What Should Cancer Patients Eat?

An article today in the Guardian warned cancer patients not to adopt extreme diets as a reponse to illness or as an aid to recovery.  generally sensible advice, but just what should cancer patietns eat?  Can they eat anything that helps fight cancer or prevent its recurrence?  The answer is yes and for many reasons.

Most importantly, I think cancer patietns need to gain some control back in their lives.  prior to illness they were the master of their domain; after a diagnosis you are told what to do by an army of healthcare types and family.  Your body may not even follow your commands!  Choosing what you eat (or don’t eat) is tantamount to exerting control over your life.  Now I agree with the expert at the World Cancer Research Foundation, patients should maintain adequate nutrition but what this means is variable.

For example eating a vegetarian diet can be highly nutritious or frankly toxic.  It all boils down to food choice.  Further, what resonates in the cancer prevention community is total caloric intake and red meat.  Individual studies are highly variable but the satellite view consistently shows that obesity is dangerous for cancer patients.  Many (not all) suspect that red meat is major cause of cancer and studies show this effect.  However, it may be that red meat is a surrogate for excess calories and an untoward lifestyle.  You know, first a cheeseburger, then a steak, and before you know it you are on the really hard stuff; rump roast, Waygu, and cote de bouef!

Seriously though, cancer patients need practical advice for nutrition.  They should be told to reduce their BMI if possible.  I layout the extremes of eating with vegan and one end and a “super size me” world at the other.  The closer to the vegan lifestyle the better.  You do not have to be vegan but we all certainly know healthy choices from dangerous ones.  Define the extremes and you will know where the middle is.

And of course certainfoods MAY have beneficial effects.  They certainly are not harmful.  For example:

• Mushrooms may stimulate the immune system
• Turmeric (curcumin) and curry have anti-angiogenic and anti-inflammatory properties
• green Tea 
• Caretinoids in fruits and veggies can stimulate Natural killer cells and inhibit cancer growth in the lab
• Berries contain ellagic acid and anti-cancer polyphenols that promote apoptosis
• Garlic and onions contain sulphur molecules that may block nitrosamines and promote cancer cell death 
• Ginger can help alleviate nausea from chemo and radiation

I think it is important for doctors to be better educated about the possibility of benefit for nutrition and food choices with respect to wellness.  Helping patients out of illness is valuable but we could really do so much more if we spent time practicing and speaking about prevention.

PSA: Screening versus Testing

Urologists have cajones.  Who else would issue new guidelines on use of the PSA test in the face of a huge failed Phase III trial of PSA screening?  For nearly 20 years we asked, “Does PSA screening save lives?”.  The USA answer, NO.  The European answer, YES but the benefits are exceedingly small (1500 screened to 50 radical surgeries to save 1 life).  The number needed to treat makes the test diffcult to accept as a screening tool.

But the AUA is not afraid to suddenly say that PSA testing (not screening) at age 40 can help doctors diagnose, assess risk, and stage prostate cancer.  All without any Level 1 evidence.  What is this “Groundhog Day”?

Now truth be told, I like this idea, I like this use of the test.  I think it makes intuitive sense.  But so did PSA screening.  I think we all need to do a much better job explaining this test and what we know and don’t know.  And mostly we don’t know.  

Download the guideline at the AUA website