prostate cancer integrative approaches

Prostate CancerHealthy Nutrition

for prevention of recurrence and progression

Presented by: Adam Rinde, ND

Sound Integrative Health, PLLC

Background

• Adam Rinde, ND• Graduate of Bastyr University, Kenmore, WA• Completed Residency in Family Medicine at the

Bastyr Center for Natural Health, Seattle, WA• Adjunct Faculty Bastyr University• Sound Integrative Health, PLLC

My background with oncology

• Current, Men’s Health Specialty, Sound Integrative Health, PLLC Bellevue, WA

• Resident, Oncology Specialty Shift, Bastyr Center for Natural Health, Seattle, WA (Winter, Spring, 2007)

• Resident, Urology Rotation, Urology NW, Mountlake Terrace, WA (Winter, 2007)

• Intern, Naturopathic Care, at Highline Cancer Center, Burien, WA. (Spring, 2006)

Naturopathic Medicine practitioners who work with PRCA

• Adam Rinde, ND , Kirkland, WA– Sound Integrative Health, PLLC (425)-889-5894

• Matt Brignall, ND Seattle, WA – Bastyr Center for Natural Health (425)-834-4100.

• Davis Lamson, ND, Kent, WA – Tahoma Clinic (425)-264-0059

Prostate Cancer Basic Premises

• Most of the time PRCA is a hormone-responsive cancer

• Typical hormones involved with prostate cancer promotion are Dihydrotestosterone (DHT) (a derivative of Testosterone) and Estrogen

• DHT is a promoter of prostate differentiation – Research is evolving about the role of insulin

resistance and PRCA

General Approaches to increase survival

• Reduction of tumor cell growth

• Removal of tumor cell

• Reduction of PSA doubling time

• Reducing risk factors for progression

• Reducing endogenous and exogenous levels of testosterone and estrogens

Conventional Approaches to PRCA

• Surveillance (a.k.a. Watch and Wait)• Surgery• Radiation• Chemotherapy• Hormone Therapy (i.e.Lupron)• Adjunctive Medication (i.e. Fosomax)• lifestyle and Diet (Depends)• Possible co-management with other

providers

Naturopathic approach to PRCA

• Coordination with Oncology Care• Patient Advocate• Complementary and Palliative Care• Lifestyle (ie. meditation, smoking cessation)• Exercise Prescription• Nutrition/Dietary• Supplementation (Herbal/Nutritional)• Some: provide acupuncture

Lifestyle Interventions with PRCA

• Meditation and Prayer PMID: 17177907

• Exercise to preserve muscle mass:– Resistance Training in Androgen Deprivation

Therapy (PMID: 12721238)

• Stress reduction: Mindfulness• Intensive lifestyle changes may affect the

progression of prostate cancer (ornish) PMID: 16094059

Dietary Strategy

• To modulate volume of exogenously stimulated testosterone and estrogen (androgen-reducing diet).

• To reduce dietary triggers for prostate cell growth (anti-inflammatory diet)

• Incorporate Functional (prostate protective) foods in the diet.

Diet and Androgens

• Guess what types of foods trigger testosterone and estrogen formation

• Most likely higher fat (higher cholesterol) foods.• Dietary Fat may raise serum androgen production

– Hill, et. al.1979. Cancer Res 69(12): 5105– Hamalalinen, et. al. 1984. J Steroid Biochem 20(1) 459-

464

Dietary Strategies that slow disease progression

• Vegetable Based Diet and its Derivatives – Low Fat (low dairy diet)– Low Arachadonic Acid Diet (decreased red

meat, decreased trans fats, increased omega-3’s)

– Phytoestrogen Diet (Cruciferous + Soy)– Emerging areas of study– Insulin resistance and its connection to PRCA

• elevated Insulin Growth Factor in PRCA patients

Plant Based Diet + Stress Reduction

• Ornish, et. al. 2005. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005 Sep;174(3):1065-9; discussion 1069-70 .

• N= 93 volunteers• Serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were

randomly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group

• None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and/or progression of disease on magnetic resonance imaging. PSA decreased 4% in the experimental group but increased 6% in the control group (p = 0.016).

• The growth of LNCaP prostate cancer cells (American Type Culture Collection, Manassas, Virginia) was inhibited almost 8 times more by serum from the experimental than from the control group (70% vs 9%, p <0.001).

• Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle

Ornish diet/lifestyle protocol

• Vegan diet supplemented with soy (1 daily serving of tofu plus 58 gm of a fortified soy protein powdered beverage), fish oil (3 gm daily), vitamin E

• (400 IU daily), selenium (200 mcg daily) and vitamin C (2 gm daily)• Moderate aerobic exercise (walking 30 minutes 6 days weekly), • stress management techniques (gentle yoga based stretching,

breathing, meditation, imagery and progressive relaxation for a total of 60 minutes daily) and

• participation in 1-hour support group once weekly to enhance adherence to the intervention.10

• The diet was predominantly fruits, vegetables, whole grains (complex carbohydrates), legumes and soy products, low in simple carbohydrates and with approximately 10% of calories from fat

Plant Based Diet• Adoption of a Plant-Based Diet by Patients with Recurrent Prostate

Cancer Nguyen et al. Integr Cancer Ther.2006; 5: 214-223

– 6 month dietary change and stress reduction intervention for asymptomatic, hormonally untreated patients experiencing a consistently rising PSA level

– Patients and spouse encouraged to adopt a plant based diet

– Increase from approx 1 serving of whole grains per day to 5 and increase from approx 1 svg/day of vegetables per/day after 6 months

– Changes in the rate of rise in PSA, an indicator of disease progression, were in the opposite direction as changes in the intake of plant-based food groups, raising the provocative possibility that PSA may have inversely tracked intake of these foods and suggesting that adoption of a plant-based diet may have therapeutic potential in the management of this condition

Plant Based Diet, Continued

• Gordon Saxe et al. Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction Integrative cancer therapies 5 (3), 206-13 (Sep 2006)

• 14 PRCA patients• 6 Month Plant Based Diet plus Stress Reduction and its

effect on PSA doubling time• There was a significant decrease in the rate of PSA rise

from prestudy to 0 to 6 months (P < .01). Four of 10 evaluated patients experienced an absolute reduction in their PSA levels over the entire 6-month study. Nine of 10 had a reduction in their rates of PSA rise and an improvement of their PSA doubling times. Median PSA doubling time increased from 11.9 months (prestudy) to 112.3 months (intervention).

Prostate Health Superfoods

• Glucosolinates from Broccolli and cauliflower (PMID: 17652276 )

• Soy Isoflavones (PMID: 15042614), especially in early stage.

• Lycopene from Tomatoes (PMID: 11489752 )• Flax meal when combined with a low fat diet.

11445478 • Others Worth Mentioning: Modified citrus pectin,

Zinc, Saw Palmetto , Selenium, E (usually associated with prevention)

Prostate Super Foods under close study (animal or in vitro studies)

• Pomegranate Juice (PMID: 16192356 )

• Omega-3 fatty acid from Fish Increase Omega-3’s in diet PMID: 16899616

• Tea polyphenols and theaflavins from Black and Green Tea. (PMID: 16772446 )

• 1-2 Glasses of Wine each evening PMID: 14981946 .(Resveratol) PMID: 12504842

Soy

• .J Nutr. 2007 Aug;137(8):1974-79. • This case-control study of 200 Japanese men with

different stages of prostate cancer-one man in Stage 1, 131 men in Stage 2, 44 men in Stage 3, and 24 men in Stage 4-compared the men's soy isoflavone intake with that of 200 healthy male controls.

• Diets that delivered the most isoflavones (89.9 mg/day) from soyfoods-tofu, natto, miso soup, bean curd, soy flour, soy milk, soy sauce, edamame, and soy bean sprouts-were associated with a 58% lower risk of prostate cancer compared to diets providing the least isoflavones (less than 30.5 mg/day).

Best Sources of Soy Isoflavones in Order

• Natto (fermented soybeans)

• Tempeh

• Miso

• Tofu

• Soybean, raw

• Soy milk

Tasty Soy Snack

• Easy Edamame Salad– One-16 oz. bag of shelled edamame– 3 carrots peeled and grated– 1 Zucchini, peeled, and grated– 8 radishes quartered– Toss together and serve with low-fat sesame

dressing

Ways to get Lycopene in the Diet

• Homemade Tomato Sauce

• Chili

• Veggie Pizza Topped with Tomato Sauce

Stress Reduction

• Mindfulness-Based Stress Reduction (MBSR) – Founded by John Kabatt-Zinn– Relaxation and happiness are not the aim, but

rather a "freedom from the tendency to get drawn into automatic reactions to thoughts, feelings, and events"

– Introduction:• Full Catastrophe Living, By John Kabbat Zinn

• Biofeedback

Problems

• Change is Stressful• Reduction of Fat does not mean an

increase in simple Carbs• Reduce Fat but replace with Complex

Carbohydrates– Complex Carbs include: Whole Grains,

Vegetables, Legumes (kidney beans, lentils), Root Vegetables, Tubers (potatoes)

• Not eating enough calories

Change Management

• Decide and Commit

• Tell the world

• Make achievable goals

• Don’t sacrifice too much!

• Join a group

• Hire specialists

• A combination of the above

Nutrition Resources

• websites– www.whfoods.org– www.nutritiondata.com

• Books– The Worlds Healthiest Foods by Mateljan– The Whole Soy Cookbook by Patricia Greenberg – Everyday Cooking with Dean Ornish, MD– Feeding the Whole Family, Cynthia Lair

• Organic Vegetable Delivery: – Pioneer Organics:206.632.3424

• Healthy Food Fast– Organic To Go: 425-837-9992

Other Topics

• Nutrients/Herbs for Adjunctive Care

• Natural approaches to prostate cancer treatment side-effects.

Questions and Contact Info

• Questions from the audience

Contact:

• email: drrinde@soundintegrative.com

• Clinic phone: 425-889-5894