Nutrition, Exercise and Prostate Cancer

Nut rit ion, Exe xerrci cis se and Prost at e Ca Cancer

Authors David Heber, MD, PhD PhD Prof rofes ess sor of o f Medicin Medicine e and Publ Public ic Healt Health h Directt or of t he UCL Direc UCLA Center Center for Huma Human n Nutrit Nut rition ion Universitit y of Califo Univers aliforni rnia, a,Los Angeles St ephen J. Freedl Freedland, and, MD Associate Professor of Urology Duke Universit Universit y Medica Medi call Cent enter er Lee W. Jon Jones, es, PhD Ass As soci ociate ate Prof Profes ess sor, Depart Department ment of Surg urgery ery Duke Universit Universit y Medica Medi call Cent enter er William G. Nelson, MD, PhD William PhD Marion I. Knot nottt Direct Director or and Profess Professor or of Onc Oncolo ology gy Director, Direct or,The Sid Sidney ney Kimmel Kim mel Com ompr prehensive ehensive Cancer Cancer Cent Center er John ohns s Hopki Hopkins ns School of Medici Medicine ne

The Prostate Cancer Foundation (PCF) was founded in 1993 to find better treatments and a cure for recurrent prostate cancer. Through its unique model for soliciting and selecting promising research programs and rapid deployment of resources, the PCF has funded more than 1,500 programs at nearly 200 research centers in 20 countries around the world. As the world’s w orld’s leading leading p hila hilanthropic nthropic orga o rganiza nization tion for funding prostate-cancer p rostate-cancer research, resea rch, the PCF is now a foundation f oundation without borders. Its advocacy for f or increased incre ased government and private support suppo rt of prostate cancer programs has helped build a global research enterprise of nearly $10 billion. Today, 40 percent fewer men are dying from prostate cancer compared to what was once projected. The PCF is a force of of for more

HOPE than 16 million men and their families around the world who are currently facing the disease.

Studies have shown that lifestyle — especially nutrition and exercise — has a significant influence in prostate cancer prevention and treatment. This guide presents the latest information for men who want to maintain a lifestyle that promotes prostate p rostate health. health.

Table of Content ontents s

Nutrition, Exercise and Prostate Cancer

2

Introduction

3

Understanding th the e Links Links Between Between Nutri Nut ritt ion, Exercis Exercise, e, and Prost Prost at ate e Cancer Cancer Eff ffe ects of Ox Oxid ida ati tio on an and In Infl fla amm mma atio tion n The Contr trib ibu uti tio on of of Ca Carcinogens Eff ffe ects of Excess Sugar Put ti ting It All Toget he her

3 4 5 6

8 9 9 10

11 12 12

15 15 16

18 18 19

20 20 20

23

Obesity Obesit y and Met M etabolism abolism — Where We We Went We nt Wrong The Met ab abolic Syndrome Eff ffe ects of Excess Body Fat Effects of Muscle Loss Nutrit ion at t he Molecular Nutrition Molecular Leve Levell The Contr trib ibu uti tio on of of An Antio tiox xid ida ants and Phytochemicals The Colo lorr Syste tem m of of An Anti tio oxid ida ants The Delicate Balancing Act Act of Supplement Use Avoid idin ing g Toxic icity ity and Ov Overdosin ing g Making t he he Smart Ch Choice Implementing a Plan for Success Building St ro rong Mu Muscles Restor torin ing g a Healthf lthful ul Calo loric ric Bala lanc nce e Incorporating Good Incorporating Good Nutrit Nut rition ion and Exercis xercise e Int I nto o Your Your Everyday Rout outine ine Revi vie ewin wing g the Bene nefits fits Sta tage ge by Sta tage ge Adopti tin ng a Health thy y Approach

23

A Commit Commitment ment t o Change Change The Decision t o Change

25

The Four S’sof Succes uccess s

27

Suggested Reading

Nutrit Nut rition, ion, Exercise Exercise and Prosta Prostate te Cancer

Introduction

T

reat ment opt reat o ption ions s for prostate p rostate cancer cancer are are more effective than ever before. Yet, for many men, t he diagnos diagn osis is and and t reatment of cance cancerr brings bring s to their t heir attention attenti on the t he need need to change their th eir diet d iet and exercise exercise behaviors. behaviors.While the th e primary focus of the th e prostate cancer cancer survi survivor vor is to lilive ve a life free fr ee of cancer, cancer,more men are beginning beginnin g to t o realize realize that a healthy healthy diet and regular exercise exercise ca can n be an import imp ort ant step toward t oward preventing other diseases that commonly occur with wi th aging, incl includi uding ng heart disea diseas se and and diabetes di abetes.. Exciti xciting ng new n ew data suggest suggest th that at this t his same same app approach roach may also also slow prostate ca cancer ncer growt grow t h. This guide takes the best published evidence from populat pop ulation ion stu tudies, dies,bas basic ic science, science,and limi l imited ted human studies studi es,, and put s t hem togeth to gether er in ways that th at make practi practica call sense sense — with wi th th the e overall overall goal of helping h elping you achieve achieve “t “thrivers hrivership” hip” not just survivorship. What is i s t hri hrivers vership hip? ? The Merriam-Webster Merriam-Webster dictionary define d efines s thriver thriver as as one who w ho pro progress gresses es toward to ward a goal des despi pite te circumstance cir cumstances s, and flouri fl ouris shes hes.. The diagnosis di agnosis of prostate p rostate cancer cancer can lead you in in one of two t wo directions. di rections.Some will wil l react react t o this t his diagnosis di agnosis wi witt h a sens sense e of resign resignati ation on and fatalism. fat alism. This view can lead lead to t o helpless help lessnes ness s — waiting wait ing for the t he other ot her shoe shoe of cancer recurrence recurrence or progress pro gression ion t o drop. On the t he other oth er hand,th thrivers rivership hip put puts s you you in th the e

2

dri ver’s seat — making you driver’s yo u as vit vital al to your you r care and t reatment as any doctor doct or or nurse.You may have had pros pro st ate cancer cancer,, but now you are in charge of your life, lif e,adopti adopting ng new hea healtlthy hy habits habit s and enjoying ea each ch day to itits s fulles full estt . As a prostate prostat e cancer cancer thri t hriver ver,, you can use us e the latest latest knowledge know ledge about about nut nutrit rition ion and exerc ex ercise ise to improve your overall healt health h and qualit y of lilife. fe.Your di diagnosis agnosis of prostate p rostate cancer cancer can be the t he beginning beginn ing of a healt healthier hier lifest lifest yle.

As a prostate cancer thriver, you can use the latest knowledge about nutrition and exercise to improve your overall health and quality o lie

A working group of the t he leading leading expe expert rts s and scholars in nut nutrit rit ion ion,, exe exercise rcise,, and prostate p rostate cancer were gathered gath ered from fro m across across the Unit ed St St ates and and asked as ked to provide their t heir advice to us in developing this th is guide. It is our hope that you will benefit from the th e recommendations recommendations in this t his guide for a healt healthy hy diet di et and regular regul ar exerc exercise ise,, and that t hat you wil w illl achieve a better understandin understanding g of the t he roles of diet di et and exercise exe rcise in the t he preventio pr evention n of age-rela age-related ted disea diseas ses es,, as well as in th the e recurrence and and prog progres ress sion of prostate cancer.

Nutrit Nut rition, ion, Exercise Exercise and Prostat Prostate e Cancer Cancer

Underst anding the Underst t he Links Links Bet etween ween Nutrit Nutrition, ion, Exercise, and Prostate Cancer

O

ur modern mod ern societ society y is chara characteri cterize zed d by a lifestyle wit h low l ow leve l evels ls of exercis exercise e coupled with wit h consumpti consumption on of foods that are high in calories,fat, sugar, sugar,and salt. But But your bod body y still stil l respon res ponds ds in the t he only onl y way it know k nows s — it st ores exc exces ess s food as fat to t o prepare for times tim es of prolonged prol onged st arvatio arvation. n. Of course, course, becaus because e prolong prol onged ed starvation starvati on t ypically does not happen in modern society, society,th this is safety mechanism means that we just continue to gain weight and store store more fat. This exces excess s fat, fat, es especially th the e fat around aroun d the t he middl mid dle e of your bod body, y,has been ass associated wi with th an increa in creas sed risk of many dis di seas eases es,, incl includi uding ng pro pros st ate cancer, cancer, and parti p articularly cularly aggres aggress sive prostate pr ostate cancer. cancer.But you don’t hav h ave e to be 50 pounds overweight overweight to suffer the ililll effects eff ects of exces excess body fat. fat . Body fat f at is i s actuall actually y an organ wit wi t h functi fun ctions. ons.It secretes secretes hormones hormon es and specialized proteins that can increase inflammation and oxidation in t he cells cells of your body — two tw o natural process processes th that at are stro strong ng contribu cont ributors tors to th the e development and progression of prostate cancer.

Effects of of Oxidation Oxidati on and Inflammation Inflammat ion Oxygen is ess essenti ential al to lif life, e,but t he chemistr chemistry y of oxygen and oxidation oxidati on drives d rives ca cancer ncer develop development. ment. Oxidati xidation on is a normal chemical reacti reaction on that t hat occurs when free radicals form radicals form within wit hin the t he cells cells of the prostate. Eac ach h oxygen atom contains two tw o electrons electro ns t hat cling clin g togeth t ogether er..When heat or light li ght breaksapa apart rt t he atom, atom , t he electrons electr ons are separated, leaving unpaired unp aired oxygen o xygen radicals.These radi radicals cals are are free fr ee to roam around and init i nitiate iate a process process of brea b reaking king down dow n normal n ormal cellular cellul ar str structu uctures res,, ca causing using dama d amage ge

and promoting promot ing the deve d evelopment lopment of cancer cancer.. The more mo re free radicals radi cals present, the more m ore cancercausin caus ing g damage d amage occurs. This process process is simi similar lar to what happens during durin g the t he browning browni ng of an apple after it is sliced sliced open and the flesh fles h of the apple is expose exposed d to t o the t he oxygen oxygen in the air.The oxygen atoms in the t he air intera int eract ct wit w ith h the t he sugar in the apple, forming oxygen radicals. These radicals break down the t he flesh of the t he apple, or oxidize it, and the apple begins to rot . As long as th the e outer peel of the t he apple protects the th e inner fles fl esh h from oxyge oxygen, n, it is not oxidize oxid ized. d. But when prot p rotective ective “anti “antioxidant oxidants s” are are removed, the th e damage damage from oxidation oxidati on is allowed allowed t o occur unimpeded. uni mpeded. Likewi Likewis se,our bod bodies ies have many soph ophisticated isticated defense defenses s against against oxidat oxidation ion.. But But when these defenses break down, cancerous cells form and are allowed allowed t o grow. One of th the e most common ca cause uses s of the t he loss of protective antioxidants is inflammation, a biochemica bio chemicall process process th that at your body initi ini tiates ates when fight fi ghting ing off of f an infection. infection . If the th e body sens senses es invaders,such as bacteri bacteria, a,wh whitite e blood bl ood cells are mobiliz mobili zed to go t o the th e sit site e of the invasion invasion and to releas relea se oxygen oxygen and nitrogen nit rogen radicals to help h elp kill kil l the t he invaders. Unfortunately, if they remain unchecked, t hese same same oxygen radicals radi cals can also also break b reak down normal tiss t issue ue and and promot pro mote e the develop development ment of cancer. cance r.Oxy Oxygen gen radicals damage nor normal mal DNA DNA,, causing ca using errors t hat allow ca cancer ncer growth. growt h. In fact, invest invest igat igators ors have have noted not ed the t he presence presence of inflammatory cells in virtually all prostate cancer

3


ti ssue that tis t hat is removed surgi surgica calllly, y,and have found t hat inflammatio inf lammation n leads to t he atrophy, atroph y,or wast wast ing awa away y, of normal no rmal pros pro st ate tis ti ssue adjacent adjacent to t o precancerous precancerous and cancerous areas areas of prostat prostate e tiss ti ssue. Based on these and other observations, evidence is mounting that inflamma i nflammation tion and oxidation pla pl ay key roles in t he development of prostate p rostate cancer cancer.. Why is this thi s imp import ort ant? Beca ecause use alth although ough ot other her contrib cont ribut utory ory factors facto rs such as aging and altered alt ered hormone secre secreti tions ons are are difficult diff icult or imposs i mpossibl ible e to change,nut nutrit rit ion ional al and and exercise exercise habit habits s t hat reduce the development development of inflammation i nflammation and oxidati oxidation on can ca n be b e changed.

Although some actors that contribute to prostate cancer are difcult or impossible to change, nutritional and exercise habits that reduce inammation and oxidation can be changed

and veget vegetables, ables, herb herbs s, and spices spi ces can all act against aga inst both oxidation oxidati on and inflammati inflammation. on. Fin inally, ally, recent res r esearch earch has sugg ugges ested ted t hat regul regular ar exercis exe rcise e may be one of t he best best natural n atural antioxid ant ioxidants. ants. Regular exercise causes many changes in your body t hat help reduce redu ce circulati circulating ng levels of react react ive oxygen inflflammatio in ammation. n. Beyond burni b urning ng calories calori es,, endurancet ype exercises, exercises, such as walking, walki ng, runnin runn ing, g, cyclin cycling, g, and swi wimmin mming, g, are part particularly icularly effective effecti ve at at increa i ncreas sing the t he body’s bod y’s natural leve l evels ls of antioxidant anti oxidants s, elimi eliminatin nating g inflammatory inf lammatory molecules m olecules th that at drive dri ve canc cancer er..

Endurance-type exercises, such as walking walking,, running, cycling, and swimming, are particularly eective at increasing the body’s natural natural levels o antioxidants

The Contribution of Carcinogens There are are many ant anti-in i-inflammator flammatory y and antioxidant antioxi dant substance ubstances s found in i n colorful color ful frui fruitt s and vegetables, vegetables, whole grains, and spices — nearly all of which are absent abs ent from th the e process processed foods food s that rely r ely on sugar, sugar, salt, and fat for flavor. By focusing your diet on fresh fruit frui t s and vegetables, veget ables,ocean-ca ocean-caugh ughtt fish, f ish, and whole whol e grains, grains, you can increas increase the th e protective prot ective antianti inflammator inflamma tory y components components of your diet and begin to bene b enefit fit from their t heir effects effects.. For example, tomato-based products such as soup oups s, pasta, and ju juices ices can can increas i ncrease e levels level s of the antioxidant antioxid ant lycopene in the t he prostate prostate gland. Drinking Drinki ng bevera beverages ges such such as pom pomegranate egranate juice jui ce and green gr een and black b lack tea can can increa i ncreas se levels of antioxidant-containing polyph polyphenols enols..The cruciferous vegetables vegetabl es such such as broccoli, broccoli , Bruss russels els sprout sprou t s, bok choy, wasa wasabi bi must mustard, ard, and horse ho rseradish radish all contain substances th that at may induce protective proteins prot eins in your liver and titis ssues ues,, whi while le vit vi t amins,min minerals erals,, extracts of frui fruitt s

4

Inflammation Inflammati on and oxidati oxidation on are two of o f the t he body’s natural processes, which, when they are allowed to proceed unchecked,ca can n infl i nfluence uence the development develop ment of pr prostat ostate e cancer. cancer.But extern external al substances also play an important import ant role — and can can also also be thwarted th warted by keeping kee ping to a healt healthy hy diet. A carc carcinog inogen en is a chemical chemical that directl d irectly y or indirectly indi rectly causes caus es or leads l eads to mor more e aggressive aggressive form forms s of cancer. cancer. Hundreds of chemicals chemicals have have been been definit defi nitively ively linked li nked to ce cellllular ular changes th that at lead to cancer cancer development, development , and hundreds hund reds more have been implicated impl icated in process proces ses t hat migh m ightt be involved. i nvolved. In today’ t oday’s s indus ind ustr trial ial society,itit’s ’shard to t o avoid all expos exposure ure to to carcinogens. ca rcinogens.But by focus f ocusing ing on a healt healthy hy diet di et and on healthy eating eati ng practi practices ces, you can avoid increa i ncreas sing your exposure exposure to carcinogens carcinogens t hat contribut contri bute e to t he develop development ment of o f pros pro stat tate e canc cancer er.. For example, overcooking of any t ype of meat at very high hi gh temperatures t emperatures produces a set set of


carcinogens carcinog ens called called heterocycli heterocyclic c amines, amines, one of of which wh ich,, kno known wn as PhIP, has been shown show n t o cause pros pro st ate cancer cancer in animal studies stud ies.. In addition addit ion,, charbroil cha rbroiling ing red meat meat or chicken, chicken, wit h it s skin skin int act, prod produces uces yet another anot her set set of carcinogens, calllled ca ed polycyc pol ycyclilic c aromat aromatic ic hydrocarbons. The deleterious deleteri ous effects effects of th thes ese e two tw o carcino carcinogens gens are well known know n — when tobacc t obacco o lea l eaves ves are burned in cigarettes cigarettes,, heterocyclic amines and polycyclic po lycyclic aromatic hydrocarbons are are produced prod uced and inhaled, inh aled, play pl aying ing a role in the t he develop development ment of lun lung g cancer cancer.. Remarkably, by eating overcooked and charbroiled meats,t he average American cons con sumes the t he same amountt of carcinog amoun carcinogens ens (as (as Phl hlP Ps) as are inhaled inh aled in in a pack-and-a-half of cigarettes a day. Laboratory Laborat ory res resea earch rch find f inding ings s have have sugg sugges ested ted t hat intake in take of thes th ese e charred charred meat carcinog carcinogens ens triggers mutations in prostate cell DNA and leads to a chronic chroni c inflammatory infl ammatory response in the t he pros pro st ate.This comb combinat ination ion of o f mut atio ations ns and inflamma infl ammati tion on appear appear to be b e a key to t he development developm ent of prostate cancer. cancer.

charbroi ling charbroili ng meats.Also Also,, using alternate alt ernate methods meth ods to cook meat meat can can signi significantly ficantly cut down d own on the t he amount of carcinogens carcinog ens pro produced: duced: choose steamin steaming g or baking over charbroiling charbroilin g or pan-frying, p an-frying, marinate the th e meat, meat, and turn th the e meat meat frequently f requently to t o prevent overcooking. overcookin g. Fin inally, ally,in increa creas se your cons consump umptt ion of cruciferous crucif erous veget vegetables ables,, whi which ch have uni unique que properties propert ies th that at enable enable them t hem to help h elp “sponge “sponge up” carcino ca rcinogens gens and and poss p ossib ibly ly even counterac count eractt some of t he dama d amage ge caused caused by b y thes t hese e carcino carcinogens. gens.

Effect ects s of Exces xcess s Suga Sugarr Over the th e last 20 years, years, as in intt ake of sugars from proces process sed foods fo ods has gon gone e up, obesit obesity y rates have skyro skyrocketed, cketed, leading leadin g many researchers t o implilica imp catt e exce exces ss sugar in t he current obesity o besity epidemic. epid emic. In fact, recent recent work wo rk suggest suggest s th that at highhi ghfructose fru ctose corn syrup syrup — a form of sugar frequently frequent ly found foun d in i n proces p rocess sed foods foo ds such such as soft dri drinks nks — is converted converted to fat much more quickly qui ckly than is naturally occurring glucose.

PhIP (depicted in yellow and dark blue) has the same DNA mutational capacity as cigarette smoke but the carcinogen accumulates only in the prostate. This fnding has triggered major new studies on the healthiest way to cook meats in order to protect the prostate rom accumulating carcinogens over a lietime.

Yet, the th e negative negat ive effect ef fects s of excess excess sug sugar ar begin begi n even before befor e it is sto stored red as fat. Sugar is is a prime energy source for many cancers, includi incl uding ng prostate p rostate cancer cancer.. Mos Mostt normal n ormal cells can ca n adapt to t o an environment low l ow in i n sugar sugar and use other oth er energy energ y sour sources ces — a proces pro cess s developed through evolution when people would go throu through gh periods p eriods of starvati starvation. on. Howe However ver,, cancer ca ncer,, whi which ch grows gro ws faster faster th than an normal norm al cells, does not hav have e the same same abilit y to adapt t o low sugar environ envi ronment ments s.Thus, t he more m ore excess excess sugar consumed, consumed, th the e more the th e tumor tumo r is sti stimul mulated. ated. Indeed, several animal studies suggest that cutting simple sugar intake can slow prostate cancer growth.

Swit witching ching to t o alternate sources sourcesof protein p rotein th that at are not prone pro ne to formin forming g carcinog carcinogens ens when cooked, such as soy,is an an impor im portt ant first fi rst step step in i n mini mi nimizin mizing g t he damage cause caused d by overcooking o vercooking and

Exce xces ss sugar int i ntake ake is fur furtt her linked li nked to to prostate cancer growth through its interactions wit h ins in sulin ulin.. Upon consumpt consumpt ion of o f sugar, sugar,th the e body produce produ ces s insulin, which helps to break down t he

5


sugar, ens ensuri uring ng t hat t he sugar is st st ored as needed. needed. When too to o much sugar is consume consumed d and t he body constant cons tantly ly produces prod uces high levels of ins in sulin to help h elp process proces s it, the cells can can become immune to t o the t he effects of ins i nsuli ulin, n, res result ulting ing in t oo-hig oo-high h levels of sugar in the th e blood — a common common sign of metabolic metabol ic syndr yndrome ome and a str strong ong risk r isk fact fact or for fo r diabetes. di abetes.In addition, addit ion, high ins in suli ulin n levels hav have e been linked to to an increased risk of diabetes, heart disease, and prostate canc cancer er growth, growt h, ind independent ependent of its i ts interaction with sugar. Put uttt ing th this is evidence evidence together, tog ether,res resea earch rch is beginning beginn ing to suggest that t hat th the e more proces pr ocess sed sugarsyou eat, the higher hi gher your insulin lev l evels els,, and the more likely li kely it is that your prostate cance cancerr will wi ll grow.

Research is beginning to suggest that the more simple sugars you eat, the higher your insulin levels, and the more likely it is that your prostate cancer will grow

Yet, cut cuttt ing back on sugar sugar int in t ake is only one on e import impo rtant ant step. Stu tudies dies of animals wit h pros pro state cancer ca ncer have have shown shown th that at restr restricti icting ng overa overallll ca calori loric c int ake can slow slow advance advancement ment of their t heir disea d iseas se. Maint Ma int aining a healt healthy hy diet and engaging in a regular exerc exercise ise regimen will wil l not only help you achieve ac hieve and and maintain maint ain your goal weight, weight , it migh mightt also als o help h elp slow th the e growt h of o f cancer. cancer.Working with wit h a qualifi qualified ed nutrit ional couns counselor elor will help

6

you identif id entify y “good” and “bad” foods,whi while le working worki ng wit h a qualified quali fied ex exerc ercise ise physiol physiologist ogist willl help you develop an exerc wil exercise ise regimen to keep kee p you fit. fi t.

Putt utting ing It All Together The modern diet d iet and sedent edentary ary lifestyle can lead t o an accumulati accumulation on of body b ody fat, which, in turn, t urn, ca can n contribute to the development development of inflamma inflammation tion and raise insulin levels levels.. At t he same same time, t ime, a highhig hcalor ca lorie, ie, hig high-sugar h-sugar,, pro-i pro-infl nflammatory ammatory diet d iet ca can n promot pro mote e age-related age-related chroni chronic c diseas diseases and may prove an an import ant link between between nutrition nut rition and pros pro st ate cancer cancer develop development ment and progr p rogres ess sion ion.. Even modest changes in body b ody fat composit composition ion through changes in diet choices and regular exercise can be beneficial — a 5% weight loss has been shown shown to decrea decreas se markers markers of inflammati inf lammation on by 30% in obes ob ese e diabetic diabeti c patients patient s and to reduce redu ce insulin leve l evels ls by 20% in non-diabetic people. p eople. While excess excess weight has been been associated associated wi witt h more severe and rapidly progressive prostate cancer ca ncer,, up t o 60% of men m en at normal norm al body weight and wit w it h an average-sized average-sized wais w aistt ca carry rry exc exces ess s body bod y fat around t heir abdomens abdo mens.. Focus ocusing ing on a diet that th at is rich in antioxidants, anti oxidants,low in i n proinflflammator in ammatory y and carcinogenic carcinogeni c substances substances,, and low in i n simpl simple e sugars — coupl coupled ed with wit h a regular exercis exe rcise e regimen — can make make an an import im port ant differenc dif ference e in improving improvin g the overall overall health of every pros pro st ate cancer cancer thriver .


Key Points to Remember 1

Oxidation and inflammation play p lay important import ant roles in the development of prostate canc cancer er

2

Anti-inf lammator Anti-inflamma tory y and antioxidant anti oxidant substance substances s found in colorful fruit s and and vege vegetables tables can can counteract countera ct t he damage damage caus caused ed by oxidation oxid ation and inflamma infl ammati tion on

3

Carc arcinogens inogens from charred charred meat can trigger t rigger chronic chroni c inflamma infl ammati tion on in i n t he prostate

4

Using altern Using alternate ate methods metho ds to cook meat and increasing increasing cruciferous vegetabl vegetables es ca can n minim mi nimize ize intake int ake of and damage from carcino carcinogens gens

5

Sugar is a pri primary mary energy source source for cancer cancer and st st imu imulates lates production product ion of insulin i nsulin,, whi which ch is linked to to an increas in creased ed risk ri sk of di diabet abetes es,, heart di dise seas ase, e, and prostat p rostate e cancer cancer

6

Cut uttiting ng bac b ack k on sugar intake int ake,, maint maintainin aining g a healt healthy hy diet, diet , and engaging in a regular exercise exercise regimen can can help slow th the e growth growt h of ca cance ncerr

7


Obes besit ity y and Met Metaboli abolis sm — Where We We Went Went Wrong

T

he human hum an genome dates dat es back more t han 50,000 50,000 years years,, t o a time t ime when w hen man m an was a“hu “hunt nter-gath er-gatherer erer,” ,” consumed consumed a diet d iet consisting of about 90% plant-derived foods, and engaged in constant physical activity to survive. In t he modern, modern , post-i post-indu ndus st rial era,our level l evel of physical actitivit ac vity y is dramatically dramatically reduced reduced and our diet has increas increa singl ingly y shifted tow toward ard a meat-b meat-bas ased ed diet: di et: the average ave rage adult in th the e United Unit ed Stat States es consumes close to 200 pounds pound s of meat, m eat, pou poultltry, ry,and fis fi sh per year, year, an increase increase of 50 pound p ounds s per person person from f rom 50 years ago.Comp ompared ared with wit h plant-b pl ant-bas ased ed prot pro t ein sources, sources, animal-bas animal-b ased ed protei pro tein n sources sources are hig higher her in saturat aturated ed fat, low lower er in fiber, fi ber,and poorer poo rer in micronutrients, especially antioxidants. More than th an 50% of adult adul t s in the t he United St St ates do not ea eatt a singl single e piece of fruit fru it per day and and more than 80% do not mee meett the recommended recommended int ak ake e of five f ive servi servings ngs of frui f ruits ts and vegetables vegetabl es per day d ay.. In fact, if one elimin eli minates ates pot atoes (and (and French French fries fri es), ), the th e average average American American eats eats fewer than t han two t wo servings of frui f ruits ts and vegetables per day. day. At the t he same same time, tim e, only about 20% of American American adults adult s meet meet t he minimum mini mum exercise exercise guidelines guidelin es of at leas leastt 30 minutes minut es per day d ay,, t hree times t imes per week.

More than 80% o adults do not eat the recommended ve servings o ruits and vegetables per day; eliminating potatoes (and French ries), the average American eats ewer than two servings o ruits and vegetables per day

8

The modern Wes Western tern diet d iet has h as vir virtt ually elimin eli minated ated malnutrit ma lnutrit ion in the t he majority majority of the t he population. population. However,, many of the However t he food choices cho ices for indi i ndivid viduals uals of limit l imited ed means means,, or for tho thos se uneducated uneducated in i n the t he relati rela tions onship hip between food and healt health, h, are of poor p oor nutrit nut ritional ional value and and are lacking lacking key vitamins and minerals mi nerals.. In fact, f act, th the e least least expens expensive ive foods fo ods availa av ailable ble t oday provide fewer nutrients nut rients per calorie t han do the t he more expensive expensive foods food s. Thus,in th the e process process of solving solvin g the t he problem prob lem of malnutrit ion t hrough indus in dustri trializ alization, ation, we’v we’ve e created cre ated a low-cost low-cost food suppl upply y that th at promot es a global epidemic epid emic of obesit obesit y.In addi additi tion, on, t he largely sedentary sedentary lifes li festt yle indica indi catt ive of an “advanced” “adva nced” society society effectively means th that at we now have to pay for exercis exercise e — wit h money mon ey,, t ime, or bot b oth h — beca b ecause use ex exercis ercise e in t he form of hard phys p hysical ical work, as part of daily dail y living, livi ng, is scarce. Mult ip iple le stu studies dies in the th e past past deca d ecade de have show hown n an increased incidence of obesity, chronic diseases of aging, heart heart disea diseas se,and cancer cancer in i n popu p opulati lations ons eatt ing a Wes ea estern tern diet and having a sedentary sedentary lilifes festt yle, vers versus us populatio popul ations ns that are physicall physically y active and eat fewer calories, less refined carbohydrates, less meat, and more fruits, vegetables, cereals, and whole grains. To understand unders tand why this t his lifestyle lifestyle shift would hav have e such such a profound effec effectt on human health, inves investi tigators gators have hav e begun to t o look loo k more closely closely at the t he true tru e effects effects of the metabolic syndrome and its co-conspirators, excess exces s bo body dy fat f at and muscle loss lo ss, on t he human hu man body.


The Metabolic Syndrome For many m any years years,, doct doctors ors noticed not iced that t hat overweight o verweight or obese obese patients often had the following foll owing common diseas disea ses — high h igh blo blood od pres press sure or hypert hypertens ension, ion, increased increas ed blood bl ood sugar or diabetes diabetes,, and high hi gh levels of blood b lood fats,specifically trig t riglycerides lycerides.. In addition, addit ion, t hes hese e patients patient s were at at greater risk of developing developin g insulin res resistance istance and and t ype 2 diabetes di abetes.. Beca ecause use t hes hese e different dif ferent condi conditt ion ions s are are so so common, common , t heir coexistence seeme seemed d to t o be a simp imple le coincidence coin cidence — after aft er all, commo common n disea d iseas ses occur commonly. commo nly. However However,, in th the e last last t wo deca decades des,, t he coexistence coexistence of thes t hese e cond conditition ions s, collect collectively ively known know n as metabo metabolilic c syndro syndrome, me, has been found fou nd to to have a very specific underlying cause — increased abdominal abdomi nal fat and ins in suli ulin n resistance resistance.. Metabol ic syndro Metabolic syndrome me affects up to t o 50% of Americans bet between ween the t he ages of 45 and 65. Since an estimated 65% of adults in the US are overweight or obese, obese,it is not surprising that t hat metabolic syndrome syndrome and the detrimental det rimental effects of its i ts component chroni chronic c diseas diseases es is so common. common .

Effect ects s of Exces xcess s Bod Body y Fat Obes besit ity y is the result result of an imbala imb alance nce of food int intak ake e and exercise exercise..When you eat more m ore and exercise less less, fat accumulates in the t he body. bod y.The firs fir st pl plac ace e that th at fat accumulates ac cumulates in men is in the t he middle middl e of the t he body around the th e belly and abdomen. Belly fat is specially specially evolved to sto tore re fat quickly qu ickly and releas rel ease e it qui quickly. ckly.Thus,t hi his s is the th e first fi rst place pl ace t he fat fat sett sett les when you gain weight and the first plac pl ace e it leaves wh when en you lose l ose weig weight ht.. Sin ince ce this thi s fat grows so so quickly, qui ckly,it ca can n sometimes outgrow itits s blood supply, causing the fat cells to die. When t hi his s happ happens ens,, t he body’s bod y’s im immun mune e sys systt em sends sends out sca cavenger venger white whit e blood cells to clean up the

debr is — whi debris w hich, ch, as we des d escrib cribed ed earlier, earli er,sets off a cas casca cade de of inf inflammatory lammatory and oxidative oxidati ve event events s that th at can ultimately ult imately promo promote te heart disea diseas se,diabetes diabetes,, and certain t ypes of cancer, cancer,includ including ing prostate cancer. But th the e effects effects of belly fat on prostate cancer ca ncer growt h are not limi l imited ted to t o its it s impact on inflammati i nflammation. on. Hormones produ produce ced d by belly b elly fat affect the abilit abili t y of cells cells to properly prop erly take up insulin. In In t urn, this resistanc resistance e to insulin res result ults s in t he overproduction overproduction of insulin and insulin-like growt h factor (IGF), bot both h of whi which ch are pot potent ent stimulants for prostate cancer growth. When applied t o human prostate cells cells in the t he laboratory, IGF IG F prevent prevents s pro pros st ate cancer cancer cells from fro m dying dyi ng and helps help s t hem grow. gr ow. At the t he same same time, t ime, t he release release of special proteins prot eins that “spong “sponge e up” and reduce the levels of IGF is decreased, thereby exacerbating t he effects effect s of the t he increa in creas sed circulat cir culatin ing g IGF IGF. Of note, not e,one of t hes hese e specia speciall bind b inding ing prot proteins eins (IGF (IG F bin binding ding prot protein-3) ein-3) has been shown shown to directly directl y sti stimulate mulate pros pr ostate tate cancer cancer cell death — compounding compound ing th the e effects effects of t he loss of IGF IGF bindin bin ding g proteins prot eins res result ulting ing from f rom insulin resistanc resistance e and excess excess belly fat.

Hormones produced by belly at lead to an overproduction o insulin and insulin-like growth actor, both o which are potent stimulants or prostate cancer growth

Beyond the t he effects of t he exces excess s body fat, fat , t he consequences cons equences of ca calori loric c imbalanc imb alance e that th at lea l eads ds to fat ac accumulat cumulation ion ca can n be b e sign signifificant. icant. Cance ancerr cells grow fas f aster ter than t han do normal norm al cells cells and require excess exce ss energy for t hei heirr grow g rowtt h. Thus, exce exces ss calor ca lories ies — above your body’s bod y’s need — will wi ll help feed fee d tumor t umor growth.

9


Also, rapidly growing Also, grow ing tumo tumors rs live on the th e edge of survi urvival val due to a lack lack of an adequat adequate e blood supp upply ly and low levels of oxygen. Witithout hout oxygen, t he cell cells s can’t ca n’t break b reak dow down n fat but b ut instead i nstead rely rely on sugars and carbohydrates for energy. Thus, the higher your sugar intake int ake,, t he more nutrient nut rient s you are providing to t he tumor. tumor. In animal stud studies ies,, cutt cutting ing down on carbohydrate carbohydrate intake has been shown to dramatically slow tumor growth. growt h. In human stud studies ies,, cutt cutting ing down on carboh ca rbohydrate ydrate int ake has been show shown n to t o be one of the t he best best ways w ays to lose l ose weigh weight, t, whi which, ch, in turn, t urn, has dramati dramatic c healt health h benefit benefi t s and can can slow slow tu tumor mor growth. Despite Despi te some very prom promising ising res resea earch, rch, t he degree to which cutt ing all ca carbohydrates rbohydrates is helpful in t he long run rema remains ins unknown. But what is not disput d isputed ed is that eating eati ng simple simpl e sugars sugars has has no real benefit, promotes obesity and possibly tumor growth, and should be avoided.

Eff ffects ects of Musc uscle le Los Loss s Muscle play Muscle pl ays s a number of roles r oles in maintainin maint aining g health.. Not only health on ly are muscles muscles crit critical ical to posture, p osture, balance,, and movement, but t hey maint balance maint ain healthy bones bon es by put p uttiting ng a physical physical stress stress acros across s the bones bon es.. Hormonal therapies t herapies oft en used used in men wit wi t h advancing advanc ing prostate cancer can can hav h ave e a detriment detri mental al effect on muscle muscle,, leading to musc muscle le atrophy atrop hy or wastt ing. Thus, was Thus,wi with th musc muscle le loss l oss from aging, inactivi inact ivitt y,and hormonal horm onal therapies t herapies,, t he bones become more britt bri tt le and the t he loss of balance b alance ca can n lead to bone fractures. In addit ion ion,, th the e loss of mus mu scle can can undermin und ermine ea potential mechanism to alleviate insulin resistance. The upt ake of sugars sugars into int o the t he muscle muscle can occur occur via vi a a process process that is i s independent independ ent of insuli insulin. n. Therefore, in men wit w ith h metabolic metabol ic syndro syndrome, me, th the e loss loss of muscle mas mass s preclud precludes es t heir abilit abil it y to effectively effect ively control blood sugar control and overcome overcome insulin resistance through exercise.

Key Points to Remember

10

1

Exce xces ss fat promot p romot es insuli insulin n resistance, resistance,whi which ch reduces levels levels of IGFbi bindi nding ng prot eins that th at stimul sti mulate ate prostate prostat e cancer cancer cell cell death

2

Cutt ing ca carbohydrate rbohydrate intak int ake e can can cut down on exces excess s fat fat and weight and slow slow tumo tumorr growt h

3

Muscle loss due to Muscle t o aging, inactivit inactivi t y,and hormonal hor monal t herapies can can weaken weaken bones b ones and and undermi u ndermine ne a mechanism mechanis m to t o alleviate alleviat e insulin res resistance istance


Nutrit Nut rition ion at t he Molecular Molecular Lev Level el

I

t has been only onl y a few years since the t he human hum an genome was sequenced, and what we learned throug th rough h this t his process processs has radically altered alt ered our unders und erstt anding of human h uman genetics genet ics.. As a general general rule, rul e,scient cientists ists th though oughtt t hat each each gene contained the th e information needed needed to produce prod uce one protein, a key element element use used d in i n nearly every bodi b odily ly proces p rocess s. And, gi given ven the complexit compl exity y of humans comp compared ared wit h other ot her animals animals and and wit w ith h plants pl ants,, it was es estitimated mated t hat the t he human genome would woul d have 100, 100,000 000 genes or more mor e that coded cod ed for prot p roteins. eins.In fact, th the e human genome g enome has onl only y about 30, 30,000 000 genes t hat code for prot p roteins; eins;at least least 98% of t he genome does d oes not code for proteins at at all.

spi pinac nach h and green g reen lettuce lett uce,, part participat icipates es in a pathway pathw ay leadin leading g to t o the t he stabi stabilization lization of DNA.Early man evolved on a rich plant-bas pl ant-based ed diet, di et, so our metabolism metabol ism came came to depend d epend upon a rich supp supply ly of foli f olic c acid acid to t o ass assist in mult ipl iple e process processes prott ecti pro ecting ng against disea d iseas se.However,as hum humans ans began to migrate mig rate out of agricult ural lands, lands, th the e ability abilit y to grow enough green green plant plant food to t o provide adequate adequat e folic fol ic acid was w as reduced. As a resul result, t, it is believed that t hat changes occurred in the t he genome of individ ind ividuals uals to conserve conserve folic acid acid for fo r DNA DNA integrity integri ty while whi le sac sacrif rificing icing it i t s ot other her roles in metabolism met abolism — ultimately ult imately contribut ing to an increas increased ed risk risk of heart di dis seas ease e and cance cancer. r.

It t urns out th that at most most of o f our DNA is the software involved in determining d etermining how and when wh en 30,0 30,000 00 genes are express expressed. ed. Regul egulati ation on of o f thi t his s express expressio ion n can be affected by environmental, nutritional, and other ot her factors. f actors.Thes hese e changes to t he genome genom e by external factors, called epigenetic changes, can have sign ignifi ifica cant nt effects on a wi wide de variety of molecular mol ecular process p rocesses es..

If this t his sounds sounds far fetched, cons consider ider the t he Agouti Agout i mouse m ouse.. Thi his s t ype of mouse mouse has has been specially bred t o make a mutated protein pro tein called the t he Agout Agoutii protein pro tein..The protein dis d isrupts rupts the brain’s abilit ability y to signal tha th at the sto tomac mach h is i s full and control appetit appetite, e,so the t he mice eat eat to excess excess and and become obes ob ese. e.At the t he same same tim t ime, e,the Agouti protein prot ein interfereswit with h the t he action action of another protein that t hat turns t urns the coa coats ts of the t he mice brown. Beca ecause use of thes t hese e genetic genet ic changes,th the e Agouti Agout i mouse mouse has a yell yellow ow coat, as as well as alilifet fetime ime in increa creas sed ris ri sk of diabetes di abetes and some forms fo rms of cance cancer. r.However However,,if you supplement the t he diet of a pregnant pregnant Agouti mous mouse e with wit h folic foli c acid acid and other similar compounds,th the e yellow-coa ye llow-coated ted mother mot her will give birth to a lean lean brown mouse with wit h no increas i ncreased ed ri ris sk of dis di sea eas se.The addition addit ion of foli f olic c acid acid silenced the t he express expression of the t he abnormal Agouti gene — no Agouti prot protein ein is produced,and the th e mouse mouse is born normal. n ormal.

Most o our DNA is involved in determining how and when genes are expressed, and can be aected by environmental environmental and nutritional actors For exampl example, e,one of the th e most most impor i mportant tant nut nutrit ritional ional factors modulatin modul ating g gene express expression is folic acid: a lack of folic fol ic acid has been been linked l inked t o an increa in creas sed ris ri sk of heart di dis seas ease e and cance cancer. r.Fol olic ic acid, which whi ch is found in dark green leafy vegetables such such as

Similarly, in the development of human prostate cancers ca ncers,, th the e tumor tum or silences prod producti uction on of a protein protei n

11


called GSTP1, wh which ich pl plays ays a critical crit ical rol r ole e in defending defendi ng DNA agains againstt mut m utatio ation n cause caused d by oxidation in i n the t he prostate. prostate. It is i s believed that t he on-off switch for this t his protein is mediated mediated by epigenetic changes changes simil imilar ar to t hat which wh ich allows folic acid acid to t o mediate the change change in the t he Agout Agoutii mouse,, enablin mouse enabling g a healt healthy hy brown brow n mous mou se to be born from a diabe di abeti tic c yellow yellow mous mouse. e. The mere existence existence of thes t hese e and and oth o ther er epigeneti epig enetic c changes demonstrat demonstrates es th that at your you r DNA is not set in stone. It is i s a living part of th the e cells cells in your body and its it s software software code code can can be influenced inf luenced by nutritional and environmental factors. In fact, it is est est imated t hat only o nly 30% of proces p rocess ses norm normally ally ass as sociated wit w ith h aging are di dictated ctated by b y genes, genes, whi while le 70% are under your personal control — through diet,, exe diet exercise rcise,, and and ot other her lifestyle l ifestyle behaviors.

The Contri ontribut bution ion of Antioxidants Ant ioxidants and Phytochemicals

12

liquid, water-like environment of muscle cells. This latt latt er adaptation adaptation is part particularly icularly import ant, as the primary p rimary energy producers wit hin mus muscle cle cells,, t he mito cells mi tochondr chondria, ia, als also o lea l eak k oxygen radicals r adicals in oxygen-poor oxygen-p oor environment enviro nments s.The abi abililitt y of antioxidant anti oxidants s t o mop up th thes ese e radi radica cals ls enables enables them th em to play an an important impor tant role rol e in the fight aga against inst cell damage and the t he development develop ment of ca cancer ncer..This is where exercise exercise ca can n be b e particul part icularly arly useful useful — exercise exe rcise increas increases the levels l evels of many antioxid ant ioxidants ants in th the e muscles muscles,, th thus us reducin reducing g the t he levels of dangerous free f ree radicals.

The ability o antioxidants to mop up ree radicals enables them to play an important role in the ght against cell damage and the developmentt o cancer developmen

The Color Color Sys Systtem of Antioxida Ant ioxidant nts s

Early bacteria living in Earth’s oxygen-poor atmosphere learned learned to t o extract energy from the t he sun sun — by combining t he energy energy with wit h carbon carbon dioxide di oxide from the t he air and and water w ater from the t he ocean, ocean,th they ey were able to form the t he glucose glucose they needed needed for their t heir cell cells s to fu funct nction ion..Thi his s pro proces cess s, know known n as ph phot otosynth osynthes esis, is, gave these bact bacteria eria a huge advantage advant age over competing competi ng species pecies,, but crea created ted a problem: prob lem: t he oxygen they produced asa byprod byproduct uct of this t his chemicall reacti chemica reaction on threatened t hreatened to destroy them through th rough oxidati oxidation on of o f their t heir DNA.So, th they ey develop developed ed specialize pecialized d anti antioxidants oxidants called phyt phytochemica ochemicals ls,, which whi ch have have properties propert ies th that at enabl enable e them to absorb the th e ext ext ra electron electrons s found on oxidize oxidi zed d chemicals and oxygen oxyg en radicals.Phyt hytochemi ochemicals cals are truly tru ly sponges for oxygen radicals.

The different dif ferent t ypes of antioxid ant ioxidants ants can, can,for the t he most part,, be group part gro uped ed by color. col or. For example, exampl e,t he antioxidants anti oxidants found in red tomatoes t omatoes are ident identical ical to those found in red watermelon or pink gra g rapefruit. pefruit. Although Alth ough th the e sys system tem is i s by no mea means ns perfect, organizing phyt phytochemica ochemicals ls by color is an an easy easy way to help you differe dif ferenti ntiate ate between between the t he different t ypes of antioxidants anti oxidants and and lea l earn rn how to t o get a variet variety y of phytochemicals and antioxidants into your diet.

In the human body bod y, diff differe erent nt typ types es of antioxidants anti oxidants are foun found d in specific loca lo catt ion ions s where they th ey can can be most effective. eff ective. For example, some some act onl only y in th the e oily environment of fat cells cells while others ot hers ac actt in i n the t he

The red group, group, includi including ng tomatoes t omatoes,, pin pink k grapefruit, and watermelon, waterm elon, cont contain ain lycopene, one of the t he most well-studied antioxidants anti oxidants in the t he fight aga against inst pros pro st ate cancer. cancer.Popu opulat lation ion-bas -based ed studies stud ies that were

Organizing phytochemicals phytochemicals by color is an easy way to dierentiate between the types o antioxidants and to get a variety o antioxidants into your diet


condu cted when conducted w hen pros pro st ate cancer cancer was di diagnose agnosed d at more advanced st st ages clearly demons demon st rated that t hat increa in creas sed blood bl ood levels of lycopene lycop ene and increa in creas sed intak int ake e of lycopene-containing lycopene-containing foods were ass as sociated wi witt h a reduced risk r isk of aggres agg ress sive pros pro st ate cancer. cancer.In recent yea years rs,, as t he popu p opulat lation ion of prostate cancer cancer patients has shif hifted ted t o the t he ident id entifificati ication on of ca cancers ncers at earlier stages, stages, and as t he population of patients has changed, some of these ass as sociati ociations ons can can no longer lon ger be demons demon st rated. There are seve everal ral shor shortt -term studies stud ies in which whi ch tomato to mato paste pas te or lycopene l ycopene supp supplement lements s were given to t o men prior pri or to t o prostatectomy. prostatecto my.Lycopene was was ident identifi ified ed in t he prostate tiss t issue ue after surgery and there th ere were changes in prostate p rostate cell cells s sugg ugges estiting ng benefit b enefit.. Multip Mult iple le anim animal al stu studies dies have als also o demonstrated the t he ability abilit y of lyc l ycopene opene to reduce tumor growth g rowth aswell. It is als also o clear clear from mult multipl iple e stud studies ies that the bene b enefit fits s of lycopene are more readily available when wh en absorbed absorbed from cooked tomato products and juicesthan from whole who le tomatoes. t omatoes.In fact, more than 80% of the t he lycopene in the t he American American diet di et comes from cooked tomat omato-b o-bas ased ed prod product ucts s such as pasta sauce, sauce,to tomato mato soup, tomato jui juice ce,, and ketchup. ketchup . Ulti mately, st udi Ultimately, udies es focuse focused d on the t he abi abililitt y of lycopene to preve p revent nt the initi ini tiation ation and progress progression of prostate p rostate cancer cancer have not yet est est ablished definit ively the benefits of increas increasing t he intak int ake e of lycopene lycopene-containing -containing foods or supplements. More resea research rch is needed to clarify clarif y the th e potent ial benefit bene fit of this t his nutritional component. component. Importantly, some animal studies have shown minimal or no bene benefit fit to lycope lycopene ne alone alone for slowi lowing ng prostate cancer cancer growt h, whi while le whole whol e tomato to mato extracts have have been been shown shown t o slow slow t umor growth grow th..Thus hus,, th the e benefits benefit s to the t he red group are lilikely kely due to more m ore than jus j ustt lycopene l ycopene,, and simp simply ly taking a lycopene lycopene supplement supplement will w ill not confe conferr the t he same benefit as ea eatiting ng whol w hole e fruits frui ts and vegetables. vegetables. Again, Aga in, this thi s is a simp simple le reminder remind er that t hat there t here are no short cuts to a healt healthy hy diet di et and regular exercis exercise. e.

The red/ red/purple purple group, group, incl includi uding ng pomegranates po megranates,, grapes grap es,, pl plums, ums, and assor assortt ed berri b erries es,, all cont con t ain anthocyanins anth ocyanins,, whi which ch account accounts s for the t he color of t he group. Howeve However, r,dif different ferent berries b erries in this t his group grou p have unique uniq ue propert prop erties ies.. For example, pomegranates have ellagitannins, which inhibit inflammation and may have benefits for heart health,, ca health cancer ncer prevention, preventi on, and dementia, dement ia, whi while le cranberries have have proanthocyanidi proant hocyanidins, ns,whi which ch target a bacteria bacteria common in urinary trac t ractt infection infections s. The full ful l benefit b enefits s of blac bl ackberri kberries es,, st rawberries, and raspb raspberries erries are stitillll being b eing studied, stud ied, but th they ey all have have anti antioxidant oxidant power pow er and and work t ogether wit h the other red/purple red/purp le berries berries. The orange group, group, incl includi uding ng carrots carrot s, mangoes, apricots, cantaloupes, pumpkin, and sweet sweet potat po tatoes oes,, cont contain ain alpha and beta bet a carotenes. Beta-carotene, the more well-studied of the t he two, is converted converted by the body bod y into int o vitamin vit amin A,which is i s important import ant for vis vision, ion, and and works together tog ether wit w ith h the t he red, green, and yellow/gree yellow/ green n antioxidants. ant ioxidants.Note that t hat carrots provide about half the t he alpha alpha and beta carotene carotene in the t he avera average ge American American diet, diet , wi witt h sign signifificant icant contributi contrib utions ons from tomato-bas t omato-based ed products product s. The orange/yellow group, group , inclu includi ding ng oranges o ranges,, peaches,, papaya, and nectari peaches n ectarines, nes,cont contain ain betab etacryptoxanthin, a minor ca carotenoid rotenoid that ac accounts counts for only a minute amount of t he daily daily int ak ake e of all carotenoid carot enoids s by the t he average average American. American. About 87% of crypt oxanthi oxanthin n comes from orange o range juice jui ce,, oranges orang es,, and t angeri angerines. nes.However, one must m ust be be caut ca utiou ious s about relyin relying g on proces process sed juices ju ices as some of t he nutrients nut rients are are removed removed during duri ng production product ion and high h igh amounts of sugars sugars are often oft en added. added. The yellow/green group, group , including spinach, collard, coll ard, yell yellow ow corn corn,, green peas peas,, avocado, and honeydew melon, contain lutein and zeaxanthin. Thes hese e carot carotenoid enoids s concentr concentrate ate in th the e eye and and contrib cont ribut ute e to eye health. health . Lower int i ntake akes s have been

13


associated wi ass witt h cataracts and age-related mac m acular ular degeneration, degeneratio n, th the e primary prim ary preventable preventabl e cause cause of blind bl indnes ness s in America America.. The green group, group, including includi ng broccoli broccoli,, Bruss Brussels els spr prout out s, cabbage, bok choy, cho y,and kale, k ale, cont contain ain sulforaphane, isothiocyanates, and indoles. Thes hese e comp compound ounds s stitimul mulate ate genes in t he liver to to produce prod uce enzymes enzymes t hat break b reak dow down n carcino carcinogens gens,, including includi ng thos t hose e that are produced produced when overcooking over cooking and/or and/ or charbroiling charbroili ng mea m eats. ts. The white/ green group, The group, incl includi uding ng garlic, garl ic, oni onions, ons, asparagus, as paragus, leeks,shallot s, and and chi chives ves,, cont cont ain ally allyll sulf ulfid ides es,, whi which ch activate an antioxidant anti oxidant res respon pons se in cells. Plant foods foo ds th that at don’t fit f it int into o the th e color color system system can ca n also have h ave unique uniq ue benefit b enefit s. For exa exampl mple, e,celery has salicyl alicylic ic acid, wh which ich is i s closely related to t o the t he acti ac tive ve ingredient in as aspiri pirin n and has been been used for centuries centu ries to reli relieve eve headaches headaches.. Mushrooms are a complex comple x group of plant foods with wit h possible possible effects on the t he immune immun e sys system tem at t he level of the t he intestines.

Also, keep in mind Also, mi nd t hat beca b ecause use t he color of th the e fruit or vegetable is ti tied ed to its i ts chemica chemicall properti p roperties es,, foods food s wi with th deeper,richer colors color s are t ypically more mo re nutrit nut rit iou ious s. Comp ompare are,, for example, a regular storebought tomato with wit h one bought from a loca local farm. To be able to t o ship a firm tomato by truck, t ruck,th the e tomato is picked picked while it is sti stillll green and is rapidly ripened by being blasted with ethylene gas, a substance normally produced pro duced by the th e plant as a signal t o ripen. ri pen.While ripening, ri pening, the family of lycopene compound comp ounds s accumulates accumulates,, es especially in respon res pons se to heat and lig l ight ht.. Howeve However, r,once ripening rip ening stops, the accumulation of lycopene stops. Because the th e ripening proces process s is sti tilt lted, ed,th the e color of t he t ypica ypicall store-bought tomato is often somewhat somewhat washed was hed out . By contrast, t he tomato tom ato that t hat ripens ri pens naturally on the t he vine at at th the e local local farm is typica typi cally lly deeperr in color and richer in tas deepe t aste te — and thus t hus more nutritious. Incorporating Incorporati ng a variety variety of both bo th colorful color ful and colorles colorl ess s phyt phytochemicals ochemicals in frui f ruitt s and vegetables can ca n help to maximize m aximize intake int ake of key chemical elements required to t o maintain maint ain healthy tiss t issues ues and reduce the t he ris ri sk of di dis sea eas se.


14

Color Group

Examples

Antioxidants

Red

Tomat oes, pink grapefruit s, wat ermelon

Lycopene

Red/purple

Pomegranat es, grapes, plums, berries

Ant hocyanins

Orange

Carrot arrots s, mang mangoes oes,, apri apricot cots s, cant cantalou aloupes, pes,pu pump mpki kin, n, sweet pot at oes

Alp ha and Alpha bet a carot enes

Orange/yellow

Oranges, peaches, papaya, nect arines

Bet a-crypt oxant hin

Yellow/green

Spi pinach, nach, coll collard, ard, yell yellow ow corn, green peas peas,, avocado, honeydew honeyde w mellon mell on

Lutein Lutei n and zea zeaxant xanthi hin n

Green

Broc rocco coli, li, Brus russ sels sprouts prouts,, ca cabba bbage ge,, bok choy hoy,, ka kale le

Sulfor ulfora apha phane ne,, isothiocyana isothi ocyanates, tes,ind indoles oles

White/green

Garli rlic c, on onio ions ns,, aspa para ragu gus s, le lee eks, sha hallo llots ts,, chiv hive es

Ally llyll sulf sulfide ides s


The Deli Delic cat ate e Bala Balanc ncing ing Act of Supp upplem lement ent Us Use e

F

or more mo re than th an thir th irtt y years years,, t here have been comprehensive multivitamin/multimineral tablets on the market market t hat provide what scient cientists ists have have agreed agreed are the t he adequate amounts amount s of vit amins and minerals minerals for prevent prevention ion of vit vitaminamindeficiency diseases. True vitamin-deficiency dise di seas ases es are also also rare in t he Unit ed St St ates today tod ay because becaus e of the th e wide variety of available foods food s and because because so so many stapl staples es are fortif fort ified ied wit w ith h additional additi onal vitamins vit amins to ensure that at least least th the e bare minimu min imum m requirement requ irements s are are met. Thus, Thus, resea res earchers rchers have identif ident ified ied a new pur purpose pose for mult multivit ivitamins amins,, mult multimin iminera erals ls,, and other ot her specia pecialized lized suppl suppleme ements nts — providing provi ding opt optimum imum nutrit nut rition ion for the prevention of chronic disea diseas ses through improve improved d cellular cellular nutrition. nut rition. This is an an area of cont inu inuing ing cont controvers roversy y among opinion opin ion lea leaders ders in nutri n utriti tional onal scienc science. e. In fact, US USDA dietary guid g uidelin elines es cont contain ain no recommendations for a multivitamin, instead offering an outline outli ne of which types of foods contribute which types of nutrients. Nevertheless, the th e public publi c has has embra embrace ced d the t he idea of benefit in pill pi ll form,, as evidenced by the form t he continu cont inued ed purchas pur chase e of supp upplement lements s in health healt h food fo od sto tores res,, grocery stores, stores, and drug dru g stores. stores.

Avoidi voiding ng Toxicity Toxicity and Overdos Overd osing ing Because some vitamins can be toxic if taken at extremely extreme ly high dose doses s and/or in i n the t he wrong form, learning learnin g how t hey are are formed, how t hey act, act, and and how t hey are are clea cleared red from the t he body can can help in unders und erstt anding how bes b estt t o ensure ensure the th e safe safe use use of

suppl ements supplement s.Vit Vitamin amin A, for exampl example, e, off offers ers an an excellent exc ellent les less son in i n how h ow exc exces ess s intake int ake,, part particularl icularly y in th the e wrong wron g form, fo rm, can can have toxic consequences consequences..

Learning how vitamins are ormed, how they act, and how they are cleared rom the body can help in understanding how best to ensure the sae use o supplements

Vititamin amin A is ac actt ually a hormone, hormon e,whi which ch the body bo dy forms from the beta-carotene beta-carotene found in i n bright bri ght orange orang e carrots carrot s, pu pump mpkin kin,, or squas squ ash. h. Becaus ecause e the t he body will wil l only convert convert t he orange orange pigment betabet acarot ca rotene ene to vit vi t amin A when it is needed, needed, if you eat too many orange orange plant foods foods,, your skin skin might mi ght tur turn n orange,, but you will not orange n ot be b e subject subject to t o vitamin A toxicity. By contras cont rast, t, vitamin vitami n A toxicit toxi city y is possib possible le when wh en vitamin vit amin A or vitamin vit amin A containing foods are are eaten eaten direct di rectly. ly. For example, examp le, es eskim kimos, os,wh who o eat whale w hale liver l iver that th at is rich in stored vitamin vi tamin A, could develop health iss issues ues from vit vitamin amin A poisoning, po isoning, such such as liliver ver dis di seas ease e or bone b one diseas d isease. e. Toxicit oxicity y occurs wi with th int ake akes s of greater g reater than th an 25,000 25,000 interna int ernati tional onal unit s (IU (IU)) of vit amin A, which is i s only fifive ve times ti mes t he required requir ed amount or RDA RDA of 5,000 5,000 IU. IU. At one time, mult multivit ivitamins amins could contain up to to 10,000 10, 000 IU of vit amin A. However However,, after repor reportt s from Harvard population scientists that nurses taking more than t han 8,500 8,500 IU IU of vitamin vit amin A from food f oods s and supp upplement lements s had had evidence evi dence of bone b one disea d iseas se,th the e

15


vitamin industry in dustry reduced reduced or eliminated vitamin A from mult ivit ivitamins amins and replace replaced d half or all with wit h beta-c bet a-carotene, arotene, whi which ch could be b e safely safely convert converted ed to vitamin A without lea leading ding t o vitamin A toxicity. Of note, not e,alth although ough bet beta-c a-carotene arotene is safe safe when inges ing ested ted from foods, f oods,some have quest quest ion ioned ed its it s safety when taken in mega-doses as supplements. After noting not ing a lower incidence incidence of lung lun g cance cancerr in people who had high leve levels ls of beta-carotene beta-carotene in their blood, blo od, inves investt igat igators ors at at the t he Nati National onal Cance Cancerr Inst Inst ititut ute e gave beta carot carotene ene supp supplement lements s to smokers in an effort to preve p revent nt the development of lung l ung cancer cancer.. The study was sto topp pped ed prematurely premat urely beca b ecause use t he subj ubjects ects actuall actually y showed an increased increased risk risk of lung lun g cancer. cance r.However,t he dos do se was so high hig h that t hat sub ubject jects s were,in effect, eff ect, given six times ti mes th the e amount amount of betab etacarot ca rotene ene found in a healthy diet d iet..Thus,alth although ough t he st udy results led to t o ques qu estitions ons of whether wh ether exces excessive intake int ake of beta-ca b eta-carot rotene ene is safe safe in smokers mokers,,t he vitamin vit amin remains safe when ingested i ngested from foods fo ods or when take t aken n at st st andard doses doses in mult mu ltivi ivitamin tamins s.

Making Maki ng the t he Smart Smart Choic hoice e Dietary supp supplements lements are just that t hat — a supplement to a healt healthy hy diet, di et, not a replacement replacement for one.Taking megadoses of any vit vi t amin is i s never a good id idea. ea.The body’s own protective mechanisms have ensured that th at it’s it ’snearly impossibl impossible e to get to t o toxic levels when inges ing estiting ng vitamins vit amins and minerals from eating fruitt s and vegetables. frui vegetables. Start wit h thes t hese e natural plant pl ant sources ources,, th the e ideal way to rec receive eive the right ri ght amount amounts s in th the e most absorbable form. Then, Then, if you wish, w ish, supplement with wit h a mult multivit ivitamin/mult amin/multimineral imineral and educate educa te yourself yourself on o n the t he scienti scientific fic literature li terature and so you can make an an inform i nformed ed choice.

16

Dietary supplements are just that — a supplement to a healthy diet, not a replacement replaceme nt or one

Kee eep p in mind t hat multivit mult ivitamin amin formulations that include a mix of di fferent complexes complexes of vit amins and minerals mi nerals can can offer a reas reasonable way w ay to get g et some addit addit ional nutriti nutri tional onal value value into your diet in in t he most efficient eff icient way possibl possible. e.For example, because becaus e high hig h levels of zinc can can block bl ock absorp absorptition on of copper copp er and and can lead lead to t o a copp copper er deficiency anemia,t he ratio of o f thes t hese e two min minerals erals is controlled controlle d in multivit multivita amins mins.. Be careful careful not n ot onl only y to avoid takin taking g toxic t oxic doses doses, but also als o to t o avoid supplementation of a singl single e vitamin or mineral mi neral if t here is no specifi specific c deficiency. For exampl exa mple, e,t aking a sing single le B vit vitamin amin in i n high hi gh dose d oses s instead of a Bvit vitamin amin complex compl ex can can lead lead to t o what is is called ca lled a conditioned condit ioned deficiency: d eficiency:th the e high dose of t he single B vitamin vit amin causes causes an increase increase in th the e breakdown brea kdown of th the e B vit vitamins amins that are not being supplemented. In extreme cases, the breakdown of t hes hese e B vit vitamins amins to low enough levels can can cause cause neurol neur olog ogic ic prob p roblems, lems, such as seizures. seizures. Ultimately,it is important import ant to reme remember mber that you should not rely on suppl suppleme ement nts s to mak m ake e up for a poorr diet poo d iet.. Frui ruitt s and and vegetables are rich sources sources of mixed mi xed vitamins, vit amins,min minera erals, ls,anti antioxidant oxidants s and other ot her specialized substances substances in combi combinati nations ons that th at cannot cannot be duplica dupl icated ted in i n most suppl suppleme ements. nts. A colorful diet, with repres representation entation eve every ry day from as many color col or grou g roups ps as po poss ssib ible, le, remain remains s t he best way to ens ensure ure you receive a well balanc b alanced ed set set of key nutrients nutri ents..


Rec ecommended ommended Ranges for Key Vitamins Vitami ns and Mineral Mi nerals s Recommended Intake*

Upper Level Intake†

Vitamin A

900 µg/ day

3,000 µg/ day

Vitamin B6

1.7 mg/ day

100 mg/ day

Vitamin B12

2.4 µg/ day

ND

Vitamin C

90 mg/ day

2,000 mg/ day

Vitamin D

400 IU/ day

2,000 IU/ day

Calcium

1,200 mg/ day

2,500 mg/ day

Folic acid

400 µg/ day

1,000 µg/ day

ND=not determinable. ND=not *Recommended dietary allowances or adequate intakes to be used as goals for individual intake. †The †T he maximum level of daily nut rient int intake ake th that at is likely to t o pose no risk of adverse adverse effects;repres represents ents tot al intake int ake from food,, water, and supplement food supp lement s.Values are are for fo r healthy h ealthy males aged 51-70. Source: Institute of Medicine of the National Academies. Dietary reference intakes. Available at http://www.iom.edu/Object.File/Master/21/372/0.pdf.

17


Impl mplement ementin ing g a Plan for Suc ucc ces ess s

P

18

ersonalized ersonalize d nut nutrit rition ion advice goes goes beyond the th e general general dietary guidelines guid elines for a population and hones in on t he needs needs of an individual. indi vidual. Body composit composition ion determination d etermination can ca n provide provi de information informati on on tot al energy energy needs, needs, lean body mass, mass, pro protein tein requir requirement, ement, deviati deviation on from hea h ealtlthy hy body bod y fat, and a personali personalize zed d target t arget weight. weigh t. The diet di et can be analyzed analyzed at t hree levels: levels: (1) the overall caloric content and macronutrient profilile prof e (ie,prot ein, carbohydrate, carbohydrate, and fat composit compos ition); ion); (2) the vitamin vi tamin and micronutri m icronutrient ent adequacy for prevention prevent ion of deficiency d eficiency dis di sea eas ses es;; and (3) the adequacy of vitamin and mineral intake from a combination combinati on of foods and and supplements for optimized nutrit nutrition. ion.

Buil uilding ding Strong Mus M usc cles

The science science of opt o ptimi imize zed d nut n utrit rition ion and personalized personalized nutrit nut ritional ional advice is sti stillll evolving.The new field of gene-nutrient gene-nutri ent interaction in teraction drawing d rawing from bas b asic ic scienc science e and stu studies dies of populatio popu lations ns is in its i ts infancy,and efforts effort s to improve i mprove the science science and its it s appli applica catition on to to personaliza pers onalizatition on of nut n utrit rition ion advice are are underway. underway.

Note also that maintaining maintaining mu muscle scle mass can can have a posit positive ive impact imp act on metaboli met abolis sm. A pound of musc muscle le burns bu rns 14 calor calories ies for every 3 calor calories ies burned bur ned by a pound po und of fat. f at. Thus,th the e number numb er of calor ca lories ies burned per p er day is at at leas leastt in part determined by the t he rati ratio o of muscle muscle to fat.

In the meantime, meantim e,it is crit critical ical to focus on the benefits benefit s of a healt healthy hy diet di et and regular exercis exercise. e. Whil hile e the relationships relati onships between diet and exercis exercise e and cell cellular ular process processes wit hin th the e prostate gland are not yet fully ful ly establ established, ished,it is clear clear that antioxidants anti oxidants found in many foods can can play a role in prot p rotecting ecting against aga inst ca cancer ncer cell cell growt h whil w hile e substance substances s that promote inflamma in flammati tion on and oxidation ca can n stimulate prostate cancer cancer cell cell growt g rowth. h. In addition addit ion,, th the e overall overall stat tatus us of your diet d iet and exercis exercise e can can affect th the e development of oth o ther er diseas diseases th that at are common among older old er men with wit h pros pro stat tate e canc cancer er,, includ including ing heart di dis seas ease e and diabetes. di abetes.

Avoiding Avoid ing t he muscle muscle loss common in i n aging, inactivit y, and hormonal thera t herapies pies and/ and/or or gaining muscle through increased protein intake and exercise exe rcise can can help you achieve and and maint m aintain ain a healt hea lthy hy body weight, w eight, giving you more energy and and an abil abilit ity y to enjoy enj oy active active sport sport s more fully.

Increased Increas ed protein prot ein intak int ake e at at th the e upper end of t he range recomme recommended nded by the t he Insti Institut tut e of Medicine (10% to 35% of to tott al calories) has has been been shown, shown , in severa everall clini cl inica call studi stu dies es,, to reduce hunger hung er and improve imp rove lean lean body bod y mass mass dur during ing weight w eight loss loss.. Exerc xercising ising for durati d urations ons of appr approximatel oximately y one hour each ea ch day is an an excellent excellent st rategy for weigh weightt maintenance maint enance,, whi while le progr p rogres ess sive resistance resistance trainin t raining g has been been shown to bui build ld musc muscle, le, increas increase e rest rest ing metabolilis metabo sm, improve impro ve glucos gl ucose e tolerance t olerance,, increas increase st rengt rength, h, musc muscle le functi fun ction, on, and and aerobic aerobi c fitnes fit ness s, contribute to increased bone density, and improve quality of life.

Avoiding muscle loss and/or gaining muscle Avoiding can help you achieve and maintain a healthy body weight, giving you more energy and an ability to enjoy active sports more ully


Res esttori oring ng a Healthfu Healt hfull Calor Caloric ic Balance Balance Concentrating on fruits and vegetables can pay divid di vidends ends immediatel immed iately. y.The average average vegetable veget able servin erving g is i s onl only y 50 calor calories ies and the t he average average fruit frui t servin erving g is i s onl only y 70 calor calories ies,, whi while le the t he average average servin serving g of refin refined ed carbohydrates carboh ydrates such such as potatos, pot atos,rice,pas pastt a,

bread,bagel bread, bagels s, or cakes is mo more re than t han 200 calori calo ries es.. Considering that t hat you have to run 3 miles in 30 minutes minut es to burn b urn off the t he calories calories in a medium medium potato p otato and bicycle 8 miles in 30 minutes minut es to burn b urn off th the e calori ca lories es in a donut, donu t, minimizing your calori caloric c intak int ake e from fro m thes t hese e types of refined refin ed carbo carbohydrates hydrates can can help you maximize maximi ze t he effects of regular regul ar exercis exercise. e.

Key Points to Remember 1

Avoid voiding ing muscle loss loss and/ and/or or gaining gaini ng mus mu scle throug th rough h increa in creas sed prot ein intake in take and and exercise exercise can can help in achieving and maint maintaining aining a healt healthy hy body weight

2

Increas Increa se intake int ake of fruit fr uit s and vegetables and minimi min imize ze ca calor loric ic intake int ake from refined r efined carbohydrates carbohydr ates

19


Incorporating Incorporat ing Good Nutri Nut ritt ion and Exerc xercis ise e Int nto o Your Your Everyd veryday ay Rout Routin ine e

M

edia stori stories es oft often en provide provid e confusing confusing and cont contradictory radictory advice in their t heir effort to make t he latest st st udy results sound sound excitin ex citing, g, and typica t ypically lly don’t d on’t offer of fer the context cont ext required to unders und erstand tand how th the e different piec pi eces es fit together together.. There is no nutrient nut rient or exercise exercise for which whi ch a survi survival val benefitt in benefi i n pros pro stat tate e cancer cancer has been demonstrated demonstrat ed in a controlled, control led, randomize randomized d study — the gold go ld standard of clinical trials. Nevertheless, there is a greatt dea grea deall of evidenc evidence e that bala b alance nced d nut rit rition ion and regular exercise, exercise,coupl coupled ed wit w ith h weight w eight loss loss,, ca can n lea l ead d to better b etter overall overall hea h ealt lth h while whi le reducing your risk risk of common chronic chro nic dis di sea eas ses of aging, agi ng, incl includi uding ng diabet di abetes es,, heart di dise seas ase, e, and stroke. st roke. Thus,by combinin combi ning g the t he insights insight s gained from fro m many different different stu tudies dies wit with h what is known about prostate cancer cancer and the t he underlyin und erlying g dis di sea eas se process proces ses t hat promot p romot e its it s developm development, ent, we’ve we’ve compiled compi led a logica logi call set set of o f diet di et and exercise exercise recommendations recommendati ons for prostate cancer cancer thri t hrivers vers..

Reviewing the Benefits Stage by Stage In the t he majorit major ity y of ca cas ses es,, when prostat prostate e cancer cancer is detected early,pri primary mary surgi surgica call or radiati r adiation on treatment is i s cura curati tive ve and and taking t aking additional additi onal steps steps to prevent preve nt th the e growth of the t he cance cancerr might migh t see eem m unneces unn ecessa sary. ry. Nevert Nevertheless heless,, men at t hi his s st st age would do well to t o take an opportunity opport unity to t o inventory inventory and tune-up t une-up t heir nutri nu triti tional onal habits habit s. Reme emember, mber, maintaining a healt healthy hy diet and regularly exerc exercising ising can ca n be important impor tant steps tow toward ard preventing preventing oth other er

20

di sea dis eas ses th that at commonly commonl y occur occur with wi th aging, agi ng, includi incl uding ng hea h eart rt disea diseas se and and diabetes. d iabetes. Men with advanced prostate cancer or with dis di sea eas se that has recurred can can begin begi n incorporat in corporating ing healt hea lthy hy diet and regular exerc exercise ise into their regular rout ines to help slow t he progres prog ress sion of dise d iseas ase, e, while whil e recognizing recognizing that there t here is limi limited ted direct proof of t he effecti eff ectiveness veness of such changes chang es..The key in t his phase phase of the t he diseas disease is to rationall rati onally y make dietary di etary and exe exercise rcise changes changes in a way that t hat complement any complement any ongoing t rea reatment tments s. Men who have received hormonal treatments are at particularl part icularly y increased increased risk of developing develop ing weaker bones b ones and muscles m uscles.. For t hese men, endurance training traini ng to t o keep the cardi cardiovas ovascular cular sys ystem tem strong, stron g, and resistance resistance or weight tr trainin aining g to to keep the muscles st rong, coupl coupled ed wit h healthy dietary di etary choices focusing on achieving achievin g a goal weight,, ca weight can n be int egra egrated ted into i nto the trea t reatment tment plan pl an on an ongoing ongoin g basis. basis. Finall inally, y,in men wit wi t h metas met astt atic or adva advanced nced diseas dise ase, e,suppor upporti tive ve nutriti nutri tion on is i s most most impor important. tant. Beca ecause use weig weight ht loss and loss l oss of appeti app etite te is is common in men at th this is stage stage of di dis sea eas se,healthy nutrit nut rition ion and ensuring ensuring ade adequate quate calories calories is crit critica icall to th the e succ succes ess s of therapy and to th the e suppor supportt of a healthy health y immune immun e sys system. tem.

Adopting a Healt Heal t hy Approach Approach It is i s a lot easier easier than th an you think thin k to incorporate i ncorporate good nutrit nut rition ion and exerc exercise ise int into o your everyday everyday routine. rout ine.


The key is to recognize that implementin i mplementing g dietary changes changes does not mea mean n giving gi ving up thi things ngs you love and that t hat exercising exercising does not mean spending additi additional onal time t ime that t hat you don’t hav have. e.The key is to see your life li fe in a new way — wit h a new set of lifestyle l ifestyle changes all desig designed ned to t urn you from a prostate cancer cancer survi survivor vor int o a prost prost ate cancer ca ncer thriver. th river.

1. Los Lose e the t he body fat f at Losing Los ing fat is i s a simp simple le equation: equati on: eat eat fewer calories per day d ay than you burn burn..This can can be b e done by by changing cha nging your dietary pattern patt ern away away from high fat f at foods, sweets, fast foods, and savory snacks and eati ea ting ng more colorful colorfu l fruit s and and vege vegetables tables,, low-fat protein pro teins s from poul p oultt ry, fish, and seafood, seafood, and fewer refined carbohydrates. Here are some practical examples of places you can cut calories: • Substit ubstitute ute whit wh ite e meat meat of turkey t urkey or chicken chicken for high-fat hig h-fat red meats and and farmed fish f ish • Substit ubstitute ute colorful color ful fruit s and and vege vegetables tables for rice, ri ce,pasta, po pott ato, and breads b reads • Substit ubstitute ute mixe mi xed d berries b erries and fruits frui ts for ice i ce creams, cakes, pastries, snack chips and highfat, high-sugar hig h-sugar dessert desserts s • Substit ubstitute ute non-fat non -fat and low-fat low -fat dairy and soy products product s for chees cheese e and and full-fat f ull-fat dairy products produ cts • Substit ubstitute ute water for soft drinks • Reduce the t he use of added add ed fats fat s, oi oils, ls,margari margarine, ne, butter, and salad dressing

2. Mainta Mai ntain in muscle muscle mass In order ord er to t o maint m aintain ain mus mu scle mass mass as as you age, it is important import ant to take in adequate adequate amount amounts s of protein pro tein and to t o exercise exercise muscles muscles adequately to to maintain maint ain them. t hem. As you age, t he body’s bod y’s metabol metabolism ism slow lows s dow down n due in large l arge part to t o the th e decreas decrease e in muscle mas mass that is seen seen wit h inactivi i nactivitt y.It is harder t o build bui ld musc m uscle le as you age and and it i t break b reaks s dow down n more quickly wit h inacti inactivit vity y than in younger younger indivi ind ividuals. duals.However However,, it is poss possib ible le to bui build ld and maintain maint ain muscle muscle mass mass well int i nto o your 90s by simply

eating eati ng adequate adequate protein prot ein and doing mus muscle cle buildi bui lding ng exe exercise rcises s. Also, bui Also, build lding ing musc muscle le mass is one of th the e most effective effecti ve ways ways to change your metaboli met abolis sm: bui build ld 10 ext ext ra pounds pound s of mus mu scle,and you will wi ll burn b urn an extra 140 calories per day. However, to maintain that th at muscle muscle you need need to t o do more than simpl simply y provide provi de the t he extra 140 calor calories ies per 10 pounds; you mustt also mus also suppl supply y the right amount of the t he right kinds of protein p rotein to nourish the mus mu scles cles.. Your lean body bo dy mas m ass s determines determin es how much prot ein you need each each day. day. In fact, it ’s about t wi wice ce what was recommended by government advisory groups until unti l recentl recently y, when the t he Insti Institut tut e of Medicine broadened broadened its i ts recommendation recommendation to 10% to 35% of calorie calori e intake int ake.. It t ake akes s about 1 gram of prot ein per pound po und of o f lean body bod y mass mass or 29% of resti res ting ng energy expenditure, which is i s the number numb er of calories you burn at res restt to buil build d and maintain muscle. musc le.For example, a t ypical man m an wit wi t h 150 pound p ounds s of lea l ean n body bo dy mass mass wi willll burn 2100 calories calories at at res restt per day and and will wi ll nee need d about 150 grams of prot ein per day. Here is a list of some low-fat, Here low-f at, hig high h protein pro tein choices you can make: • 7 egg whites: whi tes:25 g protein prot ein and 115 calor calories ies • Chicken breast (4 oz): 25 g protein and 140 calories • Oc Ocea ean-caught n-caught fish (4 oz):25 g prot p rotein ein and 140 calories • Canned tuna t una in water (3.5 oz): oz): 25 g prot p rotein ein and 110 calor calories ies • Two veggie vegg ie burgers: bu rgers:28 g prot p rotein ein and 180-22 180-220 0 calories • Soy protein prot ein shake shake with fruit : 25 g protein prot ein and 200 calor calories ies

3. Exercise every day Regular exercise exercise will wil l help h elp you lose fat, bui build ld muscle, musc le, and improve imp rove your outloo out look k overall overall..

21


A combinati combination on of cardiofi cardiofitn tnes ess s and weight lift li fting ing willl not only wil on ly help to round out th the e benefit benefits s, but the variety will wi ll help make it more intere int eres sti ting. ng.This is key key to sticking sti cking t o a regular routine: rout ine: choose an exerc ex ercise ise you like and/or and/ or one that t hat you can do with wi th friends fri ends to make m ake it more m ore enjoyable. enjoyabl e.For example, walk 30 minutes minu tes every every day at at a comfo comfort rtable able pace and lift weights three times each week, alternating differe diff erent nt body parts p arts and and allowing allow ing a day day of rest rest between weightlif weight lifti ting ng days. days. If you work on your chestt muscles and triceps ches t riceps one day,swi witch tch to your back muscles muscles and biceps bi ceps on the t he next, followed follo wed by leg muscles and shoul shoulders ders on the t he third th ird day day.. Most impor Most important, tant, obtain profess professional instruction instructi on on how to perf perform orm exercises exercises for each of thes t hese e muscle muscle groups and and consult consult wit h your doctor before st arti arting ng the t he exercis exercise e program to t o be sure it is safe safe for you. A certifi certi fied ed fit fi t nes ness s inst inst ruct ructor, or, exe exercise rcise

physiologist, or physical therapist can provide exercise exe rcise instr instructi uction on and ensure that you are maximizing max imizing the t he benefit benefit from your workouts. 4. Eat Eat colorful fruit f ruits s and vegetables The USDA USDA recommends recommend s eati eating ng 9 serv servin ings gs of fruitits fru s and vegetables vegetabl es every day, day, equivalent to about one cup or 100 grams per servin serving. g. Why is this th is import ant? A typica typi call serving of vegetables has has about 50 calories calories and a typical serving serving of fruit has about 70 calor calories ies,, making t hem some of the t he least least calor ca lorie-dense ie-dense food ounce per p er ounce oun ce.. So by b y simply simpl y increasing the amount of fruits and vegetables you eatt ea ea each ch day, day, you wil w illl be b e decreas decreasing th the e number numb er of calories per bit e of food eve even n while whi le packing packing in hig high h levels of nut rient s. Als Also, o, fru fruitits s and vegetables are are rich in i n fiber, fi ber, so five fi ve servin servings gs of fruit fru it and vegetables vegetabl es ca can n easil easily y get you t o the t he recommended 25 grams of fiber fi ber per day d ay..


22

1

Lose body fat: fat : ea eatt fewer calories per day than th an you burn b urn

2

Maintain muscle mass: increase protein intake and exercise

3

Exerc xercise ise every day: combi combine ne cardi cardiofi ofitt nes ness s and weight weig ht lilift fting ing

4

Eat colorf colo rful ul fru fruitits s and and vegetables:recommended nine n ine servings serving s a day


A Commi ommitt ment t o Change Change

M

aking a commi committ ment t o change is a first step in succe ucces ssful t hri hrivers vership hip.. Changi hanging ng dietary diet ary patterns patt erns and exercise exercise habit s is nott eas no easy. y.You need to t o have h ave the t im ime, e, t he resources, resources, and,mos mostt impor important, tant, the commitment at a deep deep level to make these changes. Taking lifestyle change cha nge gradually gradually and and only committ ing to t o the changes you can sustain sustain over the th e long-term long -term is is critical crit ical to t o succes success in th this is proce pro ces ss.

The Decision Decision to Change When it When i t comes to healthy behaviors,everyone knows know s what t hey should do. Eat well, w ell, exercis exercise e regularly, regul arly,get enough sleep, sto top p smoki moking, ng, and and minimi min imize ze str stres ess s. But if eve everyone ryone know knows s this thi s, why doesn’t does n’t everyone do it ? The simple simpl e reason reason is i s that change is one of the most most difficult d ifficult thin things gs for an individual to do. And las lastt in ing g change chang e is even harder. Unles Unless s you are rea ready dy and willin wil ling g to modi modify fy behaviors — eatt hea ea healt lthier hier food fo od and exercis exercise e regularly — no amount of counseling counseling or educati education on will wil l be effective. effect ive. That hat’s ’s why evaluatin evaluat ing g your you r readines readin ess s to cha change nge is a key key step step in th the e lifestyle decisiondecisionmaking makin g proces p rocess s. Rea eadi dines ness s to change can be determined det ermined using the t he different di fferent st ages of change theory, t heory, whi which ch propose prop oses s that th at lifes li festyl tyle e change change is a gradual gradual evolution evoluti on in t houg hought ht proces process s and action. action . An indivi ind ividual’s dual’s st age of readines readiness s can can change overnight overnigh t — a heart attac att ack k or a diagnosis di agnosis of prostate p rostate cancer cancer can be an extremely mot m otivati ivating ng event. event .Yet change bas b ased ed on

fear and crisis do not lead to t o las l astt ing change.The key is to ut utililize ize the “t “tea eachable chable moment” moment ” aft after er such such an event event to t urn motivation mot ivation into in to action, and action action into int o lasti lasting ng change. The trans t ranstt heoreti heoretica call model m odel of change ass assumes t hat the t he average average person goes th throug rough h five fi ve step steps s in moving toward t oward lasti lasting ng adoption adopt ion of new behaviors behaviors.. The first fi rst stage, know known n as pre-contemplation pre-contemplation,, is that th at necess necessary st st age when you are not even thinking thi nking about changing as ye yet, t, at at lea leas st not wit within hin the next six months. Some people can get stuck in t his stage, stage, and are res resistant to t o obtaini ob taining ng informati inf ormation, on, discus discuss sing, or even thinking thin king about abou t the t he issue iss ue at hand. Obvi Obviously, ously,one has h as t o move mo ve beyond this th is stage stage to t o effect any sign signifi ifica cant nt cha changes nges.. When you can clearly When clearly state an intent int ent to t o change wit hin the next six months mont hs,, you have have moved to the second stage, known as contemplation contemplation.. In this th is stage, you aware of the t he benefit s of changing, changi ng, but also aware of the t he costs or barriers barr iers to change. Those who are st uck in this t his st st age are are often oft en procras procra sti tinators nators who are mulling over the idea id ea of change cha nge but not are not rea ready dy to t o make the change. change. Preparation, t he third Preparation, thi rd stage,is when you intend int end to t ake concrete or well-defined well-d efined steps to change witt hin t he next mont wi mon t h. Since this thi s stage is a prelu prelude de to th the e next next stage of action, it is more of a transit transition ion and most people do not stay in this th is stage for long. l ong. Action, th Action, the e fourth four th st age,is when you have made made real and eas easilily y perceived diet and lifes li festt yle changes

23


over the th e past past six month mon ths s. At this t his point poi nt,, actual changes in bi biomarkers omarkers such such as body weight w eight , waist circumference,or cholesterol ca can n be mea m eas sured. In the th e final stage of maintenance maintenance,, the changes have been made and a goal has been reached; the work at this thi s poin pointt is i s to keep the diet and lilifes festt yle benefit b enefits s you have h ave achieved. achieved.The stage is characterized characterized by active acti ve st st eps taken taken to t o prevent p revent relaps rela pse e and to firm up any gains made made during duri ng t he action acti on ph phas ase. e.Pas assive sive accept acceptance ance of any changes chang es made is not sufficient suffi cient for succes success sful maint maintenance enance and long-term stability. Constant daily efforts are needed nee ded to keep from sliding bac b ack k into int o old habits. h abits. As you progres pro gress s t hroug hrough h each each stage,you will wi ll fifind nd that diff differe erent nt skills and strategies strategies are are required to to achieve your you r goals. g oals.For exampl example, e,exercise on a regular basis basis is the most import im port ant strategy to maintain weight but it is i s not sufficiently effecti effective ve without wit hout dietary changes in the action phas phase, e,when weightt loss weigh l oss is the goal. The process process of cycling cycli ng throu t hrough gh relaps rel apse e and and recove r ecovery ry and then maintaining maint aining beha b ehaviors viors for six six months mont hs to a yearr gives yea gi ves a reali realis st ic view of o f the t he process process of lifestyl l ifestyle e change.This is not somet omethi hing ng you do once o nce and

forg et. The changes are not earned unti forget. un till they t hey are maintained for at least a year. Relapse is expected and planning pl anning for rela relapse pse preventi prevention on is i s crit critica ical.l. As As you adopt hea healtlthier hier lifes l ifestyl tyle e choices choices, you will wi ll move t hrou hrough gh the t he st st ages ages,, making progr p rogres ess s and losing ground, gro und, learni learning ng from f rom mis mi st akesmade over time, ti me,and using us ing tho thos se gains to move forward. for ward. Res esea earch rch has shown shown t hat indi i ndividu viduals als who regain weight do not ruin their metabolism metabolism but los lose e weight at the t he same same rate on repeated repeated attempts att empts when the same diet is used. Cancer patients are often oft en far more moti motiva vated ted than t han those who are simpl imply y overweight or have high choles cholesterol, terol, and and it is import impor t ant to t o realize t hat a cancer cancer diagnosis ca can n be a very very powerful pow erful moti motiva vator tor and may push push you from “pre-contempl “pre-contemplation” ation” to “acti “action” on” overnight overnight . However, some cancer survivors have the urge to push the th e cance cancerr out of their t heir minds mi nds and and behav b ehave e as as t houg hough h it had never occurred. occurred. A reali realis stitic c balance between bet ween the th e shor short-t t-t erm stress stress of a cancer cancer diagnosis di agnosis t hat mot ivates behavior change over a few months mont hs,, and the long-t l ong-term erm realiza realizati tion on that t hat better bett er diet and lifestyle can can improve your your quality qualit y of life, l ife, ca can n lead to both b oth rea reall and import imp ortant ant changes changes and the t he maintenance maint enance of those t hose changes over the th e long-term.


24

1

Making a commitment commit ment to change is a first step step in i n succes success sful th thrivership rivership

2

Effect ffective ive change can only be b e accompl accomplished ished in st ages

3

Lea earn rn from f rom mis mi stakes made over time ti me and use th the e gains to move forward for ward


The Th e Fou ourr S’s of Success

T

here are four S’s of general behaviors t hat you can use use to make lifestyle change more successful — stress reduction, st imu imulus lus cont control, rol, self-mo elf-monit nit ori oring, ng, and social social support.

1. Stres Stress Redu educti ction on Express your feelings. If feelings of stress, sadness, or anxiety are causing causing physica physicall probl p roblems ems,, keeping t hes hese e feelings feeling s insid inside e can can make m ake you you feel worse wo rse.. It It’s ’s okay to let your loved l oved ones know when w hen somethin something g is botherin bot hering g you. However However,, remember that t hat your family and friends may may not be able to help you deal with your feelings appropriately. At these t imes,as ask k someone someone outside ou tside the t he situation situat ion — such as your family f amily doct doctor, or, a counselor, counselor, or a religio reli gious us advisor advis or — for advic advice e and and support to help you improve your emoti emotional onal healt health. h. Live a balanced life. li fe. Try not n ot t o obs ob ses ess s abou aboutt t he problems prob lems at at work, w ork, school chool,, or home hom e that lea l ead d t o negative negat ive feelings. feeli ngs.This doesn’t mean you have to pretend pret end to t o be happy when w hen you feel stress stressed, anxious,or upset. It It’s ’s imp import ort ant to t o deal with wit h thes th ese e negati negative ve feeling feelings s, but tr try y to focus on the t he positive posit ive thing th ings s in your you r life, li fe, t oo.You may want to to use us e a journal to kee keep p t rac rack k of t hings that mak make e you feel f eel happy hap py or o r peac p eaceful eful.. Res esearch earch has show shown n that th at having a posit positive ive outlook outl ook can can improve imp rove your your qualitt y of life quali li fe and give your health healt h a boost. You may also also need to find fi nd ways w ays to let go g o of some t hin hings gs in your life li fe that th at make you you feel stress stressed and overwhelmed.Ma Make ke time tim e for t hings you enjoy.

Calm your min mind d and bod body. y.Relaxa elaxatt ion meth methods, ods, such as medit atio ation n throug t hrough h exercising, exercising, str tretchin etching g or brea br eath thing ing deeply, are use useful ful ways to bri bring ng your emotions emotion s into balanc balance. e. Take care care of your yourse self. lf. To have h ave good emot emotio ional nal healt hea lth, h, it it’’s impor important tant to take care care of your body b ody by having hav ing a regular regular rout ine for ea eati ting ng hea healt lthy hy meals meals,, gettiting get ng enough enoug h sleep, sleep, and exercis exercising ing t o relieve pent-up tens tension. ion. Avoid Avoid ove overea reati ting ng and underexercising, exe rcising, and don’t do n’t abus abuse e drugs drug s or alcohol.

2. St Stimul imulus us Cont ontrol rol Plan ahead. ahead. If you knew t hat you woul w ould d be waking wakin g up to t o a cold cold floor fl oor when you got out of bed, it would woul d make sens sense e to prepare p repare by leaving a pair of slilipp ppers ers at the t he sid side e of your bed.S bed. Simi imilar larly, ly,if you are going to t o eat eat at a res restaurant taurant,, plan ahead and think about how to t o ens ensure ure you you eat healthy health y foods . If you yo u are going goi ng t o be stressed, stressed, you may need to t o have a heightene height ened d level level of determination determinatio n to sti stick ck wit h your plan. p lan. If you ca can n plan p lan your week and make an an appointment appoint ment wit h yourself yourself for exercis exercise e and relaxa rela xati tion on at appropriate approp riate times ti mes,, you will wil l be b e more likely to follow through.

3. Self-Monit Self-Monitoring oring A conscience conscience is said to t o be the t he knowledg know ledge e that someone is watchi watching ng you. While implement imp lementing ing change behaviors, be your own conscience and monito moni torr your action act ions s. Set up a food and exercise exercise log to t rac rack k your prog progres ress s. Us Use e an establ established ished

25


computer-based program or just a paper journal. computer-based jou rnal. Try to t o record the t he behaviors as as th they ey happen in terms of foods, exercise, and lifestyle behaviors and set a time t ime to t o review the t he record record so that you can ca n chart your you r performance perf ormance weekly. weekly.

th at you maint that maintain ain a hea healt lthy hy relationship relationship with wi th individuals indi viduals who unders u nderstand tand what w hat you are going t hrou hrough. gh. In particular, part icular, prostat prostate e cancer cancer supp support ort groups can can be helpful in i n finding find ing fellows fellow ship among others ot hers who are deali dealing ng wit w ith h the t he same same iss issues you are facing facing now. n ow.

4. Social Social Suppor upportt

Lifest yle changes carried Lifest carried out ou t in a balanced balanced fashion fas hion can lead lead to t o optimum opt imum hea h ealt lth h in th the e physica physical, l, mental, ment al, and spi spirit rit ual realms realms — es establ tablishing ishing for f or you a healt healthy hy approach approach t oward thrivers t hrivership. hip.

Social support suppor t is available available from fr om family, f amily, fri friends ends,, relatives relati ves,, relig religiou ious s groups group s, hob hobby by grou groups, ps,or prostate cancer cancer survi survivor vor groups. gro ups.It is i s imp import ort ant


26

1

Reduce stress: stress: lilive ve a balanced life li fe and t ake care care of yourself yo urself

2

Control your environment: plan ahead to eat healthfully and minimize stress

3

Monitor Monit or your ac acti tion: on: track your behaviors behaviors to help chart your progress progress

4

Establ tablish ish a supp upport ort sys ystem: tem: maint maintain ain healthy relation relat ions ship hips s wi with th peopl people e who unders und erstand tand what w hat you are are going through t hrough


Sugge ugges st ed Read Readin ing g Cross AJ, AJ, Pet eters ers U, Kir irsh sh VA, et al. A prospect ive stud study y of meat and meat m eat mut agens and pros pro st ate cancer cancer risk.Cancer risk.Cancer Res . 2005;65:11779-11784. Freedland SJ, Mavrooulos J, Wang A, et al. Carbohydrate restriction, prostate cancer ca ncer growth, growt h, and the th e insulin insulin-like -like growt h factor ax axis is..Prostate . 2008;68:11-19. Galvão DA, Newton RU, Taaffe DR, Spry N. Can exercise ameliorate the increased increas ed risk r isk of ca cardi rdiovas ovascular cular disea d iseas se and di diabetes abetes ass associated wi witt h ADT ADT? ? Nat Clin Pract Urol . 2008;5:306-307. Jon ones es LW, Demark-Wahnefr Demark-Wahnefried ied W.Diet Diet,, exercise,and compl com plement ement ary t herap herapies ies after primary pri mary treatment for cancer cancer..Lance Lancett Oncol . 2006;7:1017-1026. Nakai Y, Nelson Nelson WG, WG, De Marzo AM. The The diet d iet ary charred ch arred meat carcino carcinogen gen 2-amino-1-methyl 2-a mino-1-methyl-6-phenylimidazo[4, -6-phenylimidazo[4,5-b]pyrid 5-b]pyridine ine acts as as both a tumor tumo r initiator init iator and promoter in the rat ventral prostate. prostate.Cancer Cancer Res . 2007;67:13781384 Orni sh D,Magb Ornish Magbanua anua MJ,Weid eidner ner G, et al. Chang hanges es in prost p rostate ate gene g ene expres expr ession sion in men undergoing an intensive nutrition and lifestyle intervention.P intervention.Proc Natl Nat l Acad Sci U S A. A. 2008;105:8369-8374. Segal RJ, Reid RD, Courneya KS, et al. Resistance exercise in men receiving androgen deprivation th thera erapy py for prostate cancer cancer..J Clilin n Oncol . 2003;21: 1653-1659. Shai I, Schw chwarzfu arzfuchs chs D, D, Henki Henkin n Y, et al. Weig eight ht lo loss ss wi witt h a lowlo w-carboh carbohydr ydrate, ate, Mediterranean, Mediterranea n, or low-fat low -fat diet. di et.N N Engl J Med . 2008;359:229-241.

27


My Nutrit Nut rition ion and Fit itnes ness s Plan

28

pcf.org 1250 Fou ourrt h St reet Sant anta a Mo Moni nica, ca, CA 90401 Tel 800.757. 800.757.C CURE (2873) Fax 310.570.470 310.570.4701 1 © 2009 Prostat Prostat e Cancer Cancer Found Foundati ation on

Nutrition, Exercise and Prostate Cancer

Recommend Documents