic effects of exercise in men on hormonal therapy, but I don’t give a damn if exercise ends up being physically beneficial to cancer patients. What excites me is the impact on the quality of life of a man. Patients are completely different on hormonal therapy when they are regular exercisers. Mentally, they’re still in the game. They’re beautiful to be around.

Socialized exercise also gives you a boost. When you work out in your basement, you’re not getting all the benefits of exercise. When you have a trainer, go to a gym, or work out with support group members, you get an added mental health boost. You can become isolated in exercise.

Finally, I’d like to add that we lose credibility if we don’t follow probability with supplements. The results from the VITAL trial, which looks at vitamin D and cancer in about 26,000 people, will be published next year. I’m going to wait for those results before I recommend higher vitamin D intakes to patients.

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