Prostate cancer Integrative Approaches


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  • Glucosinates from Broccolli and Flower, Kirsh, et. al Prospective Study, 1338 PRCA patients, risk of extraprostatic cancer (stage III and IV) decreased with cruciferous vegetable intake
  • Prostate cancer Integrative Approaches

    1. 1. Prostate Cancer Healthy Nutrition for prevention of recurrence and progression Presented by: Adam Rinde, ND Sound Integrative Health, PLLC
    2. 2. Background <ul><li>Adam Rinde, ND </li></ul><ul><li>Graduate of Bastyr University, Kenmore, WA </li></ul><ul><li>Completed Residency in Family Medicine at the Bastyr Center for Natural Health, Seattle, WA </li></ul><ul><li>Adjunct Faculty Bastyr University </li></ul><ul><li>Sound Integrative Health, PLLC </li></ul>
    3. 3. My background with oncology <ul><li>Current, Men’s Health Specialty, Sound Integrative Health, PLLC Bellevue, WA </li></ul><ul><li>Resident, Oncology Specialty Shift, Bastyr Center for Natural Health, Seattle, WA (Winter, Spring, 2007) </li></ul><ul><li>Resident, Urology Rotation, Urology NW, Mountlake Terrace, WA (Winter, 2007) </li></ul><ul><li>Intern, Naturopathic Care, at Highline Cancer Center, Burien, WA. (Spring, 2006) </li></ul>
    4. 4. Naturopathic Medicine practitioners who work with PRCA <ul><li>Adam Rinde, ND , Kirkland, WA </li></ul><ul><ul><li>Sound Integrative Health, PLLC (425)-889-5894 </li></ul></ul><ul><li>Matt Brignall, ND Seattle, WA </li></ul><ul><ul><li>Bastyr Center for Natural Health (425)-834-4100. </li></ul></ul><ul><li>Davis Lamson, ND, Kent, WA </li></ul><ul><ul><li>Tahoma Clinic (425)-264-0059 </li></ul></ul>
    5. 5. Prostate Cancer Basic Premises <ul><li>Most of the time PRCA is a hormone-responsive cancer </li></ul><ul><li>Typical hormones involved with prostate cancer promotion are Dihydrotestosterone (DHT) (a derivative of Testosterone) and Estrogen </li></ul><ul><li>DHT is a promoter of prostate differentiation </li></ul><ul><ul><li>Research is evolving about the role of insulin resistance and PRCA </li></ul></ul>
    6. 6. General Approaches to increase survival <ul><li>Reduction of tumor cell growth </li></ul><ul><li>Removal of tumor cell </li></ul><ul><li>Reduction of PSA doubling time </li></ul><ul><li>Reducing risk factors for progression </li></ul><ul><li>Reducing endogenous and exogenous levels of testosterone and estrogens </li></ul>
    7. 7. Conventional Approaches to PRCA <ul><li>Surveillance (a.k.a. Watch and Wait) </li></ul><ul><li>Surgery </li></ul><ul><li>Radiation </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Hormone Therapy (i.e.Lupron) </li></ul><ul><li>Adjunctive Medication (i.e. Fosomax) </li></ul><ul><li>lifestyle and Diet (Depends) </li></ul><ul><li>Possible co-management with other providers </li></ul>
    8. 8. Naturopathic approach to PRCA <ul><li>Coordination with Oncology Care </li></ul><ul><li>Patient Advocate </li></ul><ul><li>Complementary and Palliative Care </li></ul><ul><li>Lifestyle (ie. meditation, smoking cessation) </li></ul><ul><li>Exercise Prescription </li></ul><ul><li>Nutrition/Dietary </li></ul><ul><li>Supplementation (Herbal/Nutritional) </li></ul><ul><li>Some: provide acupuncture </li></ul>
    9. 9. Lifestyle Interventions with PRCA <ul><li>Meditation and Prayer PMID: 17177907 </li></ul><ul><li>Exercise to preserve muscle mass: </li></ul><ul><ul><li>Resistance Training in Androgen Deprivation Therapy (PMID: 12721238) </li></ul></ul><ul><li>Stress reduction: Mindfulness </li></ul><ul><li>Intensive lifestyle changes may affect the progression of prostate cancer (ornish) PMID: 16094059 </li></ul>
    10. 10. Dietary Strategy <ul><li>To modulate volume of exogenously stimulated testosterone and estrogen (androgen-reducing diet). </li></ul><ul><li>To reduce dietary triggers for prostate cell growth (anti-inflammatory diet) </li></ul><ul><li>Incorporate Functional (prostate protective) foods in the diet. </li></ul>
    11. 11. Diet and Androgens <ul><li>Guess what types of foods trigger testosterone and estrogen formation </li></ul><ul><ul><ul><li>Most likely higher fat (higher cholesterol) foods. </li></ul></ul></ul><ul><ul><ul><li>Dietary Fat may raise serum androgen production </li></ul></ul></ul><ul><ul><ul><ul><li>Hill, et. al.1979. Cancer Res 69(12): 5105 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hamalalinen, et. al. 1984. J Steroid Biochem 20(1) 459-464 </li></ul></ul></ul></ul>
    12. 12. Dietary Strategies that slow disease progression <ul><li>Vegetable Based Diet and its Derivatives </li></ul><ul><ul><li>Low Fat (low dairy diet) </li></ul></ul><ul><ul><li>Low Arachadonic Acid Diet (decreased red meat, decreased trans fats, increased omega-3’s) </li></ul></ul><ul><ul><li>Phytoestrogen Diet (Cruciferous + Soy) </li></ul></ul><ul><ul><li>Emerging areas of study </li></ul></ul><ul><ul><li>Insulin resistance and its connection to PRCA </li></ul></ul><ul><ul><ul><li>elevated Insulin Growth Factor in PRCA patients </li></ul></ul></ul>
    13. 13. Plant Based Diet + Stress Reduction <ul><li>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 . </li></ul><ul><li>N= 93 volunteers </li></ul><ul><li>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 </li></ul><ul><li>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). </li></ul><ul><li>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). </li></ul><ul><li>Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle </li></ul>
    14. 14. Ornish diet/lifestyle protocol <ul><li>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 </li></ul><ul><li>(400 IU daily), selenium (200 mcg daily) and vitamin C (2 gm daily) </li></ul><ul><li>Moderate aerobic exercise (walking 30 minutes 6 days weekly), </li></ul><ul><li>stress management techniques (gentle yoga based stretching, breathing, meditation, imagery and progressive relaxation for a total of 60 minutes daily) and </li></ul><ul><li>participation in 1-hour support group once weekly to enhance adherence to the intervention.10 </li></ul><ul><li>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 </li></ul>
    15. 15. Plant Based Diet <ul><li>Adoption of a Plant-Based Diet by Patients with Recurrent Prostate Cancer Nguyen et al. Integr Cancer Ther. 2006; 5: 214-223 </li></ul><ul><ul><li>6 month dietary change and stress reduction intervention for asymptomatic, hormonally untreated patients experiencing a consistently rising PSA level </li></ul></ul><ul><ul><li>Patients and spouse encouraged to adopt a plant based diet </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>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 </li></ul></ul>
    16. 16. Plant Based Diet, Continued <ul><li>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) </li></ul><ul><li>14 PRCA patients </li></ul><ul><li>6 Month Plant Based Diet plus Stress Reduction and its effect on PSA doubling time </li></ul><ul><li>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). </li></ul>
    17. 17. Prostate Health Superfoods <ul><li>Glucosolinates from Broccolli and cauliflower (PMID: 17652276 ) </li></ul><ul><li>Soy Isoflavones (PMID: 15042614), especially in early stage. </li></ul><ul><li>Lycopene from Tomatoes (PMID: 11489752 ) </li></ul><ul><li>Flax meal when combined with a low fat diet. 11445478 </li></ul><ul><li>Others Worth Mentioning: Modified citrus pectin, Zinc, Saw Palmetto , Selenium, E (usually associated with prevention) </li></ul>
    18. 18. Prostate Super Foods under close study (animal or in vitro studies) <ul><li>Pomegranate Juice (PMID: 16192356 ) </li></ul><ul><li>Omega-3 fatty acid from Fish Increase Omega-3’s in diet PMID: 16899616 </li></ul><ul><li>Tea polyphenols and theaflavins from Black and Green Tea. (PMID: 16772446 ) </li></ul><ul><li>1-2 Glasses of Wine each evening PMID: 14981946 .(Resveratol) PMID: 12504842 </li></ul>
    19. 19. Soy <ul><li>. J Nutr. 2007 Aug;137(8):1974-79. </li></ul><ul><li>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. </li></ul><ul><li>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). </li></ul>
    20. 20. Best Sources of Soy Isoflavones in Order <ul><li>Natto (fermented soybeans) </li></ul><ul><li>Tempeh </li></ul><ul><li>Miso </li></ul><ul><li>Tofu </li></ul><ul><li>Soybean, raw </li></ul><ul><li>Soy milk </li></ul>
    21. 21. Tasty Soy Snack <ul><li>Easy Edamame Salad </li></ul><ul><ul><li>One-16 oz. bag of shelled edamame </li></ul></ul><ul><ul><li>3 carrots peeled and grated </li></ul></ul><ul><ul><li>1 Zucchini, peeled, and grated </li></ul></ul><ul><ul><li>8 radishes quartered </li></ul></ul><ul><ul><li>Toss together and serve with low-fat sesame dressing </li></ul></ul>
    22. 22. Ways to get Lycopene in the Diet <ul><li>Homemade Tomato Sauce </li></ul><ul><li>Chili </li></ul><ul><li>Veggie Pizza Topped with Tomato Sauce </li></ul>
    23. 23. Stress Reduction <ul><li>Mindfulness-Based Stress Reduction (MBSR) </li></ul><ul><ul><li>Founded by John Kabatt-Zinn </li></ul></ul><ul><ul><li>Relaxation and happiness are not the aim, but rather a &quot;freedom from the tendency to get drawn into automatic reactions to thoughts, feelings, and events&quot; </li></ul></ul><ul><ul><li>Introduction: </li></ul></ul><ul><ul><ul><li>Full Catastrophe Living, By John Kabbat Zinn </li></ul></ul></ul><ul><li>Biofeedback </li></ul>
    24. 24. Problems <ul><li>Change is Stressful </li></ul><ul><li>Reduction of Fat does not mean an increase in simple Carbs </li></ul><ul><li>Reduce Fat but replace with Complex Carbohydrates </li></ul><ul><ul><li>Complex Carbs include: Whole Grains, Vegetables, Legumes (kidney beans, lentils), Root Vegetables, Tubers (potatoes) </li></ul></ul><ul><li>Not eating enough calories </li></ul>
    25. 25. Change Management <ul><li>Decide and Commit </li></ul><ul><li>Tell the world </li></ul><ul><li>Make achievable goals </li></ul><ul><li>Don’t sacrifice too much! </li></ul><ul><li>Join a group </li></ul><ul><li>Hire specialists </li></ul><ul><li>A combination of the above </li></ul>
    26. 26. Nutrition Resources <ul><li>websites </li></ul><ul><ul><li> </li></ul></ul><ul><ul><li> </li></ul></ul><ul><li>Books </li></ul><ul><ul><li>The Worlds Healthiest Foods by Mateljan </li></ul></ul><ul><ul><li>The Whole Soy Cookbook by Patricia Greenberg </li></ul></ul><ul><ul><li>Everyday Cooking with Dean Ornish, MD </li></ul></ul><ul><ul><li>Feeding the Whole Family , Cynthia Lair </li></ul></ul><ul><li>Organic Vegetable Delivery: </li></ul><ul><ul><li>Pioneer Organics:206.632.3424 </li></ul></ul><ul><li>Healthy Food Fast </li></ul><ul><ul><li>Organic To Go: 425-837-9992 </li></ul></ul>
    27. 27. Other Topics <ul><li>Nutrients/Herbs for Adjunctive Care </li></ul><ul><li>Natural approaches to prostate cancer treatment side-effects. </li></ul>
    28. 28. Questions and Contact Info <ul><li>Questions from the audience </li></ul><ul><li>Contact: </li></ul><ul><li>email: [email_address] </li></ul><ul><li>Clinic phone: 425-889-5894 </li></ul>