The Prostate Cancer Diet
Men with prostate cancer want to know they personally can do to help their fight against prostate cancer. Eating the right foods is definitely a good start! But what are the right foods? Is there a certain diet that can help fight the cancer and even improve the chances of cure? In this page I am going to make my case why I believe that a Low Carb Mediterranean Diet is the optimal diet for many men with prostate cancer.
You may possibly be wondering “why should a low carb diet help fight prostate cancer?” It probably has something to do with the metabolic syndrome. This may be the most common medical condition that you have never heard of. It afflicts 35% of American adults and is related to pre-diabetes. It is caused by insulin resistance, which is the same cause as for type II diabetes, but it just may have not progressed to diabetes yet. There are also many people with milder degrees of insulin resistance who have not yet been diagnosed with metabolic syndrome or diabetes. One study found that 40% of young Americans ages 18-44 already had some degree of insulin resistance… and it only gets worse with age.
The official criteria for diagnosing metabolic syndrome are to have at least 3 of the following:
- Waist circumference greater than 40″ in men or 34″ in women
- Triglyceride level greater than 150 mg/dL
- HDL cholesterol less than 40 mg/dL in men or less than 50 mg/dL in women
- Systolic blood pressure at least 130 mm Hg or diastolic blood pressure at least 85 mm Hg or taking hypertension medications
- Fasting blood sugar level at least 100 mg/dL or taking diabetes medications.
People with metabolic syndrome are more likely to have heart disease, stroke, dementia, cancer, fatty livers (NASH), sleep apnea, gout, low testosterone, erectile dysfunction, and many other conditions.
Metabolic Syndrome and Prostate Cancer
So what does metabolic syndrome have to do with prostate cancer? Heart disease is the #1 killer of men with prostate cancer and if you have metabolic syndrome you are 3x as likely to have a heart attack. Metabolic syndrome is associated with more aggressive prostate cancer, and androgen deprivation therapies like Lupron (ADT) which are used to treat prostate cancer can worsen metabolic syndrome. Low Carb Diets have been found to reverse metabolic syndrome in many people and can reduce the symptoms and weight gain from ADT.
CAPS1 Study (Freedland, 2019)
It is well known that hormone therapy for prostate cancer (Lupron, Eligard, etc) can cause weight gain and worsen insulin resistance. Insulin resistance is the key cause of metabolic syndrome. In this study half the men were randomly chosen to eat a low carb diet and to walk for 30 minutes each day. By 6 months insulin resistance worsened by 36% in men who were not prescribed the diet and exercise. However, insulin resistance improved by 4% in men who did daily walking + low carb diet.
CAPS2 Study (Freedland, 2020)
Men with prostate cancer were randomized to eat their usual diet, versus to go on a low carb diet for 6 months. Average weight loss was 1 pound in the usual diet group, and 26 pounds in the low carb group. After 6 months the PSA doubling time was measured to be 13 months in the usual diet group, and 28 months in the low carb group. The low carb diet SLOWED DOWN THE PSA RISE, and hence likely slowed down cancer growth.
The Spanish Ketogenic Mediterranean Diet (SKMD) Study
A study out of Spain was published called A Pilot Study of the Spanish Ketogenic Mediterranean Diet: An Effective Therapy for the Metabolic Syndrome. For anyone who does not believe in the power of clean low carb diets then I would challenge them to find a published study with more amazing diet results and email me at: Z e r o P S A @ g m a i l . c o m. This study was conducted over a 12-week period on 22 obese people with metabolic syndrome who followed the Spanish Keto Medi Diet, which focused on fish, red wine, olive oil, vegetables, and keeping carbs below 30 grams daily. The results were shocking:
Results of the SKMD Diet after 12 Weeks
- 100% of the patients were “cured” of metabolic syndrome, they no longer met the criteria.
- Average weight dropped from 234 lbs down to 202 lbs, a 32lb weight loss. BMI dropped from 36.6 to 31.7. Waist circumference dropped from 44″ to 37″.
- Triglycerides dropped from 225 to 110. Wow!! Good cholesterol (HDL) rose from 44 to 58. Bad cholesterol (LDL) dropped from 126 to 104.
- Average blood pressure dropped from 142/89 to 124/76. Another Wow!
- Fasting blood sugar went from 119 to 92.
Details of the SKMD Diet
- They could eat as many calories as they wanted, unlimited.
- Carb count was kept below 30 grams daily, which is considered a very low carb / ketogenic diet. This meant no sugar, no breads, no baked goods, no fruit or fruit juice, no starchy vegetables, no beans, nothing with any added sugar or flour, etc. The few carbs they ate came from vegetables only.
- Asked to eat fish at least 4 days a week. It was estimated that each person ate almost 2 1/2 pounds of fish per day on fish days!!
- On the other 3 days of the week they would consume other proteins including lean meat, fowl, eggs, shellfish, and cheese.
- Asked to drink 200 – 400 ml of red wine per day, divided between lunch and dinner. This is roughly equal to 1/4 to 1/2 bottle of wine total over the day.
- They had 3 servings of vegetables a day, and at least 2 of the servings each day were in the salad form. Allowed vegetables included alfalfa sprouts, lettuce, escarole, endive, mushrooms, radicchio, radishes, parsley, peppers, chicory, spinach, cucumber, chard, celery, broccoli, cauliflower, cabbage, artichoke, eggplant, squash, tomato, and onion.
- Salad dressings allowed were garlic, olive oil, vinegar, lemon juice, salt, herbs, and spices.
- A minimum of 30cc (2 tablespoons) of olive oil each day.
- Up to 2 cups of coffee & tea were allowed. Encouraged to drink at least 2 liters of water daily.
- Artificial sweeteners were allowed, but recommended against.
- Nothing with any added sugar was allowed. No trans fats. No processed meats with added sugar.
- Supplements included 2 multivitamin tablets + 1 tablet calcium 1,500mg.
- If a participant achieved his weight loss and metabolic goals, then the diet became less restrictive regarding carb intake and gradually added back nuts, berries, fruit, yogurt, milk, and legumes up to 3x weekly. “Forbidden tubers [potatoes / sweet potatoes] could be included from time to time, and cereals [grains] or their derivatives occasionally or never.”
Try the SKMD Diet Yourself!
- This was a very limited diet. I bet it would be tough to stay motivated for a long period of time. 2 1/2 pounds of fish a day sounds tough. But you can still dream of having those forbidden tubers one day.
- They conclude “There is no way to say if the healthy results are due to the ketogenic nature of the diet, the virgin olive oil, the red wine, the higher ﬁsh intake, the higher salad intake, or a synergic effect between these components”. In other words, not all of these components may be required.
- You don’t have to drink wine every day – we don’t know if adding the wine made a difference. If you do choose to consume alcohol, unsweet (dry) red wine is the best, but other low carb alcoholic beverages could be substituted.
- What happens if you don’t like seafood? I suspect fish may have played a big role in the results of this study. But what about healthy lean meats? An alternative for fish haters might be to eat 100% grass fed / grass finished beef, wild game, free range naturally fed chicken, etc. Animals raised on their natural diet often have much higher omega-3 levels which is the same healthy oil found in fish. Eating a fast-food hamburger minus the bun would not provide the same benefits as eating wild caught fish, but eating 100% grass fed/finished beef is probably a lot closer.
- This diet did not allow nuts or berries. These are a good addition to a low carb mediterranean diet! Macadamias, walnuts, and almonds are great. Limit cashews because they have a more carbs. Berries are relatively low carb and pack a nutritional punch. 1 cup of raspberries has 15g carbs – 8g fiber = 7g useable carbs.
- I did not see mention of olives or avocados, but these should be encouraged.
- Avocado oil is also great and equal to olive oil. The “Primal” brand of mayonnaise and salad dressings are low carb and made with avocado oil.
- Dairy seems to have been barely utilized in this diet. Milk is controversial for men with prostate cancer, but I do think some 100% grass-fed dairy cheese, plain yogurt and sour cream are good additions.
- Can a vegetarian follow the SKMD Diet? It is completely unknown if the results would be the same, but if you add free range eggs, unsweetened grass-fed dairy products like Greek yogurt, maybe a little soy in the form of tofu and tempeh, some nuts and avocado… you would probably get good results. The Veggie Keto Medi Diet (VKMD).
- Not everyone needs to be a on a ketogenic diet. If you do not have metabolic syndrome and are not overweight, then you can probably include more grams of carbs in your diet. See below where I talk about the Three Degrees of Mediterranean. The healthiest carbs are: starchy vegetables like sweet potatoes, whole fruit, and some beans.
Results of Standard Mediterranean Diets
Standard Mediterranean diets are often full of whole grain breads, pastas, beans and starchy vegetables. This major study had 3800 people follow a standard mediterranean diet for 5 years with extra supplementation of olive oil or nuts. It found that 63.5% had metabolic syndrome at the beginning of the study, and 65.8% had metabolic syndrome at the end of the study. Hypertension increased from 93% of participants to 95%. Fasting blood sugar increased from 65% of participants to 68%. The authors concluded a Mediterranean diet was beneficial, but I am a little underwhelmed! My thought is that if you follow a mediterranean diet from a young age you can avoid many diseases, but if you come to it later in life or already have metabolic syndrome then you may need a lower carb version.
Three Degrees of Mediterranean
I would propose three different levels of the mediterranean diet for those who want to use it to fight their prostate cancer and reduce their symptoms: 1) the standard version, 2) the lower carb version, and 3) the very low carb /ketogenic version. These diets will typically contain 50% calories from carbs, 30% from carbs, and 5-10% from carbs respectively.
Anyone who is naturally thin and not on ADT should do well on the level 1 – standard mediterranean diet. People who have metabolic syndrome and are going on ADT should look at the level 3 – ketogenic version. And those people who are in between should look at level 2 – lower carb version.
Standard Mediterranean Diet
The mediterranean diet can be interpreted in many different ways, but the principles are to eat whole foods wherever possible and avoid heavily processed foods and junk foods. Eat fish and occasional lean meats. Use olive oil. Focus on whole foods that have no ingredient list or just a few ingredients (vegetables, fruit, fish, fowl, meat, nuts, seeds, cheese, olive oil, beans, whole grains)
Allowed: All vegetables, fish, lean meats, olive oil, whole fruit, whole grain products including breads, beans, nuts and seeds, unsweetened dairy products from sheep / goats / cows, red wine.
Avoid: Heavily processed foods and junk foods like soda pop, candy bars, potato chips, cake, and donuts. Fatty meats and processed meats like hotdogs. Deep fried foods (french fries, battered food). Fast food.
Lower Carb Mediterranean Diet
This is like the standard mediterranean diet, but with the following changes:
1) Avoid sugar and foods with added sugar, except as a rare treat. Don’t buy anything with sugar on the ingredient list.
2) No sweetened drinks, no fruit juice. Artificial sweeteners are okay.
3) Avoid wheat, flour, baked goods, and bread, except as a treat. You can optionally have 1 – 2 servings a day of other whole grains like oatmeal, brown rice, or quinoa.
This diet still has a moderate carb content from the 1 – 2 servings of whole grains, beans, whole fruit, and starchy vegetables.
Very Low Carb / Ketogenic Mediterranean Diet
This is what was studied so successfully in the Spanish Keto Medi Diet, healthy protein + vegetables + olive oil + red wine, but in this list I have included a few more additions likes nuts and berries and plain yogurt.
Vegetables: all non-starchy vegetables
Fruit: Olives, avocados, some berries.
Meat: Eggs, Chicken / turkey, 100% grass fed / finished beef. Limit processed meats like bacon and cold cuts.
Dairy: (optional / controversial) 100% grass-fed dairy: cheese, plain yogurt, cream, sour cream.
Nuts/seeds: All. Best = macadamias, almonds, walnuts, coconut. Limit cashews as they have more carbs. Almond butter, tahini, unsweetened peanut butter. Almond flour, coconut flour.
Beverages: Water, mineral/seltzer waters, coffee, tea, red wine
Sweeteners: No sugar. Monkfruit the best. Other artificial sweeteners permitted but not encouraged.
Oils: Olive oil, avocado oil, 100% grass fed clarified butter (ghee).
Flavorings: olive and sesame oil, lemon/lime juice, vinegars (avoid balsamic), mustard, salt, pepper, herbs, spices, pepper sauce, Primal mayonnaise, Primal salad dressings, salsa, sugar free ketchup, tzaziki.
Vegetarians: perhaps some fermented soy in the form of tempeh and tofu. Soy products are optional / controversial, but natural fermented forms are likely best.
AVOID: No sugar, no foods with added sugar. No wheat / flour / baked goods. No grains (rice, oatmeal, quinoa, etc). No beans. No whole fruit except berries. No starchy/sweet vegetables (potatoes, sweet potatoes, corn, beets, etc).
I have included some of the reasons why I think a low carb mediterranean diet is the way to go for men with prostate cancer. It can be challenging to change diets and one certainly needs the energy and motivation, the time to read about the diet, the time to grocery shop and cook, and a willing partner at home. Below are some resources that may help with the “how to” for this diet.