Treating Advanced Prostate Cancer with Diet

Dr. Dean Ornish showed that a plant-based diet and lifestyle program could apparently reverse the progression of prostate cancer for early stage, localized, watch-and-wait cancer. What about for more advanced stage life-threatening disease?

Dr. Dean Ornish showed that a plant-based diet and lifestyle program could apparently reverse the progression of prostate cancer by making men’s bloodstreams nearly eight times better at suppressing cancer cell growth. But this was for early-stage, localized, watch-and-wait prostate cancer.

What about for more advanced-stage, life-threatening disease? There have been sporadic case reports in the literature suggesting benefit. For example, a man with extensive metastatic disease who had been given about three years to live went on a strict plant-based diet. Four years later, it appeared the cancer had disappeared. After six years, he got a little too comfortable, backslid a bit on the diet and began eating “turkey, tuna fish, and chicken,” then the cancer came raging back and he died. But that could have been a total coincidence. That’s the problem with case reports, which are kind of glorified anecdotes. You have no idea how representative the outcome is unless it’s studied formally. But, throughout the 20th century, all we had were these kinds of case reports for more advanced prostate cancer until 2001.

We had “preliminary evidence” based on all the case reports that “prostate cancer may be sensitive to diet even after metastasis develops. Plant-based diets may be associated with prolonged survival and instances of remission of bone metastasis in men with advanced disease.” So, researchers decided to put it to the test in a four-month intervention. They thought that too much saturated fat, too little fiber, and too much meat may be the biggest players in tumor promotion and progression, so they put people on a whole food plant-based diet of whole grains, beans, seeds, and fruits. Figuring this would be quite the departure from their regular diet, the researchers included a stress reduction component in hopes of improving dietary compliance.

Who were the subjects? The ten men in the study didn’t just have prostate cancer—they had all undergone a radical prostatectomy to remove their primary tumor and then subsequently had increasing PSA levels, indicative of probable metastatic disease. PSA stands for prostate-specific antigen. It’s only made by prostate cells, but the ten men had just had their entire prostates removed so their levels should have been zero. The fact that they not only still had some PSA, but that it was rising suggests that the surgery had failed, and the cancer had spread and was making a comeback.

At 2:43 in my video Treating Advanced Prostate Cancer with Diet: Part 1, you can view a graph showing the PSA levels for each of the men before the study began and see the speed at which their PSAs went up. If their PSA trajectories had stayed the same after four months of eating healthfully, it would mean the diet had had no effect. In that case, presumably, the cancer would have still been powering away and spreading just as fast as before. Instead, in two of the men, it looked as if the cancer had accelerated and grew even faster, but in the other eight men, the intervention appeared to work, apparently slowing down cancer growth. And, in three of the ten men, it didn’t just slow or stop, but appeared to reverse and shrink.

Why the different responses? Well, in the Ornish study, the more people complied with the diet and lifestyle recommendations, the better they did, as you can see at 3:31 in my video. Dietary changes only work if you actually do them. Just because you tell people to start eating a whole food plant-based diet, doesn’t mean patients actually do it. One can use fiber intake as a proxy for dietary compliance because all whole plant foods have fiber, and Ornish’s patients about doubled their fiber intake from 31 grams to 59 grams.

How did the ten men in the 2001 study do? They started out even worse, averaging 14 grams of fiber a day, and only made it up to 19 grams a day. That’s not a whole food plant-based diet—that doesn’t even meet the recommended minimum daily intake. As you can see at 4:18 in my video, only four of the ten men even increased their fiber intake at all, so that may explain the different responses. In fact, the man whose fiber improved the most had the best PSA result, and the man whose fiber intake dropped the most had the worst PSA result. Indeed, it appears the more changes they made to their diet, the better their results.

The researchers concluded that “a plant-based diet delivered in the context of MBSR [Mindfulness-Based Stress Reduction]…may slow the rate of tumor progression,” and, unlike other treatments, may give patients some control over their disease. And, as Ornish pointed out, “the only side effects are beneficial ones.”

Dr. Ornish and colleagues were able to show an apparent reversal in the progression of early-stage, localized prostate cancer with a plant-based diet and lifestyle program, and researchers at the University of Massachusetts and elsewhere showed a similar diet may help slow the progression of even advanced prostate cancer over a period of four months.

How about over six months? As I discuss in my video Treating Advanced Prostate Cancer with Diet: Part 2, researchers at University of California, San Diego put cancer patients through the same protocol as the four-month study. Once again, these were patients who had already been treated for invasive prostate cancer by either radical prostatectomy or radiation therapy, yet still had rising PSA levels, suggesting the treatment didn’t work and the cancer was on the move. “In those who have undergone a [cancer] recurrence, PSA typically tends to rise exponentially after prostatectomy or radiation therapy, reflecting the gradual, inexorable growth of the cancer in the body. After local treatment, the rate of PSA rise is the single best predictor of…development of overt metastatic disease, as well as of overall survival.” The next step would be hormonal therapy, which is chemical or surgical castration, but that has a list of side effects, including loss of libido, sexual function, strength, and vitality. “Therefore, many physicians employ a strategy of active surveillance” and try to hold off for as long as possible. If we’re just waiting, why not give diet a try?

Patients were “taught to increase intake of whole grains, vegetables, fruit, and legumes and to decrease meat, dairy, and refined carbohydrates.” Of all possible lifestyle interventions, why a whole food plant-based diet? If you look around the world, there are huge differences in prostate cancer rates, as you can see at 1:42 in my video, and our We’re #1! USA! USA! rates are up to a hundred times higher than some places in Asia, for example—and it’s not just genetic. Within one generation of migrating to the United States, cancer rates shoot up, and the grandkids of the immigrants end up with the same top-of-the-pile “approximate US rates.” A whole range of lifestyle factors have been looked at, but diet appears to have the greatest influence.

Specifically, “consumption of meat and dairy appears to increase risk, and consumption of plant-based foods appears to decrease risk.” Hence, the plant-based diet. A possible mechanism found in both meat and dairy products is arachidonic acid, an inflammatory compound that we make from omega-6-rich oils, like corn, sunflower, safflower, and cottonseed oils. It also comes “preformed” in animal-based foods and, in the American diet, is found particularly in chicken and eggs. In a petri dish, arachidonic acid appears to stimulate prostate cancer cell growth as much 200 percent, as you can see at 2:43 in my video.

So what happened when those researchers at University of California, San Diego asked men to remove processed and animal foods from their diet for six months? At 2:57 in my video, you can see a graph showing how fast the cancer patients’ PSA levels had been rising before starting the study. “In the absence of treatment, absolute levels of PSA tend to increase exponentially,” but upon eating more healthfully, nine of the ten study subjects showed an apparent slowing of cancer growth and four of the nine showed an apparent reversal in cancer growth. The average doubling time, an estimate of how long it would take for their cancer to double in size, slowed from doubling every year to closer to every ten years.

Other studies have used various diets and nutritional interventions, like vitamin supplements, but none has worked as well as this one—and the subjects’ compliance wasn’t even all that great. As you can see at 3:41 in my video, they did well in boosting their whole grain consumption in the first three months, but then backslid a bit, and they ate more vegetables, including a serving of greens, and an extra serving of fruit, at least early on. And, in the beginning, they at least ate one whole serving of legumes a day. So the researchers “did observe some [dietary] recidivism by 6 months,” with subjects sliding back into old habits. Given that, they checked to see if the study participants were better able to beat off the disease during that earlier period. And, indeed, at the end of the first three months, on average, there was PSA reversal. “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.”

Their findings suggest that, without further surgery, radiation, or chemotherapy, disease progression can be slowed or even reversed, despite “the prevailing scientific consensus…that cancer progression is largely irreversible.” The researchers state their “findings do not refute the benefits of standard therapies or guarantee that a plant-based diet and stress reduction will always induce remission,” but their results “do contribute to a growing [medical] literature that suggests that in at least some circumstances, cancer may be partly reversible and that modification of dietary and lifestyle factors may be able to help prevent disease spread”—all without getting their testicles cut off.

Hold on. We can make men’s bloodstreams nearly eight times better at suppressing cancer cell growth? See How Not to Die from Cancer.

It’s not all or nothing, though. Any movement we make towards healthy eating may help. See Prostate Cancer Survival: The A/V Ratio .


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In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

SurgAR and Medexprim start surgical AR partnership with French hospital

France’s SurgAR has joined with imaging data firm Medexprim to form a three-year partnership with a major hospital in France, to develop augmented reality (AR) software dedicated to laporoscopic surgery.

The University Hospital Centre of Clermont-Ferrand has been ranked in the top 20 French hospitals for nine years and has 7,000 staff.

SurgAR (Surgical Augmented Reality) has developed a software suite that allows for the superimposition of virtual information to real time surgical view.

The information comes from preoperative radiological imaging data and aims to guide the surgeon during operations, increasing precision.

It aims to cut complication rates, intervention times and hospitalisations.

Augmented reality has become established in the last few years as a way of improving the performance of surgeons.

In 2018 Novarad’s OpenSight Augmented Reality System was given the green light by the US FDA, allowing doctors to see inside patients before an operation.

This followed the 2017 launch of the first AR surgery platform by Philips.

This latest partnership is the first of its kind at a French university hospital and will be used to build a database of surgical videos that can be applied to machine learning.

SurgAR and Medexprim said they aim to work together with a network of European hospitals aiming to deploy the technology at around 12 sites over the next three years.

SurgAR was founded by computer sciences professor Adrien Bartoli and gynaecological surgeon Nicolas Bourdel, who both work at Clermont-Ferrand hospital.

Medexprim was founded in 2015 and describes itself as an accelerator of hospital clinical research and a tool for leveraging data from its partner hospitals.

The company aggregates imaging and clinical data in compliance with ethics and regulations, and provides hospitals with clinical data warehouses.

Medexprim has also unveiled a five-year strategy for growth last month to mark its five-year anniversary.

There are plans to expand into South America, Asia and the US and get involved in EU-funded research projects.

The company added that it wants to get closer to hospitals in the different European regions and build further partnerships with big pharma.

CEO Romain Cazavan noted that the company already has 20 employees in France, the UK and the US and has 10 partnerships with hospitals and the pharma industry.

Feature image courtesy of SurgAR (C) Richard Brunel

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UK awards COVID-19 grant to surgery software developer

The UK government is providing funding to bring a software tool used to monitor patients during surgery to market “as soon as possible”, says its developer.

Directed Systems Ltd has been awarded the COVID-19 Continuity Grant by Innovate UK to allow it to continue development of Hypotension Decision Assist (HDA), which is designed to help anaesthetists keep patients undergoing surgery safe.

HDA is classed as Software as a Medical Device (SaMD), and runs on touch-screen computers used in operating theatres and provides anaesthetists with a visualisation of how well a patient is doing, monitoring arterial pressure and other key cardiovascular characteristics.

The ‘at-a-glance’ display aims to allow anaesthetists to pick up hypotension – low blood pressure – as soon as it occurs during a procedure so the surgical team can act quickly to stabilise the patient.

Intra-operative hypotension (IOH) is a common side effect of general anaesthesia and can lead to restricted blood flow to organs, with serious consequences, including kidney and heart damage and death in serious cases.

Studies suggest that kidney damage can occur when blood pressure falls below 75mmHg, while the threshold for heart damage is estimated at around 65mmHg.

A 2014 study found that 26% of surgical patients saw their pressure fall below 80mmHg for at least five minutes, putting them close to the danger zone.

Directed Systems says that current patient monitors used in operating theatres monitor blood pressure and associated trends “but do not provide the clinical decision support information to the anaesthetist that HDA provides.”

Like many projects, the development of HDA has been disrupted by the lockdowns imposed during the coronavirus pandemic, and the new grant will allow Directed Systems to complete work needed to get a CE mark and bring it to market in Europe.

Directed Systems claimed approval in the US for HDA last November, and says the first US hospitals are starting to install the SaMD, despite some delays caused by the pandemic, as the number of surgeries starts to return to a normal level.

“The grant underscores the value of our HDA technology and recognises the impact that the COVID-19 pandemic has had in frustrating our Innovate UK project and the knock-on effect on our launch plans in the US,” said the UK company’s chief executive Mark Leaning.

“Thankfully, routine elective surgery is now beginning to return. This grant now gives us a shot in the arm to continue to support our project and business plans in a more realistic timeframe in this interpandemic period,” he added.

Innovate UK has provided £90 million in COVID-19 grants so far, typically valued at between £25,000 and £250,000. It has provided £1.5 million in grants to the HDA project to date.

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How to Treat Hiccups

Nearly everyone has experienced hiccups, but what exactly are they? It used to be thought that a hiccup is just a simple muscle spasm of the diaphragm, but that was apparently disproven more than 40 years ago. Instead, hiccups involve a complex, orchestrated pattern of muscle contractions. But, why?

Hiccups might be a leftover from the womb. During fetal life, “hiccups are universally present, their incidence peaking in the third trimester…[This] suggest[s] that hiccups might represent a necessary and vital primitive reflex” that would permit in-the-womb training of the breathing muscles without choking on amniotic fluid.

In adulthood, nearly anything can trigger hiccups. Case in point: A 19-year-old woman presented with persistent hiccups. Her physical exam was normal except for an ant crawling on her eardrum. Once the ant was removed, her hiccups stopped.

There appear to be as many cures for hiccups as there are causes, as I discuss in my video How to Stop Hiccups. As the famous Dr. Mayo put it, the less we know about something, the more treatments we seem to have for it—and perhaps “there is no disease which has had more forms of treatments…than has persistent hiccups.”

There are drugs, of course. There are always lots of drugs, from thorazine to apomorphine, but there are also a whole slew of non-pharmacological approaches—from breathing into a paper bag and drinking from the far side of a glass to smearing mustard on your tummy (as you can see at 1:24 in my video). “Many of these ‘remedies’ have not been tested and some appear to have been invented ‘purely for the amusement of the patient’s friends’.” One method, “forcible traction of the tongue” (which means pulling on someone’s tongue) was attributed to the great Dr. Osler, the first Chief Physician at Johns Hopkins Hospital, but the “therapy, however, is much older and (perhaps not surprisingly) of French origin.”

Another trick that might work to cure hiccups is “a modified Heimlich maneuver,” consisting of just three thrusts and moderate pressure. In one instance, it was so successful the patient’s “hiccups ceased immediately.” In general, however, “[t]reatment is notably disappointing, as is evidenced by the hundreds of remedies have been tried, none of which have been regularly curative.” You know doctors are starting to get desperate when they suggest things like chilling the ear lobe, and you know they are really getting desperate when they have to add prayer to the end of a miscellaneous hiccup cures list.

“Use of vinegar to relieve persistent hiccups in an advanced cancer patient” was the paper that started me down the hiccup rabbit hole. I was reviewing the latest research on vinegar and stumbled across a case where, “[a]fter the failure of common treatments for hiccups, the patient was given a sip of vinegar and his hiccups abated”—stopped after just a single sip. Evidently, sour tastes, such as vinegar and lemon, have been used to treat hiccups since the 1930s, but “nonpharmacological remedies such as vinegar…fell out of favor with the widespread use of pharmacotherapy,” that is, drugs. After all, how much can you charge for a sip of vinegar?

If worse comes to worst, there is the “phrenic nerve crush” surgery, which is as bad as it sounds. Before going that route, though, you may find it “surprising how many patients with hiccups respond to digital compression of the eyeballs.” Yes, we’re talking about digit as in finger, as in pushing your finger into someone’s eyes as a counter-irritation measure. That will get their mind off their hiccups!

If a finger in the eye somehow doesn’t distract them enough, doctors can try “digital rectal massage.” A 27-year-old man presented to the ER with “intractable hiccups.” Emergency staff tried massaging other places and even tried the digital eyeball compression, but nothing seemed to do it. So, bend over. “Digital rectal massage was then attempted using a slow circumferential motion”—and it worked! So, before giving patients drugs, maybe we would give them a massage. It’s “easy to perform” and may be less dangerous than sticking your fingers into people’s eye sockets, which, if you’re in medical school and have to memorize all these ridiculous names, is known as the Dagnini-Aschner Maneuver. (Medicine loves its eponyms.)

Speaking of maneuvers, how’s this for a pick-up line? “Hello. (Hic!) Want to help me (hic!) cure my hiccups?” In one case, on the fourth day of continuous hiccuping, the patient’s hiccups finally “suddenly and completely ceased,” with some spousal help, at the point of climax. “It is unclear,” the doctor wrote, “whether orgasm in women leads to a similar resolution, an issue that could be investigated further.” 

And it was, back in 1845. An infamous, disturbing case report that amounted to effectively bragging about sexual assault was published in what was to be become the New England Journal of Medicine. A young, religious woman with intractable hiccups fell into the hands of a Dr. George Dexter. He first attempted the best modern medicine could offer—bloodletting—but she continued to hiccup, until he pressed his hand on her genitals for a few minutes and that apparently worked. This went on for month after month, with the doctor frequently calling in his colleagues to show them this “singular phenomena.”

Who was this guy? “Although his interaction with the young female patient would not meet today’s ethical standards”—you could say that again!—“his medical observation was valid…” Even though rectal massage and sexual stimulation may help, “this kind of recommendation is reserved for carefully selected patients!”


DO NOT drink vinegar straight. In this blog, I talked about taking a tiny sip, not full-on drinking it. If you do drink instead of sip, you can make the problem worse, as I discuss in my video Vinegar Mechanisms and Side Effects. Vinegar can be great stuff, though. Check out my video series to find out why I include it in my own family’s daily diet:

There’s another way to treat hiccups—one that I’ve used myself since I was a kid. Since then, I’ve never had more than one or two hiccups because I can stop them in their tracks. Learn my trick in my video How to Strengthen the Mind-Body Connection.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: