DIETARY ADVICE FOR PROSTATE HEALTH Written by: Larry Mróz, PhD Prepared by: DIETARY ADVICE FOR PROSTATE HEALTH Index: Carbohydrates Cholesterol and Heart Disease Fish and Omega-3 Hormone Therapy and Diet Meat and Meat Alternatives Milk and Calcium Pomegranate Selenium Soy and Isoflavones Tomato Foods and Lycopene Vitamin D Vitamin E Diet and Prostate Cancer Series - 2012 CARBOHYDRATES Should I eat foods with carbohydrates? RECOMMENDATION: Eat carbohydrate-rich whole foods like whole grains, legumes, fruits and vegetables as part of your balanced diet - but cut back on ‘refined’ carbohydrates found in starchy and sugary processed foods. What’s the evidence? For Prostate Cancer Prevention? Eating too much refined carbohydrates might increase the risk of prostate cancer: • New research suggests that diets high in refined carbohydrates like sugar and starch increases prostate cancer rates, however, the few studies done had mixed results.1 • A recent large study showed only a weak link between a high-carbohydrate, low-fibre diet and prostate cancer risk.2 • There is not enough research to say that a low carbohydrate diet in itself will lower prostate cancer risk. • However, eating less refined carbohydrate and fat and more vegetables might help. For Prostate Cancer Treatment? Eating too much refined carbohydrates might increase the progression or recurrence of prostate cancer: Whole foods rich in carbohydrates also contain vitamins and minerals needed for good health Carbohydrate facts: Carbohydrates (or ‘carbs’ for short) like starch and sugar are our main energy sources, found naturally in grains and grain products, vegetables, fruit and legumes. • Sugars or ‘simple’ carbohydrates are absorbed quickly into the body and are sources of ‘fast’ energy. • Starches or ‘complex’ carbohydrates are digested and absorbed more slowly, but are eventually converted into sugar. • Fibre or non-digestible carbohydrates cannot be digested or absorbed but help reduce cholesterol, control blood sugar and improve bowel function. • ‘Refined’ carbohydrates are sugars and starches with most of the fibre and other nutrients removed - found in white flour, white rice and sugar (white, brown or ‘raw’). • There is little research on the effects of carbohydrates after a diagnosis, but one study recently found that patients who ate the most refined carbohydrates had the highest risk of aggressive prostate cancer.3 • We don’t know if a low-carbohydrate diet itself will stop or slow prostate cancer growth. • However, one research review found that eating less refined carbohydrates and losing weight might slow prostate cancer growth in some patients.4 • Similarly, in a small study, patients who ate a lowcarbohydrate diet and lost weight over six weeks before surgery showed signs of slower cancer growth.5 • Any benefits from a low-carbohydrate diet are probably from eating less refined carbohydrates while also increasing plant-based, high-fibre foods. Eating balanced diets that limit how much refined carbohydrates you eat might prevent prostate cancer or reduce cancer progression or recurrence for men already diagnosed with prostate cancer. Good carbs / Bad carbs? Carbohydrates are essential macronutrients nutrients like protein and fat - that provide energy. • Health Canada suggests we get between most of our daily calories from carbohydrates. Recommended amounts of daily energy from macronutrients: Should I eat a low carbohydrate ‘low-carb’ diet? Yes and no! There are many kinds of low-carb diets, but in general they limit foods that contain large amounts of: Total Carbs Total Protein Total Fat • Starches - like those found in breads, cereals, pasta, potatoes and carrots. 45 - 65 % 10 - 35 % 20 - 35 % • Sugars - like those found in candy, syrups, desserts, jams and jellies and fruit. Health Canada Dietary Reference Intakes 2012: http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/ref_macronutr_tbl-eng.php ‘ Bad carbs’ Refined starches and sugars that are digested and absorbed quickly and often raise blood sugar levels too high. • Eating too much sugar such as white table sugar, brown sugar, raw sugar, honey and maple or other syrups - is unhealthy and contributes towards high or uncontrolled blood sugar levels, diabetes and possibly cancer. • Canadians eat almost 21% of their calories as sugar that’s equal to 110 grams (26 teaspoons) or about 440 calories each day. • Sweetened beverages provide much of this sugar about 40 grams (10 teaspoons) are in a can of pop = 160 empty calories. • These foods are replaced by high-protein and/or high-fat foods - often meat - that can raise your cholesterol and risk of heart disease and cause long-term health problems. It’s hard to follow some popular low-carb diets because of the many restrictions and lack of food choices - people tend to drop them after a short time. • Some low-carb diets are also low in fibre - bad news for men over 50 who typically don’t get the 30 grams of fibre they need each day. • Eating a low-carbohydrate diet that cuts out healthy whole foods like carrots or fruit can leave you low in vitamins and minerals. Low-carb diets can be healthy if done right - by also eating less and exercising more. • Starch found in white flour and processed foods is quickly converted to sugar during digestion. WHAT TO DO? Cut back on ‘bad carbs’ by eating less processed, starchy and/or sweetened foods. ‘ Good carbs’ Starches and sugars found naturally in whole foods like whole grain products, vegetables, fruits and legumes. • Cut out processed foods and reduce white bread, pasta and sugary foods and drinks and replace them with plant-based foods - not animal-based foods. 1.Hori S. et. al. Prostate cancer and diet: food for thought? BJU (British Journal of Urology) International. 2011; 107(9): 1348-59 • Found with important vitamins (like vitamin C and folic acid), minerals (like calcium and potassium) and fibre. 2.Nimptsch K. et. al. Dietary glycemic index, glycemic load, insulin index, fiber and whole-grain intake in relation to risk of prostate cancer. Cancer Causes & Control. 2011; 22(1): 51-61. WHAT TO DO? Replace ‘bad’ with ‘good’ carbs by eating more whole grain products - including whole grain breads, oatmeal, brown rice and whole wheat pasta. 3.Hardin J. et. al. Impact of consumption of vegetable, fruit, grain, and high glycemic index foods on aggressive prostate cancer risk. Nutrition & Cancer. 2011; 63(6): 860-72. 4.Freedland, S.J. & W.J. Aronson, Dietary intervention strategies to modulate prostate cancer risk and prognosis. Current Opinions in Urology. 2009; 19(3): 263-7. 5.Lin DW, et al Low-fat, low-glycemic load diet and gene expression in human prostate epithelium: a feasibility study of using cDNA microarrays to assess the response to dietary intervention in target tissues. Cancer Epidemiology, Biomarkers & Prevention. 2007; 16(10): 2150-4. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 CHOLESTEROL Heart Disease and Should I worry about cholesterol? RECOMMENDATION: Eat a balanced diet and maintain a healthy body weight to ensure proper blood levels of cholesterol. What’s the evidence? Confused by cholesterol? For Prostate Cancer Prevention? High cholesterol levels might increase the risk of prostate cancer: Cholesterol is important for good health but having too much in your diet or blood can lead to clogged arteries, heart attack and stroke. • Men with heart disease might have a higher prostate cancer risk and researchers think that high blood fats like cholesterol are partly responsible.1 • A recent research review found that high cholesterol and triglycerides as found in heart disease are linked to a higher risk of aggressive prostate cancer.2 • Although lowering cholesterol can reduce heart disease risk, we don’t know if it will also lower prostate cancer risk. • However, some research has shown that men without prostate cancer who take cholesterol lowering drugs called statins might have a lower risk of aggressive prostate cancer.3 For Prostate Cancer Treatment? High cholesterol levels might increase the progression or recurrence of prostate cancer: • Some - but not all - studies have shown that patients with too-high cholesterol are also more likely to develop aggressive prostate cancer.4 • This suggests that patients who lower their cholesterol through diet and by taking statins might slow prostate cancer growth or return. • Some studies have found that patients who take statins are less likely to have prostate cancer return after treatment.5 • However, there is not enough research to recommend that all patients start taking statins after a prostate cancer diagnosis. Cholesterol facts: Dietary cholesterol is found naturally in all animal foods such as meat, seafood, poultry, egg yolks, and diary products. • Plant foods such as legumes, fruits, grains, vegetables or even high fat items like nuts or vegetable oils do not contain cholesterol. Blood cholesterol is a natural part of our blood fats (or ‘lipids’) and is used by the body in many ways – such as for making vitamin D, hormones and bile for digesting fats. • LDL, or low-density lipoprotein, is also known as ‘bad blood cholesterol’ because it builds-up plaque in arteries. • High LDL is unhealthy. • HDL, or high-density lipoprotein, is also known as ‘good blood cholesterol’ because it carries plaque away from artery walls. • High HDL is healthy. • Triglycerides are not cholesterol but are another kind of blood fat. • High triglycerides are unhealthy. Eating balanced diets that promote healthy blood cholesterol levels might help prevent prostate cancer or reduce cancer progression or recurrence for men already diagnosed with prostate cancer. Get your cholesterol checked! High blood cholesterol, especially LDL is a concern because it raises heart disease and stroke risk: Heart healthy foods are also prostate healthy! • Leads to hardening and narrowing of arteries or ‘atherosclerosis’, making it harder for blood to circulate. Eat more... Instead of... • Cholesterol build-up in arteries called ‘plaque’ can break off and block blood flow to the heart and brain. Fish, skinless poultry, lean meat, beans Organ meats (like liver), sausages and other processed meats Vegetable oils: corn, canola, olive, soybean; Fish oils/ omega 3s, nuts and seeds Saturated and trans fats: animal fats, butter, lard, hydrogenated margarine Skim or low-fat milk, yogurt, sorbet Whole milk, cream, cheese, ice cream Steamed, baked or roasted foods Sauces, deep-fried foods Clear soups Creamy soups, chowders • Eat less food that contains high amounts of cholesterol, saturated and trans fats. Whole grains, high-fibre cereals Products made with refined, white flour • Eat more high-fibre foods. Whole fruit, vegetables Juice, sugar Egg Whites Egg yolks What causes high blood cholesterol? • Things you cannot control, like genetics, family history and age [over 45]. • Other things you can control, like smoking, high blood pressure, being overweight, not exercising and bad diet. • Eating too much saturated and trans fats. Reduce your blood cholesterol! Eat more ‘heart healthy’ foods that lower overall cholesterol and LDL and raises HDL. Statins Are drugs that lower cholesterol and other blood fats and can reduce the risk of heart attack or stroke. • Common statins used in Canada are Lipitor (atorvastatin), Zocor (simvastatin), Mevacor (lovastatin), Lescol (fluvastatin), Pravachol (pravastatin) and Crestor (rosuvastatin). Red Yeast Rice extract - a natural statin? Can I eat eggs? Because eggs are high in dietary cholesterol, we thought eating them would raise blood cholesterol. • We now know that the liver makes most of our blood cholesterol and dietary cholesterol is not as important as saturated and trans fats from food. • However, it’s best to eat no more than 4 eggs per week if you have high cholesterol. Red Yeast Rice extract or RYR is a supplement made from fermented rice and used in China for treating heart disease. • Contains monacolin K, a natural statin identical to lovastatin. • RYR supplements are unregulated and the amounts of monacolin K in them vary considerably and might have serious side-effects, so they are not recommended by Health Canada. • Although shown to lower cholesterol and slow the growth of prostate cancer cells in some lab studies, we don’t know if RYR will reduce heart disease or slow prostate cancer growth or return in patients. 1.Thomas JA et. al. Prostate cancer risk in men with baseline history of coronary artery disease: results from the REDUCE Study. Cancer Epidemiology Biomarkers & Prevention. 2012; 21(4): 576-81. 2.Shafique K, et. al. Cholesterol and the risk of grade-specific prostate cancer incidence: evidence from two large prospective cohort studies with up to 37 years’ follow up. BMC Cancer. 2012; 12:25. 3.Hamilton RJ, Freedland SJ. Review of recent evidence in support of a role for statins in the prevention of prostate cancer. Current Opinions in Urology. 2008; 18(3):333-9. 4.Platz EA, Clinton SK, Giovannucci E. Association between plasma cholesterol and prostate cancer in the PSA era. International Journal of Cancer. 2008; 123(7):1693-8. 5.Hamilton RJ, et. al. Statin medication use and the risk of biochemical recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) Database. Cancer. 2010; 116(14): 3389-98. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 FISH & OMEGA-3s Should I take omega-3 or fish oil supplements? RECOMMENDATION: Include omega-3-rich foods - especially fish - in your diet. Taking fish oil supplements in moderation is safe. What’s the evidence? For Prostate Cancer Prevention? Omega-3 oils from fish might prevent aggressive prostate cancer: • Omega-3s have anti-cancer effects in lab studies. But, although some studies showed that men who ate fish and omega-3-rich diets had a lower risk for prostate cancer, other studies have not. • These differences are probably due to the types of fish eaten and how it was cooked. • Recently researchers found that although the prostate cancer risk was not lowered, a lower death rate from aggressive prostate cancer was found in men who ate the most fish.1 For Prostate Cancer Treatment? Omega-3s from fish might slow down progression or recurrence of prostate cancer: • In a few studies that looked at diet after a prostate cancer diagnosis, men who ate the most fish had the lowest risk of tumour growth and death from prostate cancer.2 • A recent clinical trial study showed some benefits for men who took fish oil supplements for 6 weeks before they had prostate cancer treatments. • Men who ate a low fat diet and took 5,000 milligrams (mg) of fish oil daily didn’t improve some blood tests for prostate cancer but did show slower cancer growth.3 • Although omega-3s supplements can reduce the risk of heart disease, the potential role of supplements in prostate cancer treatment remains uncertain. • Some men worry that eating too much ALA can cause prostate cancer, but a recent research review showed that there is no proof that it does.4 Omega-3s from foods - like fish - are needed for everyone’s good health including men diagnosed with prostate cancer Omega-3 facts: Omega-3s are also known as ‘essential fatty acids’ (‘EFA’) because they must be supplied by the diet like vitamins. • Called fats, oils or fatty acids - or sometimes ‘n-3s’ - omega-3s are types of polyunsaturated fatty acids (PUFA). • They are important for good health as parts of cell membranes and are used by the nervous system for vision and brain function. • By reducing inflammation throughout the body, omega-3s are thought to be helpful in treating heart disease and many other health conditions. • There are 3 commonly eaten kinds of omega-3s: • Alpha-linolenic acid (ALA) found in plants oils like flax and walnut. • Eicosapentanoic acid (EPA) & Docosahexanoic acid (DHA), found in fish. • A fourth type of EFA is an omega-6 fatty acid called Linoleic Acid (LA) found in plant oils. Eating balanced diets with a variety of omega-3-rich foods including at least 2 servings of fish per week might prevent aggressive prostate cancer or reduce cancer progression or recurrence for men already diagnosed with prostate cancer. The bottom line: Eat fish or take fish oil supplements Worried about eating too much fat? Fatty fish are healthy! Men need about 1,600 mg of omega-3s per day which they can get from a varied diet that includes fish or supplements. Eat at least two servings of cold water, ‘fatty’ fish each week. • While having up to 3,000 mg of DHA and EPA each day is safe, talk to your doctor before taking supplements, particularly if you have immune system problems or are taking aspirin, blood thinners or drugs for high blood pressure. • Talk to your doctor about stopping taking supplements just before and after surgery or radiation. • Omega-3 or fish oil supplements should be taken with food. If you experience a bad aftertaste or heartburn, try taking several smaller doses throughout the day. • Unlike whitefish (such as sole or halibut), fatty or oily fish (such as salmon, mackerel, herring, sardines, tuna and trout) are high in fat with lots of EPA and DHA. • Cooking style is important - poach or grill, but avoid frying or deep-frying. • Health Canada warns us to limit eating fresh/frozen tuna, shark, swordfish, escolar, marlin, and orange roughy to once a week or less to avoid eating too much mercury. Fats are important parts of our diets, but Canadians tend to overeat saturated and trans fats. • Many processed foods - like baked products and ‘junk foods’ - are full of these fats, and also high in calories. Approximate omega-3 content for various foods in milligrams (mg) Food item Omega-3 content Serving/amount Seafood (DHA & EPA) Salmon 2.5 oz 75 g 1250-3300 mg Salmon oil 1 tsp 5 ml 1400-1600 mg Sardines, canned ½ can 75 g 1200 mg 3 75 g 1100 mg Cod liver oil 1 tsp 5 ml 900 mg Tuna, canned ½ can 75 g 700 mg Oysters • Saturated fats are also found in animal foods like meat and dairy products. • Trans fats are also found in ‘partially hydrogenated’ oils like vegetable shortening and some hard margarines. • The key for health is balance - avoid too much overall fat while eating foods with healthier oils. • Replace saturated and trans fats with olive oil and other vegetable oils like canola, safflower, flax or walnut. • Eat less fried and processed foods, use non-hydrogenated margarine and choose leaner cuts of meat. 1.Szymanski KM, et al. Fish consumption and prostate cancer risk: A review and meta-analysis. American Journal of Clinical Nutrition. 2010; 92(5):1223-33. Plant foods (ALA) Walnuts (English) ¼ cup 30 g 2700 mg Flaxseed, ground 1 tbsp 15 ml 2500 mg Walnut oil 1 tbsp 15 ml 1500 mg Vegetable oil, (Canola, soybean) 1 tbsp 15 ml 1200-1350 mg Health Canada, Canadian Nutrition File, 2010: www.healthcanada.gc.ca/cnf 2.Chavarro JE, et al. A 22-y prospective study of fish intake in relation to prostate cancer incidence and mortality. American Journal of Clinical Nutrition. 2008; 88(5):1297-303. 3.Aronson WJ, et al. Phase II prospective randomized trial of a low-fat diet with fish oil supplementation in men undergoing radical prostatectomy. Cancer Prevention Research. 2011; 4(12):2062-71. 4.Simon JA, et al. The relation of alpha-linolenic acid to the risk of prostate cancer: A systematic review and meta-analysis. American Journal of Clinical Nutrition. 2009; 89(5):1558S-1564S. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 HORMONE THERAPY Diet and Can diet help with side effects of Androgen Deprivation Therapy (ADT or hormone therapy)? RECOMMENDATION: Eat a balanced heart-healthy diet and make sure you get enough exercise, calcium and vitamin D. What’s the evidence? For Heart Health? ADT can increase the risk of heart disease: • A research review by the American Heart Association found that men on ADT have increased risk factors for cardiovascular disease and might have a higher risk for heart attacks.1 • Causes for this include increased body weight, raised cholesterol and triglycerides and poor blood sugar regulation. • Increased risk for heart attacks is highest for men who already have a risk factor for heart disease including high cholesterol, high blood pressure or a family history of heart disease. For Diabetes? ADT can increase the risk of type 2 diabetes: • Men on ADT can have poor blood sugar regulation leading to increased risk of developing diabetes.2 • ADT can increase blood levels of insulin and lower insulin sensitivity resulting in too-high blood sugar levels. For Bone Health? ADT can increase the risk of osteoporosis: • After a prostate cancer diagnosis men on ADT are more likely to have significant bone mineral loss and more bone fractures compared to patients not receiving ADT. • ADT can decrease bone density making them weaker. • A recent research review found that men on ADT for prostate cancer had an increased risk for bone fractures of 23%.1 ADT slows the growth of prostate cancer cells. Prostate cancer cell grow is stimulated by male hormones known as androgens, especially testosterone. • ADT cannot cure prostate cancer, but works by reducing androgen levels or androgen’s actions on cancer cells. • There are several possible side effects of ADT that depend on the man’s health, the drug taken and dosage and treatment duration. Types of ADT Stops testosterone production in the testicles Luteinizing hormone–releasing Leuprolide (Lupron, Eligard) hormone (LHRH) agonists Goserelin (Zoladex) Buserelin (Suprefact) LHRH antagonists Degarelix (Firmagon) Estrogen Diethylstilbestrol or DES Surgery to remove the testicles Castration (orchiectomy) Blocks the action of testosterone on prostate cancer cells Anti-androgens Flutamide (Euflex) Bicalutamide (Casodex) Canadian Cancer Society: http://info.cancer.ca/cce-ecc/ Men on hormone therapy have an increased risk of heart disease, diabetes and osteoporosis that might be reduced through diet. Manage ADT side effects through diet & lifestyle Bone health and ADT Calcium and vitamin D helps keep bones healthy by preventing bone mineral loss. Possible side effects of ADT • Decreased mental sharpness • Fatigue (lack of energy, tiredness) • Breast tenderness and growth • Sexual problems (impotence, loss of sexual desire) • High insulin and blood sugar levels (insulin resistance) • Bone thinning or breaks (osteoporosis) • High cholesterol • Low red blood cell counts (anemia) • Loss of muscle • Depression • Men need a total of 1000-1200 milligrams of calcium per day from food and supplements. • Men need 600-800 IU vitamin D daily and Canadians over 50 years old should be taking at least 400 IU of supplements everyday - especially in winter. • Ask your doctor about your bone density and risk of osteoporosis. • Daily calcium (500mg) and vitamin D (400-800 IU) supplements might help prevent bone loss when combined with exercise. • Increased body fat Heart health and ADT • Hotflashes Medications can control many side effects, but taking multiple drugs can be minimized by improving diet and lifestyle.3 Get regular exercise To improve heart health, reduce depression, prevent muscle and bone loss and reduce fracture risk. • Do 30 minutes of moderate aerobic exercise every other day. • Raises your heart rate through brisk activities includes fast walking, swimming, gardening, and slow bicycling. • Do weight lifting or resistance exercises 2-3 times per week. • Builds muscle and bone through slow repeated movements with weights or other pressure on muscles - includes lifting dumbbells, using weight machines or elastic tubing and doing push-ups. Eating a heart-healthy diet reduces cholesterol and risk of heart disease - and is also prostate-healthy! • Watch your cholesterol - talk to your doctor if you have a family history of heart disease. • Check your blood pressure and fasting blood sugar levels too. Supplements to consider Although their effectiveness is not proven, several supplementsmighthavepotentialbenefits.3 • Fishoil,omega3fattyacidsandflaxseed,mightimprove heart health and can reduce hot ﬂashes. • Black Cohosh (Cimicifuga racemosa) and Garden Sage (Salvia ofﬁcinalis) have also been used for hot ﬂashes. • Ginseng (Panax quinquefolius) might reduce fatigue. • Protein powder might reduce muscle loss and lessen weight gain. Eat a healthy diet To improve heart health, blood sugar regulation and body weight. • Eat less fat - especially saturated fats (like lard) and trans fats (like shortening). • Eatmorehigh-fibrefoodslikewholegrains,vegetables and fruit. • Eatmorefishandlessmeat,processedandjunkfoods • Limit salt and sugar. 1. Levine GN, et. al. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: A science advisory from the American Heart Association, American Cancer Society, and American Urological Association. CA: A Cancer Journal for Clinicians. 2010; 60(3): 194-201. 2. Taylor LG, et. al. Review of major adverse effects of androgen-deprivation therapy in men with prostate cancer. Cancer. 2009; 115(11): 2388-99. 3. Moyad MA, Roach M 3rd. Promoting wellness for patients on androgen deprivation therapy: Why using numerous drugs for drug side effects should not be ﬁrst-line treatment. Urology Clinics of North America. 2011; 38(3): 303-12. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 MEAT Alternatives and Should I eat meat? RECOMMENDATION: If you eat red meat, have smaller, leaner portions as part of a balanced diet with lots of vegetables. Choose meat alternatives more often. What’s the evidence? For Prostate Cancer Prevention? Eating too much red and processed meat might increase the risk of prostate cancer: • Several large studies found that men who ate the most meat also had the highest prostate cancer rates. • However, not all studies showed this and a recent research review could not prove that eating red meat in itself raises prostate cancer risk.1 • Cooking with high temperatures or ‘processing’ seems to be important. • A new study found that men who ate the most hamburgers, grilled or processed red meat had the highest prostate cancer rates.2 For Prostate Cancer Treatment? Eating too much red and processed meat might increase the progression or recurrence of prostate cancer: • More research is needed to show if red meat in itself is healthy or not after a prostate cancer diagnosis - the few studies done had mixed results. Meat and meat alternatives contain essential nutrients Meat facts: • Meat and other animal foods (such as beef, poultry, pork, eggs and seafood) contain healthy protein and fats that are important parts of our diet, and are rich in B vitamins and minerals like iron and zinc. • Animal foods contain vitamin B12 – which is lacking in vegetarian diets. • Typically ‘red meat’ refers to beef, lamb and pork, while ‘white meat’ refers to poultry like chicken and turkey. • Processed meats include sausages, packaged luncheon or sandwich meat, hotdogs, bacon and ham. Is meat unhealthy? • Although it can be a healthy part of a balanced diet, eating too much meat and not enough vegetables increases the risk of heart disease and many types of cancer. • Ongoing research suggests that men who eat the most cruciferous vegetables - like broccoli and its relatives have the lowest prostate cancer risk. • However, a new study found a slightly higher risk for advanced prostate cancer for patients who ate the most meat.3 • Likewise, another study showed that patients who ate the most well-done grilled or barbequed meat also had higher risk for advanced prostate cancer.4 • Mixed study results might be from other foods typically lacking in men’s diets and suggests that replacing meat with plant-based foods is helpful. • For example, in one study men on active surveillance who switched to meat-free diets with lots of added vegetables were able to postpone prostate cancer treatment.5 Eating balanced diets and limiting how much red, processed or barbequed meat you eat might prevent prostate cancer or reduce progression or recurrence for men already diagnosed with prostate cancer. Poor health from eating too much meat is probably due to a combination of factors: Most Canadians - especially men - eat more meat than they need 1. Meat dishes often have too much fat According to Canada’s Food Guide, men need 3 servings of meat or meat alternatives each day. • Choose leaner cuts of meat - trim off the visible fat. Remove skin and fat from poultry. • Eight lower-fat beef cuts qualify for the Heart and Stroke Foundation’s Health Check™ program: Eye of round, Inside round, Sirloin tip, Top sirloin, Flank, Strip loin, Cross rib, Outside round 2. People who eat lots of meat often don’t eat enough vegetables, fruits and legumes • How much is a serving? Meat or meat alternative Serving size or amount Cooked beans, peas, lentils or tofu ¾ cup (175mL) Cooked fish, chicken, lean beef, pork or game meat 2½ oz (75 g) or ½ cup or the size of a deck of playing cards. • Eat smaller portions of meat and fill your plate with lots of colourful vegetables rather than starchy foods like potatoes, pasta, rice or bread. Cooked chicken pieces • Eat red meat less often - replace it with other healthy protein sources like skinless poultry, fish or meat alternatives like beans or tofu. Packaged luncheon meat 3. Meat is often cooked at high temperatures that can burn protein and form cancer causing products • Don’t overcook - roast instead of barbeque - and limit how much grilled meat (or poultry and fish) you eat. 4. Processed meats are often high in salt, fat and preservatives • Avoid sandwich meats, bacon, ham, sausages and hotdogs, or eat products with lower fat and lower salt content. Eggs ½ of a chicken breast or a chicken leg with thigh (without skin) 3 slices (75 g) 2 medium whole eggs Peanut butter or other nut butters 2 Tbsp (30mL) Nuts or seeds ¼ cup (60mL) http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/meat-viande/ serving-portion-eng.php Meat alternatives These are also excellent sources of protein and other nutrients with the advantage of also being high in fibre - which meat does not have. • Experiment with different types of beans like navy, kidney and black beans - try chick peas or lentils too. • Use them in soups, casseroles, burritos, and chilli or pasta sauce. 1.Alexander DD, et al. A review and meta-analysis of prospective studies of red and processed meat intake and prostate cancer. Nutrition Journal. 2010; 9:50. 2.John EM, et al. Meat consumption, cooking practices, meat mutagens, and risk of prostate cancer. Nutrition and Cancer. 2011; 63(4):525-37. 3.Richman EL et al. Egg, red meat, and poultry intake and risk of lethal prostate cancer in the prostate-specific antigen-era: Incidence and survival. Cancer Prevention Research. 2011; 4(12):2110-21. • Mash them and make dips like hummus. • Add beans, nuts or seeds to a salad. Snack on roasted nuts and sunflower seeds. • Try soybeans, edamame, tofu or ‘fake meat’ products made with soy or vegetable protein. 4.Punnen S, et al. Impact of meat consumption, preparation, and mutagens on aggressive prostate cancer. PLoS One. 2011; 6(11):e27711. 5.Frattaroli J, et al. (Dean Ornish) Clinical events in prostate cancer lifestyle trial: Results from two years of follow-up. Urology. 2008; 72(6):1319-23. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 MILK Calcium and Should I take calcium supplements or drink milk? RECOMMENDATION: Include calcium-rich foods in your diet - including milk or soymilk - and take calcium (and vitamin D) supplements if you are on hormone therapy. What’s the evidence? For Prostate Cancer Prevention? Milk and calcium do not increase prostate cancer risk: • Early studies of large groups of men suggested that high calcium - more than 1500 milligrams (mg) per day - was linked to a higher risk of prostate cancer.1 • This caused some men to worry about drinking milk and other dairy products that are high in calcium. • However, despite mixed results found in many recent studies, there is little proof of a link between calcium, milk and dairy products and prostate cancer risk.2 For Prostate Cancer Treatment? Milk and calcium do not increase prostate cancer progression or recurrence: • There has been little research on the effects of dietary milk, dairy and calcium in men after a prostate cancer diagnosis. • A recent large study followed 3,918 patients for up to 22 years after diagnosis and found that having milk or dairy was not linked to prostate cancer growth or return.3 • However, there was a small but higher risk for getting advanced prostate cancer for men who drank the most whole (‘homo’ or full fat) milk and a small reduced risk for men who drank skim (no-fat) milk, suggesting that the higher fat content was to blame. • Men on hormone therapy (Androgen Deprivation Therapy or ADT) have a higher risk for osteoporosis, so calcium supplementation of up to 1000 mg (with vitamin D) is recommended to prevent bone loss and fractures.4 Calcium is needed for everyone’s good health including men diagnosed with prostate cancer Calcium facts: • Calcium is the most abundant mineral in the body, mostly found in bones and teeth. • While best known for bone building and health, calcium also helps the heart and nerves work properly and helps with blood clotting. • Having enough calcium can lower the risks of osteoporosis, colon polyps, colorectal cancer and kidney stones, and can help control blood pressure and cholesterol. • 1% of calcium in the body is found in the blood and is controlled by vitamin D. • When you don’t have enough calcium, vitamin D causes the intestines, kidneys and bones to increase calcium blood levels. • If you have too much calcium, the amount of vitamin D in your blood lowers. • Too much calcium from supplements can be unhealthy and might even increase the risk of heart disease. Eating balanced diets that include a variety of calcium rich foods including milk or enriched soymilk is important for overall health and prevention of osteoporosis The bottom line: Try to get the recommended Eat calcium-rich food and amounts of calcium each day don’t overdo the supplements! The Recommended Dietary Allowance (RDA) for calcium is based on amounts needed to maintain bone health and prevent bone fractures: About half of Canadian men aged 50 to 70 do not get enough calcium each day. • It’s easy to add extra calcium to your diet by drinking a couple of cups of skim milk or soymilk every day or having a serving of yoghurt. • While milk, dairy products and milk alternatives like soymilk are our main dietary calcium sources, other healthy calcium-rich foods include broccoli, almonds and tofu - so be sure to have a varied diet with lots of vegetables, beans, whole grains and nuts. Calcium content Milk, enriched soymilk 1 cup 250 ml ~ 300 mg Yogurt ¾ cup 175 ml 294-332 mg Hard cheese 1.5 oz 50 g 360-400 mg Tofu ½ cup 126 g 200-330 mg Orange juice, enriched ½ cup 125 ml 155 mg Salmon, canned with bones 2.5 oz 75 g 171-211 mg Almonds ¼ cup 40 g 116 mg Kale, cooked ½ cup 125 ml 95 mg Cottage cheese ½ cup 125 ml 73 mg Lentils & beans ¾ cup 175 ml 25-150 mg Bread, whole grain/ multigrain Broccoli, cooked 1000 mg 70 and older 1200 mg Upper limit all ages 2000 mg • If you take antacids regularly, talk about lower calcium options with your doctor or pharmacist. in milligrams (mg) Oranges 51 to 70 • Antacids like Rolaids® or Tums® can add 200 to 600 mg per pill of extra calcium to your diet. Approximate calcium content for various foods Serving/amount RDA Health Canada 2010: www.hc-sc.gc.ca/fn-an/nutrition/vitamin/vita-d-eng.php • If you take calcium supplements, take no more than 500 mg at one time and with meals to be sure it gets absorbed and to reduce side effects like gas or constipation. Food item Age (years) • Men on ADT have a high risk for bone loss and osteoporosis and need to get enough calcium to reduce the risk of bone fractures or breaks - which are especially dangerous for men over 70. • Some doctors think that the recommended total calcium amounts from food and supplements should be increased to 1500 mg per day for men on ADT. • Having too much calcium from supplements might lower vitamin D blood levels too much. • To avoid this, take at least 400 IU of vitamin D per day along with your calcium supplements. 1.Giovannucci, E. et al. A Prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiology Biomarkers & Prevention. 2006 15:203-210. 1 medium 65 mg 2.Huncharek M, et al. Dairy products, dietary calcium and vitamin D intake as risk factors for prostate cancer: A meta-analysis of 26,769 cases from 45 observational studies. Nutrition & Cancer. 2008; 60(4):421-41. 1 slice 33-58 mg 3.Pettersson A, et al. Milk and dairy consumption among men with prostate cancer and risk of metastases and prostate cancer death. Cancer Epidemiology Biomarkers & Prevention. 2012; 21(3):428-36. ½ cup 125 ml 33-50 mg Health Canada, Canadian Nutrition File, 2010: www.healthcanada.gc.ca/cnf 4.Holzbeierlein J. Managing complications of androgen deprivation therapy for prostate cancer. Urologic Clinics of North America. 2006; 33(2):181-90. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 POMEGRANATE Should I eat pomegranates, drink pomegranate juice or take supplements? RECOMMENDATION: Include fresh pomegranates or pomegranate juice as part of your balanced diet - don’t rely on taking pomegranate extracts or supplements until more research is done. What’s the evidence? For Prostate Cancer Prevention? Pomegranate juice and extracts might prevent prostate cancer cell growth: • There is growing lab research showing that pomegranate juice and/or its extracts can stop the growth of - or even kill - prostate cancer cells but this has not been tested on people.1 • There is no evidence that drinking pomegranate juice or taking pomegranate extracts or supplements can lower the risk of getting prostate cancer for healthy men. For Prostate Cancer Treatment? Pomegranate juice and extracts might prevent progression or recurrence of prostate cancer: • There are only a few clinical studies that have tested drinking pomegranate juice or taking pomegranate supplements in men after a prostate cancer diagnosis, however, ongoing research is promising. • A US clinical trial studied men with rising prostate specific antigen (PSA) after surgery or radiation for prostate cancer and found that drinking 8 ounces of pomegranate juice daily was linked to a slower PSA rise and other markers of slower cancer growth.2 • This suggests that drinking pomegranate juice might slow down the growth of prostate cancer in patients but much more research is needed before recommendations can be made. • An ongoing Canadian trial is testing pomegranate extracts taken by men in the month prior to surgery for localised prostate cancer and will look at the effects of supplementation on prostate tumour characteristics.3 Much of this benefit is thought to be from polyphenols found in pomegranates Polyphenol facts: • Polyphenols are antioxidants found in many fruits and vegetables and are known to promote health. • The polyphenols most plentiful - and most studied - in pomegranates are ellagic acid and punicalagins. • Ellagic acid is found in the arils - the red berry-like fleshy seeds inside the fruit. Also found in green tea raspberries and cranberries. • Punicaligins are found in the outer red rind and are thought to be stronger antioxidants than ellagic acid. • When pomegranate juice is commercially made, the whole fruit including the rind is crushed ensuring that the juice contains both ellagic acid and punicalagins. • Thus, although the fresh arils are a healthy fruit full of vitamins (vitamin C) and minerals (potassium), pomegranate juice has the most promise for fighting prostate cancer. Including pomegranate juice as part of a balanced diet with lots of other fruits and vegetables might help reduce cancer progression or recurrence for men diagnosed with prostate cancer The bottom line: Drink pomegranate juice not supplements! Potential prescription drug interactions A commonly eaten fruit in the Mediterranean and Asia - pomegranates also have a history of being used as a herbal ‘medicine’ for a wide range of conditions. • Pomegranate juice and extracts have traditionally been used to treat sore throats, dental problems, fungal infections, stomach and bowel issues, headaches and hardening of the arteries. It was thought that pomegranate juice or supplements might affect prescription drugs like grapefruit juice does. However, this is probably not a problem except for some drugs that are processed by the liver. • Pomegranate juice or supplements might interfere with ‘ACE inhibitors’ and other blood pressure drugs by lowering your blood pressure too much. Some drugs used to treat high blood pressure include: • Pomegranate juice is expensive and might not be healthier than drinking other fruit juices or eating other fruits - like blueberries and raspberries - that are also rich in antioxidants. Generic name Brand name Lisinopril Prinivil® or Zestril® • There is not enough proof to say that drinking pomegranate juice or taking supplements is helpful for men who have been diagnosed with prostate cancer. Ramipril Altace® Benazepril Lotensin® Captopril Capoten® Enalapril Vasotec® Trandolapril Mavik® • We don’t know how safe pomegranate supplements are. • A lack of research should not stop you from drinking pomegranate juice - as long as you don’t drink too much. But you should be aware of possible risks including having too-much sugar, allergies and potential prescription drug interactions. • Pomegranate juice also interferes with Rosuvastatin (Crestor ®) - a drug used to treat high cholesterol - and could worsen any drug side-effects you might have. • Until we know more about potential drug interactions, ask your doctor about drinking pomegranate juice or taking supplements if you are taking any medications that are processed in the liver or if you have high blood pressure, high cholesterol or liver problems.4 Having too-much sugar Each 8 ounce (250 ml) glass of pomegranate juice contains almost as much sugar as a can of soda-pop. • That’s nearly 32 grams (8 teaspoons) or 128 calories making it easy to take in too much sugar and calories. • Limit yourself to one or two glasses per day. Allergies If you have asthma or any plant allergies you might also be allergic to pomegranates. • Although not common, symptoms can include gas, stomach aches, diarrhea or rashes, but are usually not serious. 1.Bell C & Hawthorne S. Elliagic acid, pomegranate and prostate cancer a mini review. Journal of Pharmacy & Pharmacology. 2008; 60(2):139-144. 2.Pantuck AJ, et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clinical Cancer Research. 2006; 12(13):4018-4026. 3.Guns E et al. Can daily pomegranate extract impact the growth of prostate cancer in a cohort of men awaiting radical prostatectomy? A randomized placebo-controlled clinical trial underway. Pharmaceutical Biology. 2009; 47:8-9. 4.Farkas D & Greenblatt DJ. Influence of fruit juices on drug disposition: discrepancies between in vitro and clinical studies. Expert Opinion on Drug Metabolism & Toxicology. 2008; 4(4):381-393. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 SELENIUM Should I take selenium supplements? RECOMMENDATION: Include selenium-rich foods in your diet but don’t take high-dose supplements unless your doctor recommends it low doses found in multi-vitamins are considered safe. What’s the evidence? For Prostate Cancer Prevention? Having enough selenium from food might prevent prostate cancer: • Studies show that selenium is linked to colon, breast and prostate cancers, as well as heart disease. People who get enough selenium from food have the lowest rates of almost every type of cancer.1 • Some studies suggest that higher blood amounts of selenium were linked to lower risks of prostate cancer. Other studies, however, have found no links between selenium intake and prostate cancer risk. • The effectiveness of selenium supplementation in prostate cancer prevention is uncertain.2 For Prostate Cancer Treatment? Having enough selenium from food might slow down progression or recurrence of prostate cancer, but selenium supplements can be harmful: • Natural selenium from food is important for overall good health for everyone, including men diagnosed with prostate cancer.1 • However; there is growing evidence that taking individual selenium supplements does not stop the growth or return of prostate cancer and might even be harmful - especially for men who are already eating enough selenium. • Taking large doses (800 micrograms or mcg) of selenium raised the Prostate Specific Antigen (PSA) for some men on active surveillance suggesting that taking too much selenium in pills might actually increase the growth or return of prostate cancer.3 More research is needed to see how much selenium can be safely taken in supplements and who would best benefit. Selenium facts: • Selenium is an essential mineral and the Recommended Dietary Allowance (RDA) for adult men is 55 mcg per day. Canadians 60 years and older get about double that amount in their diets. • The body’s first lines of defence against cell-damaging free radicals are antioxidant enzymes. Without enough selenium, these enzymes don’t work at peak levels, leaving the potential for cell damage that can lead to cancer. • Men with low levels of selenium show the most benefit from supplementation, whereas men with normal or greater than normal levels of selenium show no benefit or even harm. This explains why taking supplements shows such a wide range of effects in groups of men. Eating balanced diets that include a variety of whole, selenium-rich foods might help prevent prostate cancer in healthy men and might also reduce cancer progression or recurrence for men already diagnosed with prostate cancer. The bottom line: Eat food not supplements! Eat brazil nuts or snack on sunflower seeds! Because of the potential harm from taking too much selenium, it’s best for men with prostate cancer to get their selenium from eating a balanced diet with a variety of foods. If you are thinking of taking selenium supplements talk to your doctor - or just take a regular multivitamin. • In general, individual selenium supplements are not recommended for anyone unless they don’t eat enough selenium or have low selenium blood levels. • Most of our dietary selenium comes from eating plant-based foods such as, grains (including whole-wheat, oats & rye) and vegetables (including garlic & onions) with the rest from seafood (including fish & shellfish) and meat (including organ meat, chicken & pork). • Selenium can be measured by a blood test or toenail analysis. If you are considering taking selenium supplements, talk to your doctor about checking to see if supplementation is necessary. • The SELECT (SELenium and vitamin E Cancer prevention Trial) study found that neither supplements reduced the risk of prostate cancer in healthy men.2 • The selenium in soil determines the selenium found in grains and vegetables, and varies greatly across North America - however, Canadians who eat a wide variety of foods and a balanced diet get enough selenium from food. • In fact, excess Vitamin E might increase the risk of prostate cancer, and selenium supplements more than of 200 mcg per day might increase some men’s risk for diabetes. • If you want to take selenium supplements, take a multivitamin with minerals. Most multivitamins have healthy and safe amounts of selenium, between 25 to 200 mcg. • While the ‘Upper Limit’ (UL) of safety for selenium is 400 mcg per day from food and supplements, selenium supplements with more than 200 mcg might be unsafe and are not recommended. Approximate selenium content for various foods in micrograms (mcg) Food item Serving/amount Selenium content Brazil nuts ¼ cup 60 ml 680 mcg Mixed nuts (no peanuts) ¼ cup 60 ml 154 mcg Shellfish (mussels, oysters) 2.5 oz 75 g 60-115 mcg Tuna, canned in water ~½ can 75 g 60 mcg Salmon 2.5 oz 75 g 20-30 mcg Meat (beef, pork) 2.5 oz 75 g 20-30 mcg Poultry (chicken, turkey) 2.5 oz 75 g 20-30 mcg Pasta, whole wheat ½ cup 125 ml 20 mcg Cottage cheese, 1% ½ cup 125 ml 12 mcg Bread, whole grain 1 slice 10-20 mcg Barley ½ cup 125 ml 7 mcg Broccoli & other veggies ¼ cup 60 ml 3-5 mcg Health Canada, Canadian Nutrition File, 2010: www.healthcanada.gc.ca/cnf • Taking unnecessary supplements may be harmful, and large amounts of selenium can lead to hair loss, brittle nails and other side effects. 1.Rayman MP. Selenium and human health. The Lancet. 2012; 379(9822):1256-1268 2.Dunn BK, et. al. A nutrient approach to prostate cancer prevention: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). Nutrition and Cancer. 2010; 62(7):896-918. 3.Stratton MS, et. al. Oral selenium supplementation has no effect on prostate-specific antigen velocity in men undergoing active surveillance for localized prostate cancer. Cancer Prevention Research. 2010; 3(8):1035-43. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 SOY FOODS Isoflavones and Should I eat soy food products or take isoflavones? RECOMMENDATION: Include soymilk and other soy products in your balanced diet - don’t rely on taking soy extracts or isoflavone supplements until more research is done. What’s the evidence? For Prostate Cancer Prevention? Soy food products and supplements might prevent prostate cancer: • Studies show that eating soy foods like soymilk or tofu helps prevent prostate cancer, as seen by the lower number of prostate cancer deaths in parts of the world where lots of soy foods are eaten.1 • In other studies soy extracts and isoflavones were found to slow or stop the growth of prostate cancer cells in research labs.2 For Prostate Cancer Treatment? Soy food products and supplements might prevent the progression or recurrence of prostate cancer: • Eating soy foods like tofu or soymilk might improve Prostate Specific Antigen (PSA) levels and reduce treatment side effects for some patients. • Most men diagnosed with prostate cancer can safely eat a variety of soy foods as part of a balanced diet. • Drinking 2-3 glasses (around 500 ml) of soymilk per day gives roughly the amount of isoflavones (around 200 milligrams) that have shown beneficial effects.3 • Soy extracts and isoflavone supplements might slow the growth of prostate cancer cells. • The effects of soy supplements on PSA levels have been positive in several studies. • There is not enough proof to recommend the safe use - especially in large doses - of soy extracts or isoflavone supplements to slow down or stop prostate cancer from returning. Much of these benefits are thought to be from the phytoestrogens naturally found in soy foods: Phytoestrogens: • Plant compounds with weak estrogen hormone activity might lower the risk of prostate cancer by reducing testosterone hormone activity. • Soy food products are our biggest dietary source of phytoestrogens. • Isoflavones are the most common phytoestrogens in our diets. • Soy based dietary supplements rich in phytoestrogens are available, including soy extracts and isoflavone supplements. Isoflavones: • The most common and well-studied isoflavones are genistein and daidzein and these can also be found in supplements. • Isoflavones might also protect against osteoporosis and cardiovascular disease (by lowering blood cholesterol levels). Eating balanced diets that include soy food products like soymilk and tofu - rich in isoflavones - might help prevent prostate cancer in healthy men and might also reduce cancer progression or recurrence for men diagnosed with prostate cancer. The bottom line: Eat food not supplements! I’ve never had soy products before, but want to start eating them Until further studies are done, increasing your isoflavone intake through food is best. One serving of most soy foods provides a similar amount of isoflavones, and at a lower price than supplements. Add soy foods to your diet: • Start by eating small amounts • Mix soymilk with regular milk to get used to the taste. Soy products: • Soymilk – also called soy beverage. Made from soybeans that have been soaked, ground and strained. A great alternative to cow’s milk, go for brands enriched with Calcium and Vitamin D. Avoid fat-free as isoflavones are fat-soluble. • Tofu – soybean curd available with varying moisture content and firmness, from soft to extra firm. • Edamame – young, green, often boiled or steamed soybeans. • Tempeh – fermented soybeans molded into a cake. An excellent meat alternative. • Soy meat substitutes – made from soy flour, these foods are high in protein, have a similar texture to ground meat, and can easily be used in place of meat in dishes such as chili and pasta sauce. • Look for meatballs, veggie burgers and other products in the grocery store. • Snack on low-salt, roasted soy nuts, they come in many flavours. • Try using soy products in your meals - like using tofu instead of meat in a stir-fry. • Soy foods are rich in high-quality protein and a great lower-fat alternative to animal foods like meat. • Generally, the more processed the soy product (such as tofu hot dogs and soy cheese), the lower the isoflavone content - however, the amounts of phytoestrogens in different soy foods can vary considerably. • The amounts of fat and added sugar can also vary between brands, so choose wisely to get the maximum benefit from soy without eating too much fat and sugar. Approximate isoflavone content for various foods • Also known as textured vegetable protein (TVP) or textured soy protein (TSP) these products have the added bonus of, unlike meat, being high in fibre! • Soy protein powder - can be used like skim milk powder. Add to milk, soymilk or use in cooking. • Soy sauce and Tamari - little or no isoflavones and lots of salt and monosodium glutamate (MSG) so don’t use too much. in milligrams (mg) Serving/amount Soy nuts, roasted ¼ cup 43 g 64 mg Tofu, firm ½ cup 126 g 28 mg Soymilk 1 cup 250 ml 27-46 mg 1 oz (1½ tbsp) 28 g 25 mg Soy yogurt ½ cup 68 g 22 mg Soy cheese 2 oz 60 g 16 mg Soy beans, ‘edamame’ ½ cup 78 g 14 mg 1 burger 100 g 7 mg Soy protein powder 1.Yan L, & Spitznagel EL. Soy consumption and prostate cancer risk in men: a revisit of a meta-analysis. American Journal of Clinical Nutrition. 2009; 89(4):1155-1163 2.Goetzl MA, et al. Effects of soy phytoestrogens on the prostate. Prostate Cancer & Prostatic Diseases. 2007; 10(3):216-223 3.Kwan W, et al. A phase II trial of a soy beverage for subjects without clinical disease with rising prostate-specific antigen after radical radiation for prostate cancer. Nutrition & Cancer. 2010; 62(2):198-207. Soy meat substitute ‘veggie burger’ USDA Database for the Isoflavone Content of Selected Foods Release 2.0 September 2008. Web site: http://www.ars.usda.gov/Services/docs.htm?docid=6382 This information is not meant to replace advice from your doctor or dietitian. [email protected] Isoflavone content Food item aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 TOMATO FOODS Lycopene and Should I eat tomato products or take lycopene supplements? RECOMMENDATION: Include tomato products in your balanced diet - don’t rely on taking lycopene supplements until more research is done. What’s the evidence? For Prostate Cancer Prevention? Tomato products and lycopene might prevent prostate cancer: • Many studies have suggested that there is a small decrease in prostate cancer risk for men with the most tomato products and lycopene in their diets.1 For Prostate Cancer Treatment? Tomato products and lycopene might prevent progression or recurrence of prostate cancer: • Lycopene might slow the growth of prostate cancer cells for men who have been diagnosed with prostate cancer • In the ‘Health Professionals Follow-up Study’, men diagnosed with prostate cancer who ate the most tomato products had a lowered risk for prostate cancer growth or return.1 • However, we don’t know if this was from lycopene or other nutrients found in tomato foods. • Other research has shown some benefits from eating tomato products or taking lycopene supplements, but the results are mixed. • A research review found that some studies showed lowered Prostate Specific Antigen (PSA) for some men after taking lycopene pills, while other studies showed no effects.2 • Without enough proof, there are no recommendations for taking lycopene supplements.3 Much of this benefit is thought to be from lycopene found in tomato products Lycopene facts: • Lycopene is a carotenoid that gives the red colour to tomatoes, but is also found in other plant foods including papayas, pink grapefruits and watermelons. • Lycopene acts as an antioxidant that protects against cancer and heart disease by destroying harmful ‘free radicals’ (‘oxidants’) in the body. • Although free radicals are natural, they can be destructive - damaging cells and causing cancer. • Lycopene is just one of many healthy plant antioxidants so be sure to eat lots of different fruit and vegetables. • Leafy green vegetables (spinach and broccoli) as well as deep orange fruits (apricots, cantaloupes) and vegetables (squash, sweet potatoes) are excellent sources of other disease-fighting carotenoids like beta-carotene and lutein. Eating balanced diets that include lots of cooked tomato products rich in natural lycopene, might help prevent prostatecancer in healthy men and might also reduce cancer progression or recurrence for men already diagnosed with prostate cancer. The bottom line: Eat food not supplements! Mixed study results should not stop you from eating lycopene-rich foods, as they offer many additional nutrients important for overall health. • For example, ½ cup of tomato sauce provides 2 grams of fibre, 3 milligrams (mg) of vitamin E, 17 mg of vitamin C and at only 48 calories per serving. • If you decide to take lycopene supplements there is little information about possible side-effects, but large doses can cause bloating and gas. • 30mg per day is considered a safe amount with the most potential benefits. Eat cooked tomato products! Add tomato paste to pasta dishes, stir-fries or fruit smoothies. You can easily get the same amount of lycopene as in a supplement from eating cooked or canned tomato products. • Most of our dietary lycopene comes from processed tomato products, adding up to about 8 mg per day of lycopene consumed by Canadian men. • While raw tomatoes do contain lycopene (about 3 mg each), due to the plant structure, experts generally consider the available amount of this lycopene to be zero. • However, canning or cooking will break down tomato cell walls, releasing the lycopene, allowing it to be absorbed into our bodies. Approximate lycopene content for various foods in milligrams (mg) Food item (canned/processed) Serving/amount Lycopene content Tomato puree ½ cup 125 ml 29 mg Tomato paste 4 tbsp 60 ml 19 mg Tomato sauce ½ cup 125 ml 18-25 mg Spaghetti sauce ½ cup 125 ml 17 mg Tomato soup 1 cup 250 ml 14-23 mg Tomato juice ½ cup 125 ml 12 mg Salsa ¼ cup 60 ml 7 mg Tomatoes, stewed ½ cup 125 ml 5 mg Tomato ketchup 1 tbsp 15 ml 3 mg Chilli ¾ cup 175 ml 2-3 mg Sundried tomatoes ¼ cup 60 ml 6 mg Pizza with tomato sauce 1 slice 140 g 3-4 mg Pink or red grapefruit ½ cup 125 ml 2 mg Watermelon ½ cup 125 ml 4 mg • But don’t stop eating raw tomatoes based solely on lycopene content - they are still loaded with other vitamins, minerals and phytochemicals that also benefit your health. • Tomato products require a little bit of fat for the lycopene to be absorbed. • No need to load your pasta dishes with cheese though; the little amount of fat that’s needed can be provided by adding some olive oil, a small amount of meat, poultry or fish, or a sprinkling of cheese to your favourite recipes. Other foods Health Canada, Canadian Nutrition File, 2010: www.healthcanada.gc.ca/cnf 1.Chan J, et al. Diet after diagnosis and the risk of prostate cancer progression, recurrence, and death (United States). Cancer Causes & Control. 2006; 17:199-208 2.Haseen F et al. Is there a benefit from lycopene supplementation in men with prostate cancer? A systematic review. Prostate Cancer & Prostatic Diseases. 2009; 12:325-332 3.Kucuk O, et al. Effects of lycopene supplementation in patients with localized prostate cancer. Experimental Biology & Medicine. 2002; 227:881-885 This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 VITAMIN D Should I take vitamin D supplements? RECOMMENDATION: Include vitamin D-rich foods in your diet and take at least 400 International Units (IU) of vitamin D supplements per day. What’s the evidence? For Prostate Cancer Prevention? Getting enough vitamin D from food, sun exposure and supplements might prevent prostate cancer: • Men living in northern areas with low sun exposure and who are low in vitamin D from food, have a high rate of prostate cancer, suggesting that having low blood levels of vitamin D (calcitriol) might increase the risk.1 • However, having higher vitamin D intakes and blood levels are not linked to a lower risk of prostate cancer in all studies. • Lab studies show that vitamin D can stop or slow the growth of prostate cancer cells but there is not enough proof to say that supplements will prevent prostate cancer in healthy men.2 For Prostate Cancer Treatment? Adequate Vitamin D from food, sun exposure and supplements might slow down progression or recurrence of prostate cancer: • Vitamin D is important for the health of men diagnosed with prostate cancer and some studies have found that it might slow cancer growth.2 • However, clinical studies where patients took vitamin D supplements have had mixed results and there is not enough proof to recommend large doses for prostate cancer treatment.3 • Current research suggests that men diagnosed with prostate cancer can safely take 400 to 1000 IU per day of supplemental vitamin D, especially if they are on hormone therapy (Androgen Deprivation Therapy or ADT). Vitamin D is needed for everyone’s good health including men diagnosed with prostate cancer Vitamin D facts: • Having enough vitamin D is linked to a lower risk of colon, breast, prostate and ovarian cancers. • Vitamin D has many roles but is best known for controlling blood calcium levels (by increasing how much you absorb from food) and keeping bones healthy. • Vitamin D also helps control cell growth and is therefore considered important in fighting prostate cancer. • There are several forms of vitamin D, all known as ‘calciferol’. • Vitamin D2 is called ‘ergocalciferol’ and is often found in supplements. • Vitamin D3 is called ‘cholecalciferol’ and is made in our skin when exposed to ultraviolet radiation from sunlight. • From food or skin, vitamin D is actually a hormone calciferol is converted in the blood to the hormone called ‘calcitriol’ which is responsible for all the health effects of vitamin D. • To convert between IU and mcg use this simple equation: 1 mcg = 40 IU. Eating balanced diets that include vitamin D-rich foods and taking supplements might help prevent prostate cancer in healthy men and might also reduce cancer progression or recurrence for men already diagnosed with prostate cancer. The bottom line: Take at least 400 IU daily vitamin D supplements Try to get the recommended amounts of vitamin D each day The Recommended Dietary Allowance (RDA) for vitamin D is based on amounts needed to maintain bone health and prevent bone fractures: Most Canadians get enough Vitamin D from all sources for good health, but about 5% of men are still low. • Vitamin D occurs naturally in only a few foods (including fish,liverandeggs)andinthepastpeopleoftenlacked it in their diets. • In Canada, milk (except buttermilk and other dairy products) has added vitamin D, as does most margarines and soy beverages and even some brands of orange juice. • Health Canada recommends that anyone over 50 should take a total of 400 IU (or 10 mcg) of vitamin D from supplements, especially in winter. • Vitamin D is often found in multivitamins (often 400 IU) and calcium supplements (often 250-300 IU) so if you already take those you might not need a separate vitamin D supplement. Approximate vitamin D content for various foods in International Units (IU) and micrograms (mcg) Serving/ amount Food item Vitamin D content (mcg) (IU) 17-25 680-1000 Fish (salmon, halibut, carp) 2.5 oz Salmon, canned 2.5 oz 75 g 10-15 400-600 Cod liver oil 1 tsp 5 ml 11 440 Sardines, canned in tomato sauce 2.5 oz 75 g 9 360 Milk, soymilk, orange juice 1 cup 250 ml 2-3 80-120 2 80 Eggs 75 g 2 eggs Margarine 1 tbsp 15 ml 1.5 60 Salmon oil 1 tbsp 15 ml 0.6 24 Health Canada, Canadian Nutrition File, 2010: www.healthcanada.gc.ca/cnf Age (years) RDA 9 to 70 600 IU (15 mcg) 70 and older 800 IU (20 mcg) Upper limit all ages 4000 IU (100 mcg) Health Canada 2010: www.hc-sc.gc.ca/fn-an/nutrition/vitamin/vita-d-eng.php • Men at risk for low vitamin D - who are older, have darker skin, a poor dietary intake, and/or do not expose their skintosunlight-mightbenefitfromdailysupplements of 600-1000 IU. • Considering taking more than 2000 IU of vitamin D? We don’t know how safe large doses are. • Talk to your doctor about watching your blood calcium levels, as very high amounts of vitamin D can cause too-high blood calcium. Vitamin D - the sunshine vitamin Not making enough vitamin D in our skin might also be linked to prostate cancer risk and is based on several factors: • Age. A high risk factor for prostate cancer, age causes a drop in the skin’s ability for making vitamin D. Older people also often spend less time outdoors and have less sun exposure. • Location. Prostate cancer is more common in the north, partly due to low seasonal sunlight levels. In Canada, sunlight is not strong enough from mid-October to mid-April for us to make enough vitamin D. • Ethnicity. Pigments that make skin darker can block vitamin D production and might explain why men of African ancestry are at a higher risk for prostate cancer. 1. Gupta D, et al. Vitamin D and prostate cancer risk: A review of the epidemiological literature. Prostate Cancer & Prostatic Diseases. 2009; 12(3):215-26. 2. Barnett CM, Beer TM. Prostate cancer and vitamin D: What does the evidence really suggest? Urologic Clinics of North America. 2011; 38(3):333-42. 3. Swami S, et al. Vitamin D metabolism and action in the prostate: Implications for health and disease. Molecular and Cellular Endocrinology. 2011; 347(1-2):61-9. This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. Diet and Prostate Cancer Series - 2012 VITAMIN E Should I take vitamin E supplements? RECOMMENDATION: Include vitamin E-rich foods in your diet but don’t take separate high-dose supplements unless your doctor recommends it - vitamin E doses found in regular multi-vitamins are safe. What’s the evidence? For Prostate Cancer Prevention? Vitamin E from food might prevent prostate cancer, but supplements might be harmful: • Many studies have shown that having enough vitamin E from food is linked to lower risk for prostate cancer as well as heart disease. • However, these benefits do not seem to come from taking vitamin E supplements, especially doses over 400 IU (International Units) per day.1 • The SELECT (SELenium and vitamin E prostate Cancer prevention Trial) study found that when healthy men took vitamin E supplements of 400 IU per day it did not prevent prostate cancer as expected, but instead might have increased their risk for developing it. 2 For Prostate Cancer Treatment? Vitamin E from food might slow down progression or recurrence of prostate cancer: • Although lab studies suggest that vitamin E slows the growth of prostate cancer cells, there is little evidence that taking separate vitamin E supplements stops prostate cancer from growing or returning. • Taking vitamin E supplements in combination with selenium, vitamin C and coenzyme Q10 did not affect Prostate Specific Antigen (PSA) or other markers of prostate cancer growth for some patients with rising PSA levels. 3 • Men on ‘active surveillance’ who took vitamin E as part of a vegan diet and lifestyle program showed PSA improvements suggesting that they might be able to delay treatment. However, we don’t know what part vitamin E played in this benefit. 4 Vitamin E from food is needed for everyone’s good health including men diagnosed with prostate cancer Vitamin E facts: • Vitamin E is a powerful antioxidant that works with the body’s natural defence system to stop free radical damage. • Although free radicals are natural, they can be destructive - damaging cells and causing cancer. • Years of research has shown the importance of dietary vitamin E in fighting disease - lowering the risk of Alzheimer’s disease, diabetes, heart disease and cancer. • More research is needed to understand the effect of vitamin E on risk of prostate cancer recurrence and survival and to see how much supplemental vitamin E can be safely taken and by whom. Eating balanced diets that include a variety of vitamin E rich foods might help prevent prostate cancer in healthy men and might also reduce cancer progression or recurrence for men already diagnosed with prostate cancer. The bottom line: Eat food not supplements! Because of the potential dangers of taking too much, it’s best for men diagnosed with prostate cancer to get their vitamin E from eating a balanced diet with a variety of whole foods. • Most of our dietary vitamin E comes from eating plant-based foods including, plant oils, nuts, seeds, grains and vegetables. • While early studies found that vitamin E supplementation was helpful for some people who weren’t getting enough in their diets, current research shows that for most people, vitamin E from food alone or a low-dose supplement is best for good health. • For most people, including vitamin E-rich foods in a healthy, well-balanced diet will promote overall health and is better than supplementation. Approximate vitamin E content for various foods in milligrams (mg) and International Units (IU) Food item Serving/amount Vitamin E content (mg) (IU) Nuts (almonds, hazelnuts) ¼ cup 60 ml 9-18 13-27 Sunflower seeds ¼ cup 60 ml 8-13 11-20 Wheat germ (cereal) ¼ cup 60 ml 5 7 2 90 g 3 5 Tomato paste, canned ¼ cup 60 ml 3 5 Peanut butter 2 tbsp 30 ml 3 5 Salmon 2.5 oz 75 g 3 5 Vegetables (asparagus, ½ cup 125 ml 1-2 2-3 Eggs broccoli, spinach, peppers) Commonly used vegetable oils Wheat germ oil 2 tsp 10 ml 14 21 Sunflower, safflower oils 2 tsp 10 ml 3-4 4-6 Canola, olive oil 2 tsp 10 ml 2 3 Health Canada, Canadian Nutrition File, 2010: www.healthcanada.gc.ca/cnf You can easily get enough vitamin E from eating a balanced diet The Recommended Dietary Allowance (RDA) for adults is 15 milligrams (mg) or 22.4 International Units (IU) per day. • Because men tend to have poor diets, the average daily intake of vitamin E among North American men aged 60 years and older is only 7 mg. • Some vitamin E rich foods (such as vegetable oils and nuts) are high in fat and calories as well. If you are worried about weight gain, choose lower fat sources of vitamin E, such as dark green vegetables and whole grains. • Most multivitamins contain amounts of vitamin E that are healthy and safe, between 50 to 100 IU, which is equivalent to 22.5 to 45 mg of active ‘man-made’ vitamin E. • There is not enough proof to say that higher amounts are better for everyone; taking separate vitamin E supplements at 200 IU or higher should be talked about with your doctor or a dietitian. • In high doses, vitamin E can actually act as a pro-oxidant, increasing the risk of cell damage rather than protecting against it. • Your daily intake of vitamin E should not exceed 1000 mg per day, especially from supplements. • Men with high blood pressure or taking aspirin or anticoagulant drugs should be cautious when taking supplements, as vitamin E has a blood thinning effect. • Talk to your doctor about stopping just before and immediately after surgery or radiation. 1.Clarke et al. Vitamin E in human health and disease. Critical Reviews in Clinical Lab Sciences. 2008; 45(5):417-450 2.Klein, et al. Vitamin E and the risk of prostate cancer: The selenium and vitamin E cancer prevention trial (SELECT). Jama - Journal of the American Medical Association. 2011; 306(14):1549-1556 3.Hoenjet, et al. Effect of a nutritional supplement containing vitamin E, selenium, vitamin C and coenzyme Q10 on serum PSA in patients with hormonally untreated carcinoma of the prostate. European Urology. 2005; 47(4):433-440 4.Frattaroli, et al. (Dean Ornish) Clinical events in prostate cancer lifestyle trial: Results from two years of follow-up. Urology. 2008; 72(6):1319-1323 This information is not meant to replace advice from your doctor or dietitian. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only. [email protected] aboutmen.ca 604-875-4495 © Men’s Health Initiative of BC, 2012. All rights reserved. For non-commercial use only.
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