DIETARY ADVICE FOR PROSTATE

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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