The Prostate Cancer Protection Plan: The Foods, Supplements, and Drugs That Could Save Your Life

Part One

A Nutritional Disease

Men in Japan and China have up to 90 percent less prostate cancer than American men. That's an astounding statistic. Ninety percent! Most men I talk to are at first surprised at the huge disparity. Their second reaction is to sort of shrug and say, "It's in the genes, nothing much you can do about that." But that's where they're wrong. The best evidence points squarely to a difference in nutrition as a much bigger major factor. The evidence is fascinating. Laurence Kolonel, M.D., Ph.D., professor at the University of Hawaii, hit on a brilliant research strategy. Why not study men who migrated from the Far East to the United States and see if their risk of cancer increased? After all, emigrating wouldn't change their genetic makeup. What happened? Bingo! Dr. Kolonel hit the nail on the head. "I would say that the case of migrants is the strongest indication that the environment is influencing prostate cancer risk," he says. He showed that when the Japanese move away from Japan, their rates of prostate cancer do increase. Now most "migrant studies," as they are called, show the greatest increased risk in the children and grandchildren of the migrants. And that's what you'd expect. The first generation would largely maintain their traditional ways, and the younger generations would adapt more readily to the new environment: burgers, fries, pizza, sodas, drive-ins, video games . . . you name it! That's precisely what happens with breast cancer rates. Asian women living in Asia have 90 percent less breast cancer than American women. But when Asian women move to America, it's their daughters and granddaughters whose rates of breast cancer close in on those of American women. What's so striking about Dr. Kolonel's studies is this. For men who moved from Japan to Hawaii, Dr. Kolonel found a large increase in prostate cancer rates in the migrants themselves! Say a man emigrates from Japan to Hawaii at age twenty: by the age of fifty, his risk of a clinically significant prostate cancer is much higher than it would have been had he stayed in Japan! Dr. Kolonel found that the risk doubled in these migrants. Here's what he concluded: "Migrants have the same genetic makeup as their families back home, and so it must be something external that is causing the risk change." So, if environment is changing risk, the question becomes what in the environment is affecting risk? Which lifestyle component is raising risk? Suggests Dr. Kolonel: "Diet is a good candidate. When Japanese migrants come to Hawaii, the biggest area of change for them is diet since Hawaii is not a heavily industrialized or polluted state. What changes here is exposure to Western diet."

What is this Western diet? Dr. Kolonel explains that it's a diet heavily based on animal products — particularly meat and dairy products — and therefore higher in fat, especially animal fat, than the diet of more traditional populations in Asia and Africa. As populations become more Westernized, they shift away from whole grains and cereals toward meat and dairy, and this changes the nature of their fat intake to more saturated fats. In comparison to the diets of Africa and Asia, the Western diet contains a lower intake of fruits and vegetables.

Now let's take a closer look at prostate cancer numbers. We read in the introduction that many of us have a latent cancer, even at a fairly young age. You'll recall that even for men in their 30s, 25 percent have latent cancer. Here's the big surprise. Latent cancer is not unique to the United States. Researchers find that, at any given age, men all over the world share the same risk for latent cancers. They have the same percentage of latent cancers at the same ages we do. You might be tempted to say: Huh? I thought you said men in other countries, especially the Far East, have less cancer. Well I did. They have less clinical cancer, but not less latent cancer.

Remember, latent cancer is in a quiescent stage that poses no harm. Let's take China as an example. Chinese men have the same percentage of latent cancer as American men. That's right. They have just as much latent cancer as you or I. But hold on! How many of those latent cancers become a clinically important cancer? In China, the answer is extremely few. Clinical rates in China are the lowest in the world at 2.8 per 100,000 people a year. American whites have 100 per 100,000. That's thirty-six times higher than rates in China. So if American and Chinese men start at square one with the same amount of latent cancer, what accounts for the difference in rates of clinical cancer? Why do these latent cancers spring to life in so many American men and not in Chinese men? What is the fuel that transforms a benign, latent tumor into a life-threatening one? In a word, diet. Charles Myers, M.D., of the University of Virginia, also concludes: "Diet definitely affects the progression of prostate cancer from a microscopic level to a metastatic level."

Here's the real irony. Sure, men eating traditional foods in the Far East have low rates of cancer, but what about those men tempted by a change to a Western diet? When they do switch, watch out. Take the burgeoning metropolis of Shanghai, where it's becoming as easy to get a burger, fries, and a shake as it is to get spring rolls and tofu. The rate of clinical prostate cancer is now beginning to rise among those men who have crossed the line from traditional to Western foods. Ann Hsing, Ph.D., epidemiologist at the National Cancer Institute, conducted a study in Shanghai to examine why prostate cancer rates were increasing. She analyzed the diets of men at high risk for prostate cancer. Sure enough. What were they eating? For starters, more animal fats, especially red meat, and preserved foods such as preserved meats and vegetables. With increased animal product intake, more calories were coming from animal fat. Add to that lots more calories than the Chinese traditionally eat. The result: these men weren't just getting prostate cancer, they were also fat. In fact, they developed the most dangerous kind of obesity, called central obesity, which occurs when fat piles up around your midsection. Central obesity is commonly seen in people who eat large amounts of starches, refined flours, and sugars. The good news is that the men who ate healthier traditional foods and vegetables such as garlic, scallions, and onions had a lower risk. The traditional Chinese diet has more fiber, plenty of fruits, and lots of soybeans, green leafy vegetables, and orange vegetables such as pumpkin. In the traditional Chinese diet, 60 percent of energy intake came from complex carbohydrates. "I think our findings corroborate findings in the U.S.," says Dr. Hsing.

The Japanese flat-out blame the Western diet for their prostate cancer travails: There were 5,399 deaths from prostate cancer in 1995 in Japan. By 2015 that number will increase to 13,494. Dr. Y. Kakehi of the Department of Urology,

Faculty of Medicine, Kyoto University, concludes: "Change in dietary habit (more Western-style diet) is considered to be a major cause of the increase."

English researchers too have concluded that nutrition is the major risk factor associated with prostate cancer, singling out low intake of fresh fruit, low intake of vegetables, and low intake of whole-grain cereal, as well as excess body fat.

The Association for the Cure of Cancer of the Prostate (CaP CURE) writes in its white paper on nutrition: "Of all the risk factors for prostate cancer, only nutrition seems to explain the differences in global distribution of this disease." Studies estimate that 75 percent of all cases of prostate cancer could be prevented by changes in diet and lifestyle. Scientists from Cap CURE conclude: "We believe, therefore, that nutrition and lifestyle practices in lower-risk countries arrest the growth of prostate cancer so that it is never clinically discovered."

Okay, you may say, what does all of this high-powered epidemiologic research have to do with me? After reading the thorough research on nutrition and prostate cancer, I have to tell you that I'm convinced. As a physician and as a male concerned about prostate cancer, I believe this research is the strongest indication that diet plays a big role in prostate cancer and that there is something you can do about your own diet to change your risk. This isn't just a pipe dream; this could be close to the whole game. But I asked myself: Which foods? What diet? Well, you're in for a real treat. There is a true treasure trove of terrific foods that can help protect you against prostate cancer. If you're like me, you don't just want to read a lot of wishful thinking by well-meaning advocates of alternative medicine. You want hard facts. The hard facts, in this case, show that foods have highly specific effects on the prostate gland. These are varied enough to give you a range of strategies to protect yourself. You'll also find, as I have, that this is high-level science. Foods have incredibly sophisticated powers, like well-designed pharmaceuticals. Re-searchers are excited enough about the power of foods that they're already intensely investigating many of them. In fact, tens of millions of dollars are being spent on nutritional research. The next section of the book will present these foods and tease apart their specific actions that can help you protect yourself against prostate cancer. You'll be pleased to learn that virtually all of them have terrific general health benefits, from lowering your cholesterol and your risk of heart disease to controlling your weight and risk of other cancers. They are also foods that will make you feel terrific, perhaps the best you have ever felt. I hope you'll develop the same enthusiasm for the foods and meals in this book that I have. Tens of thousands of men threatened with prostate cancer have already made the change. Most telling of all, men who already have the disease are finding remarkable changes in the state of their cancer with a rigorous change in diet.

Why? The most intriguing reason is that our bodies are designed to eat a specific diet. Just as putting low-grade, cheap gas into a car will eventually ruin a car engine, putting cheap fuels that we were not designed to use into our own bodies will lead to disease. Specifically, the human prostate and the Western diet may be incompatible. You see, through human evolution, our bodies became accustomed to specific foods. Unfortunately, our bodies can't turn on a dime and acclimatize overnight to a new diet, especially one loaded with animal fats and refined carbohydrates, almost devoid of fruits and vegetables. Human evolution marks time in the tens of thousands of years. The dramatic changes in our diets since the Industrial Revolution aren't even a tick on our evolutionary clocks. What's the diet we as men are meant to eat? Is it roast beef with Yorkshire pudding, roasted potatoes, and gravy? Not if you look back into the dawn of humankind.

For 90 percent of the last 200,000 years, we were fruit-and-vegetable eaters. Donald Coffey, Ph.D., who is a professor in the famed Department of Urology at Johns Hopkins, argues that humankind did not evolve fully equipped to be dairy or meat eaters. More to the point, our prostates may not have evolved to handle a diet rich in fats. Humans came from an arm of evolution that did not eat a lot of meat. Until 2.5 million years ago, we were mainly gatherers — we ate seeds and fruits and nuts. Homo sapiens first appeared 100,000 years ago, but only 9,000 years ago did we start processing and storing food and trading it. That's when we started down the road to eating the massive amounts of carbohydrates that we eat today, for example, corn, wheat, rice, barley, potatoes, and root plants. Fruit consumption dropped, since fruits were harder to store. And as we increasingly ate a diet rich in meat, which we cooked and even burned, we stopped eating as many fruits and vegetables. Dairy got big only around 3,000 years ago, and it's then that we increased our dairy intake. Before that we would get milk from goats and sheep, but it was only when we bred these animals that we developed the dairy industry.

"After fifty years of trying to prevent cancer, we've learned that we should go back to eating the foods we ate while we were evolving," says Dr. Coffey. He adds, "It's not surprising that the American Cancer Society and the National Cancer Institute make the same suggestions. They tell us to return to the diet we ate when we were evolving: more vegetables, more fruit, more fiber, less red meat, less animal fat, less dairy, less barbecuing, and more aerobic exercise." So who eats a diet closer to the one we were designed to eat? In parts of China, people eat around 6 to 8 percent fat. Compare that to the United States, where the figure is 30 to 40 percent, much of it animal fat. "Put it all together and you'll figure that our lifestyle is giving us cancer," says Dr. Coffey. I swear the reason I feel so terrific on this diet is that it's the one we're supposed to eat, the one we are designed to eat.

The great good news is that there is a diet that humans were designed to eat and a diet that can be highly protective against prostate cancer. The evidence is so strong that many top physicians in the best academic centers put their patients on a "prostate cancer diet." But don't take my word for it; just look at what the top experts have to say about diet in their own patients with prostate cancer.

I'm impressed that so many experts believe that diet could have an effect even on men who already have prostate cancer. Even more compelling than the use of a prostate cancer diet in treatment of patients is the growing interest in a prostate cancer diet for prevention.

What about real patients on the front lines of this disease? Bob Each is a survivor of late-stage prostate cancer, and he says: "For me, it's a race. I've got to run long enough to get to the cure. The diet is one way to keep me running. The diet helps keep me stay focused on suppressing the disease."

Dean Ornish, M.D., is America's foremost expert on nutrition and disease prevention. More than two decades ago he began his quest to prove that heart disease could be reversed with a stringent lifestyle program. He succeeded by showing that blockages in coronary arteries actually became smaller.

The arteries opened up as symptoms dramatically improved. So successful is the program that many major insurers now pay for this "alternative" means of treating heart disease. Medicare is now conducting a demonstration project of Dr.

Ornish's program for reversing heart disease in sites around the country.

Now Dr. Ornish and his colleagues are targeting prostate cancer. They have carefully designed for men with prostate cancer a program consisting of a rigorous diet, meditation, group support, and exercise. Their intent is to determine if this experimental program may slow or even stop the progression of cancer. The men studied all have biopsy-proven cancer. Dr. Ornish cautions that the results he has to date are not final and that the trial is far from over. There are, however, some intriguing trends. In Dr. Ornish's heart disease reversal program and in his weight control program, the more carefully men adhered to the program, the better they did. This may end up being true of the prostate study as well. I urge you to follow carefully the results as they appear in the media and in professional journals.

What is the proof Dr. Ornish and others are looking for? The bottom line is, does the program save lives? That's the gold standard that hard-nosed researchers are looking for. Until results are in, there are what are called intermediate markers. These are objective scientific measures of real progress, and they're quite valuable. One reason is that there is a great sense of reward when you can see real results. You know you're moving in the right direction. Markers tell researchers that they are changing what they want to change. Since prostate cancer can take decades to develop, it could be many years before you know if you've succeeded in protecting yourself against the disease. The same is true with other diseases. Take heart disease as an example. Doctors and patients rely on intermediate markers, the most well known of which is the cholesterol test. Patients take great satisfaction in lowering their cholesterol levels, although it does not guarantee that they will avoid a heart attack.

As foods are increasingly put to the test in the lab and in clinical trials, more and more doctors are beginning to view diet as nutritional therapy. Dr. Ernst Wynder, the late founder of the American Health Foundation, pioneered the term nutritional therapy, that is, using specific foods to treat an actual illness or prevent a latent one from becoming full blown. Researchers use for foods the words chemoprevention and chemoprotection. What's the difference between prevention and protection? Prevention is avoiding foods or substances that might cause cancer — for example, high-fat foods. Protection is taking foods or substances, such as lycopene or soy, that may actively protect you against a potentially cancerous process in your body. You'll find both of these strategies used in this book.

Many men look somewhat askance at the idea of foods as therapy, perhaps believing that I mean foods work through some kind of mystical force. Foods don't work through magic; they work like drugs, with highly specific effects on receptors, cells, enzymes, and biochemical pathways throughout the body. We'll look at these specific effects of the active ingredients found in foods: for instance, lycopene, found in tomatoes, sulforaphane, found in broccoli, and genistein, found in soy foods. Studies are showing that some foods may protect you against a cancer growing in the first place — an example is antioxidants, which may cut down on damage done to genetic material. Some strategies, such as soy protein intake, may slow or stop a microscopic tumor from becoming an important clinical case of prostate cancer. Other strategies, such as decreasing animal fat intake, may decrease the risk of metastasis, while still others could help prevent a recurrence.

The foods, drugs, and supplements discussed in this book are primarily for men who'd like to protect themselves against developing a clinical cancer. However, many of these approaches are also used by men who already have prostate cancer. In fact fully 30 percent of prostate cancer patients use alternative strategies such as nutrition. Some do so in place of any conventional treatment, but most use these methods alongside traditional treatment. If you already have prostate cancer, you'll want to discuss with your doctor what makes the most sense for you. You'll find that urologists are quite up to date on nutritional strategies and often recommend them as part of traditional therapy. Harry Pinchot is a prostate a nutritional disease cancer survivor diagnosed with metastatic disease at age 55. He says: