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How Exercise Helps Sabotage Prostate Cancer

Exercise makes the body a lot less hospitable to cancer.  Or, if you think about prostate cancer as the machine that it is, hijacking countless normal body mechanisms so it can grow and spread:  Exercise throws a monkey wrench in the works!

UCLA urologist William Aronson, M.D., was asked recently:  “What do your patients with prostate cancer ask you about exercise?”  His response:  “None of my patients ask about exercise.”  That’s a shame.

            Sadly, exercise is not on the radar for many men with prostate cancer, and it ought to be, because it extends life, improves quality of life, and slows the progression of prostate cancer.  Aronson, who also sees patients at the Greater Los Angeles VA Hospital, was asked this question at a panel discussion sponsored by the Prostate Cancer Foundation (PCF) on the effects of diet and exercise in advanced prostate cancer and survivorship.  I covered this discussion for the PCF’s website. Notably, the focus here wasn’t on preventing prostate cancer, or delaying the time to treatment – although studies suggest exercise may contribute to each of these.  Instead, it was for men already living with cancer that has escaped the prostate – and the overwhelming consensus among the panelists is that exercise and diet can make a big difference.  Hear these words: If you have prostate cancer, no matter what stage, you can help fight it with exercise!

            Results of several large studies suggest that exercise reduces the risk of dying of prostate cancer by 30 percent, and the risk of dying of other causes by 40 percent, says UCSF epidemiologist June Chan, Sc.D., who was also part of the panel discussion.  Chan is a pioneer in studying the benefits of exercise in prostate cancer.  Back in 2011, Chan and colleagues found a lower risk of progression of cancer in men who engaged in vigorous exercise.  But in later studies, “we saw benefit with just brisk walking.”

            Just what is it that makes exercise beneficial?  What does it do?  It may help to think about prostate cancer as a weed.  Exercise may not act on prostate cancer directly, but if it disrupts the environment – affects the plant’s access to sunshine, soil, air, or water – then the plant is not going to grow as well.  In other words, exercise makes the body a lot less hospitable to cancer.  Or, if you think about prostate cancer as the machine that it is, hijacking countless normal body processes and mechanisms so it can grow and spread:  exercise throws a monkey wrench in the works.

            Exercise lowers insulin and insulin-like growth factor, says Harvard scientist Edward Giovannucci, M.D., Sc.D., professor of epidemiology and nutrition and also part of the panel discussion.  “Physical activity improves insulin sensitivity, which is important for diabetes.”  Insulin, a hormone that regulates the metabolism of carbohydrates and fat, can play a role in cancer, too; so can a closely related hormone, called insulin-like growth factor.  Both of these hormones also affect cell growth and division, Giovannucci adds.  “If you have higher levels because you’re physically inactive or maybe a bit overweight, or maybe you don’t have the best diet, those high levels will sometimes lead to diabetes, sometimes lead to heart disease, and sometimes they lead to cancers.  Prostate cancer is one of those cancers that is probably sensitive to these key hormones.”

The Heart of the Matter

            Chan brought up a very interesting study at the panel discussion:  the ERASE trial, published in JAMA Oncology in 2021.  Canadian investigators looked at the effects of 12 weeks of high-intensity interval training on patients at the early end of the prostate cancer spectrum: men on active surveillance who had very low-risk to favorable intermediate-risk prostate cancer.  At first glance, you might not think this study applies to men with advanced prostate cancer.  Not only did participants have localized prostate cancer, but this was aerobic exercise: supervised sessions on a treadmill, at which the men achieved 85 to 95 percent of peak oxygen consumption, compared to a control group of men who continued their normal exercise routines.   But wait:  in just three months, exercise was shown to decrease the men’s PSA levels, slow their PSA velocity, and slow prostate cancer cell growth.  Obviously, more studies are needed to look at the effects of exercise on men at every stage of prostate cancer; in fact, the investigators noted that “to date, only one exercise study has been conducted in this clinical setting.”  But still, these are exciting results!

            Even more exciting:  Participants in the ERASE trial showed improvement in cardiorespiratory fitness.  For men with prostate cancer, cardiovascular health should be a concern, and improving it should be a goal.   “Cardiovascular disease is a major cause of illness and death for patients with prostate cancer,” says Harvard epidemiologist Lorelei Mucci, Sc.D., who moderated the panel discussion.  These are also words for you to take, well, to heart:  If you have advanced prostate cancer, and you’re on ADT, you should know that ADT can have cardiovascular side effects.  But exercise helps protect the heart.

            In related research, UCSF epidemiologist Stacy Kenfield, Sc.D., Chan’s colleague in the Department of Urology, recently led a small study specifically looking at high-intensity interval training in men with advanced prostate cancer, and a larger study is planned, “designed to look at overall survival and progression-free survival benefits and biomarkers,” says Chan.

            The bottom line:  In addition to whatever exercise does specifically to discourage prostate cancer from growing – which is still not fully understood – exercise accomplishes what many forms of therapy do not:  it prolongs life.  It lowers your risk of dying from prostate cancer and from heart disease.  Exercise is good medicine, and the good news is that you don’t have to sprint on a treadmill or cycle at Tour de France-level speed to achieve a benefit:  even moderate exercise can make a big difference!  More about exercise and advanced prostate cancer in the next post.  Note:  I know the monkey in this illustration is smoking a cigar, and smoking is bad for prostate cancer.  But his tough-guy attitude conveys what I hope you will have:  a can-do spirit to fight prostate cancer!

In addition to the book, I have written much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

 

 

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DIY Home Fitness: Starting Small is Fine!

Can’t get to a gym?  No problem! You can do a lot with your own 30-second circuit stations at home!

It can be intimidating to walk into a gym.  There’s a fair amount of peacocking (at least at the YMCA in my hometown), and there’s always at least one guy  lifting huge weights loudly, with big grunts, like you might see in an Olympic-level clean and jerk.  You’re not there to compete with Mr. Grunt, but gosh, that can be off-putting!

Or, maybe you are all set to start your own exercise program with the idea, “Go big or go home.”  Maybe it’s not the first, or the fifth, time you have done this: with the best intentions in the world, you try to do too much, too fast, quit after a few weeks, and feel discouraged.

Overambitious goals can set you up for failure.  But here’s great news:  It doesn’t have to be this way! says Harvard scientist Christina Dieli-Conwright, Ph.D., M.P.H., who recently talked about exercise at a Facebook live event for the Prostate Cancer Foundation.  What she has to say applies not only to prostate cancer patients, but to anyone who would like to become more fit:  Starting small is fine.  In fact, it’s good!

Even better: You don’t need a lot of money, or even a lot of time, to make a difference in your health.  

Note: First, talk to your doctor about what you can and can’t do.  For example, in the world of prostate cancer, men are advised to avoid heavy lifting too soon after prostatectomy, because of the risk of developing an inguinal hernia.  And men on long-term androgen deprivation therapy (ADT), who have a greater risk of fracture, should seek medical approval before lifting heavier weights.  When in doubt, start with light weights.  

“When it comes to exercise, something is better than nothing,” Dieli-Conwright says.  “Pick something you enjoy – or something that you hate the least,” if exercise is not your thing.  And stick with it.  Just do something: fit something into your day.”  You don’t have to be like the people in the home exercise equipment or athletic shoe commercials, and you don’t need to push yourself like Rocky Balboa.  You can improve your health, and your body’s cancer-fighting capabilities, with even moderate exercise.

“It’s worth it,” says Dieli-Conwright, whose research is focused on finding out why and how exercise slows or prevents cancer recurrence, and how it can reduce the risk of death from other health conditions – diabetes, obesity, cardiovascular disease – in cancer patients and survivors.  Specifically, she is tracking biomarkers in the blood, muscle and fat related to obesity, lean mass, inflammation, and metabolism to help understand the underlying physiologic mechanisms by which exercise and obesity/sedentary lifestyle make cancer more or less likely to recur.  “Exercise is a one-stop shop.”  As my friend, medical oncologist Jonathan Simons, M.D., often says, if pharmaceutical companies could make a drug that offers all the benefits that you get just from simple exercise, they would make billions.  (Well, they make billions anyway, but still.)

Exercise makes you sleep better.  It also makes you feel less tired during the day, Dieli-Conwright says.  “It makes you feel better, and lowers depression, stress, and anxiety.  It reduces the risk of diabetes, which is especially important for men on ADT.”  Men on ADT tend to gain weight more easily and also to lose muscle mass.  Exercise burns calories, and even light weights or resistance bands can maintain and build muscle strength.

Moreover, improving your cardiovascular fitness also improves your ability to do “activities of daily living,” starting with sitting down and getting up.  Exercise prevents deconditioning (loss of strength), which can affect the circulatory and respiratory systems as well as muscles and bones.

Walking:  You don’t need to join a gym or even buy any equipment (except for some comfortable walking shoes).  You can walk for free!  The first step is, literally, a step:  “Walking is a great way to start!” says Dieli-Conwright.  “It can be done outside if it’s safe, but you can even do it inside, just walking around your home.  You can walk with friends or loved ones, or your dog.”  When people are sick, she adds, “or hospitalized even for a day or two, the first thing they stop doing is walking.” Deconditioning can happen very quickly.  “Just walking from room to room, back and forth, can help prevent this.”  Over time, even if you don’t increase your distance, try to improve your gait speed.  “People who have a higher gait speed tend to live longer.”

 Note:  If you have balance issues or other conditions, your doctor can help you modify exercise to fit your needs.  The solution might be as simple as a cane! 

Circuit training:  You can do a lot in 30 seconds.  “Circuit training is faster-paced and time-efficient,” says Dieli-Conwright.  “One of the main barriers to exercise is that people feel they don’t have time.  In circuit training, you set up little exercise stations and move through each station in a systematic way (for example, alternating between upper and lower body exercises), at a good pace.”  Do 30 seconds at one station and move to the next one.  Then repeat the whole circuit.  It may be less than five minutes total, but that’s fine!  You can do this once or several times a day.  Some DIY stations you can set up: 

“Couch squats.”  Stand up and sit down, using the sofa or a sturdy chair, over and over for 30 seconds.

Push-ups.  You don’t have to do the full-body push-up with straight legs; you can do it with your knees on the ground.

Wall sits:  Back to the wall, bend your knees and slide down, hold five seconds, then push back up.  Be sure your feet are positioned far enough away from the wall so when you “sit,” your knees form a 90-degree angle.

Walk in place.  Talk about a low-budget station!  Just pick a spot, go there, and walk in place for 30 seconds.

Stairs:  Not the whole staircase!  Just one or two steps, up and down, over and over for 30 seconds.

Weights:  If you don’t have actual weights, use what’s available.  Water bottles, food cans – anything you can lift safely and easily.

“You can get in better shape without any workout equipment,” says Dieli-Conwright.  “Use what you have at hand.  The biggest thing is to make sure you have a safe space where you won’t bump into anything.”

Another thing that’s good about exercise: it’s not sedentary!  “There is a lot of evidence that sedentary behavior has an impact on mortality.  Even taking a 20-second break from sitting every half-hour or hour to take a lap around the kitchen table goes a long way.”

So, instead of “Go big or go home,” think: “Start small at home.”  Says Dieli-Conwright:  “Don’t be intimidated by unattainable goals, like an ultramarathon.  Start small, find things that are going to motivate you, and be consistent.  Just keep at it!  Consistency is the key.”

 

In addition to the book, I have written much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

 

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Matters of Prostate Cancer Survivorship

Who’s a survivor?  You are, if you are trying to get your life back after a diagnosis of prostate cancer.

 

            Survivor.  What does that word bring to mind?  (Besides, of course, the name of the rock band whose song, “Eye of the Tiger,” went double-platinum in 1982 and was the theme of “Rocky III.”)

            There are more prostate cancer survivors now than ever before.  More men are being cured of localized disease, and more men are living longer with advanced cancer than ever before.  This is great news!  It also means that, as men live longer after treatment for prostate cancer, they have new things to deal with – which brings us to the evolving area of cancer survivorship.

             Survivorship is basically the day-to-day effort to live your best life during or after treatment for localized cancer, or between and in the midst of treatments for more complicated disease.  It’s such a big part of cancer treatment now, in fact, that medical centers are devoting significant resources to it.  One of them is Dana Farber, where medical oncologist Alicia Morgans, M.D., will soon become the new Medical Director of Cancer Survivorship.

The criteria for survivorship used to be a lot more strict, she notes.  “The old-fashioned definition would say that patients living with cancer are not survivors” – that a true survivor could only be someone whose cancer has been cured.  That has changed.  “Now, anybody living after a diagnosis of cancer is a survivor and deserves to have the best quality of life possible.”

Good news: for many men recovering from treatment or living with prostate cancer, help is available.  But it may be up to you to ask for it, if your doctor doesn’t address it specifically.

Note:  Here is where your spouse, partner, family or friends can help.  Those who love you may be aware of some things that you might not have noticed, and their insights can help your doctor take better care of you – if you say it’s okay for them to talk about it.

“Men are stoic, and may not feel comfortable admitting a weakness or vulnerability, or they may not have the words to describe what they’re going through,” says Morgans.  “Or, they may not perceive a problem, but their caregivers or loved ones may.  Raising their concerns – with the permission of the patient – to the doctor can be very helpful.”  This is especially true, she adds, in cases where the patient is experiencing “psychological distress, depression, anxiety, and may not recognize it.  Sometimes the caregiver can say, ‘You don’t realize it, but you’ve had a really short temper.’ Or, ‘You may not recognize it, but you’re sleeping all day, and you’re not eating.’Or, ‘Your cancer is controlled, but your behavior is very different, and you seem really down.’  We may not perceive these changes as being different or outside our norm, but if they’re empowered to speak (with your permission!), your caregiver or family members can really help reflect back to us more accurately what’s happening with you.”

While visiting the doctor, phone a friend!  If it’s not possible for a family member to be there at the appointment, no problem!  “We can often call or conference a loved one in,” with Zoom, FaceTime, or through the medical center.  There are also “electronic ways,” Morgans adds, for loved ones to communicate with the doctor.  You can write an email to the doctor, using the patient’s portal – or even your own.  “In many systems, caregivers can have an account that’s connected to the patient.  I have many patients whose spouse has an adjacent account.  Others just use the patient’s account.”

Be sure to identify yourself, that this is the patient’s daughter, spouse, or friend.  “Don’t represent yourself as the patient if you’re not the patient.”  This does happen, Morgans says.  “Sometimes wives will get on there as the patient, and you know it’s the wife: women tend to talk a lot more than men!  I’ll see a long description, and write back, ‘Is this John’s wife?’”  The information is still appreciated, she adds.

“If there’s something they think the doctor needs to know, and if they’re empowered by the patient to speak to us, the caregiver or spouse can intervene in a meaningful way.”

Sexual Health

Sexual health is “one of the most underrecognized issues” for prostate cancer patients and their partners.  One big reason why is that men just don’t want to talk about it, either because they keep hoping it will get better, or they just decide to be stoic and carry on.  “Even though we have a roadmap for how to address these issues after surgery or radiation, we often lack the support system,” says Morgans.  “There are way too few sexual health counselors specifically dedicated to helping men recovering from prostate cancer.”  And yet: “This is an area of high interest to many patients.  Sexual health affects their personal experience, their mood, energy, everything they do.”  It also affects the health of their partners.

Although this is the issue many men wish would just go away, what they need to do is just the opposite of hoping for the best:  be proactive.  If you had surgery and you haven’t already had this discussion with your urologist, find out what you can do for penile rehabilitation.  This may include pills such as Viagra, Cialis, or other PDE5 inhibitors; vacuum devices for stretching the penis to protect against scar tissue formation; in-office or at-home treatment with a small TENS unit to stimulate nerve regeneration and help with return of urinary control; penile injection; or a penile implant.

Don’t suffer in silence!  Don’t listen to anyone, yourself included, who thinks, “Your cancer has been cured. Just be happy with that.”  There are many steps you can take to recover your sexual health – but they won’t happen if you don’t ask for help.

Intimacy: This is not the same as sexual health, but men on ADT and their partners still need intimacy.  If your oncologist or medical center does not provide counseling in this area, ask for a referral to a sexual health counselor, and keep this in mind: you are not alone, whether you’re the patient or his partner.  There are thousands of couples dealing with this issue, as well.  Your doctor also may be able to recommend support groups, online and affiliated with local medical centers.

Fighting Back on ADT

ADT will try to affect your overall health, but here’s the good news:  you can fight back, Morgans.  Arm yourself with what it might do, and you will be better able to protect yourself against its tactics.  So here, in no particular order, are some of the things ADT might affect, and countermeasures you can take:

Bone health:  Prostate cancer can affect your bones, and so can ADT, in different ways.  Treating prostate cancer in the bones not only protects them, it can improve survival!  ADT raises your risk of osteoporosis – but not only is this treatable, it’s not a “done deal” that every man on ADT will develop it!  “Avoiding fractures is so important,” says Morgans.  “Men who have fragility fractures (due to osteoporosis) can lose their mobility and independence, and can have some major changes in their lives until those fractures are repaired.  If we simply follow the guidelines we already have on how to care for bone and prevent osteoporosis, we can improve those outcomes pretty dramatically.

“A lot of the complications associated with ADT are absolutely things that we can address head on, try to prevent and to reverse; for instance, we have effective therapies to counteract bone thinning and lower the risk of fracture and complications from weak bones.  Many of the known side effects of ADT are not necessarily inevitable.”

Your risk of cardiovascular disease:  Here’s some good news:  A new drug, Orgovyx (relugolix), was approved in December 2020 by the FDA for men with advanced prostate cancer, based on results of the Phase 3 HERO study.  It lowers testosterone, but it works in a different way.  It’s also administered differently – a once-daily pill instead of a shot – and it has a significantly lower risk of major adverse cardiovascular events compared to Lupron (leuprolide).  If you have cardiovascular risk factors, such as high blood pressure, high cholesterol, a family history of cardiovascular disease, diabetes or pre-diabetes, if you’re overweight or if you smoke: heart disease needs to be on your radar, because ADT can make it worse. “Multiple studies have shown that men who have cardiovascular risk factors, particularly if they are not addressed, have higher rates of complications and even death on ADT,” says Morgans.  But treating these risk factors with diet, exercise, and medication if needed, can “improve overall survival and also quality of life.  When your body is healthier, you feel better.”

Note:  For just about every category on this list, exercise is one of the answers.  Men on ADT who exercise lower their risk of having cardiovascular and cognitive effects, developing insulin resistance, diabetes or pre-diabetes, obesity, and high blood pressure.  “All of these are modifiable risk factors,” says Morgans.

Depression:  “Depression is highly treatable,” says Morgans.  “This is important, because evidence suggests that men treated with ADT do have higher rates of depression than men who have prostate cancer but are not receiving ADT.”  But depression is underdiagnosed and undertreated in men on ADT, she adds, “perhaps because of reticence to ask for help, or a perceived stigma with mental illness,” or perhaps because it has crept up, and the patient hasn’t recognized that there’s a problem.  This is where friends, family and caregivers can help.  Depression can affect sleep, appetite, and memory, as well.

Cognitive changes:  ADT can cause cognitive decline and dementia.  However, this is more complicated than it sounds, Morgans notes.  For one thing, symptoms of depression can be mistaken for cognitive decline, and can improve with antidepressants and exercise.  For another, there are multiple forms of dementia, including vascular dementia.  “If that risk is increased because of ADT, then a medicine that reduces the risk of major adverse vascular events could feasibly lower the risk of dementia, as well,” although this remains to be proven in large-scale studies. In general, “what’s good for the heart is good for the brain,” and taking steps to improve your cardiovascular health will help protect your cognitive function, too.  “We also have strategies and mental tricks to help improve memory, and even medicines that may slow the progress of Alzheimer’s.”  The key is to tell your doctor, and get further evaluation and help if needed.  “The choice of therapies may help, as well,” Morgans notes. “In multiple ongoing studies, some really interesting MRI data suggests that there may be differences in some distribution of blood flow in the brain” between androgen-targeted medicines, “including one study with darolutamide that has just launched.”

Hot flashes:  “At its basic level, ADT is lowering testosterone, which keeps men’s bodies functioning in a way they’re used to,” says Morgans.  “Just as we see when women go through menopause, there are widespread changes.  The constellation of symptoms is much broader than just the effects of ADT on the prostate cancer cells themselves.”

Among the most annoying and persistent – and undertreated – are hot flashes, which “can affect mood, sleep, and cognition,” says Morgans.  A novel approach on the horizon is a “wearable,” she adds.  It’s like an Apple watch, and can be linked to your phone.  The basic idea is to stimulate the autonomic nerves on the wrist, with a cool sensation.  “PCF is actively engaged in supporting work that can potentially improve quality of life and reduce hot flashes in men on ADT.  This is an area with much room for improvement, where attention is needed, and pharmacologic therapies aren’t as effective as we wish.”

For now, treatment with antidepressants may help; so can exercise.  Many men seek relief of symptoms with holistic treatments, including relaxation therapy, hypnosis, cognitive-behavioral therapy, and acupuncture.

In addition to the book, I have written much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

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Worried About Prostate Cancer?  Be Proactive! Part 2: Exercise and Key Foods

Recently for the Prostate Cancer Foundation (PCF), I interviewed two scientists who study lifestyle factors and their effect on prostate cancer:  Epidemiologist June Chan, Sc.D., of UCSF, and epidemiologist Lorelei Mucci, M.P.H., Sc.D., of Harvard.  In the last post, we talked about diet.  Now let’s look at exercise, and we’ll wrap up with some quick takes on various foods.

Here’s some good news:  By launching your proactive strike against prostate cancer, you’re not just helping your prostate (or helping to keep cancer from coming back, if your prostate is long gone):  You’re helping your heart, and you’re also helping to lower the risk of diabetes and insulin resistance.  Go, you!

A sedentary life is not good for the heart.  Diet is important, but it’s not the whole story here.  The research team of June Chan at UCSF has shown in multiple studies that exercise can help delay or prevent prostate cancer progression.  “Aerobic exercise after prostate cancer diagnosis may reduce the risk of prostate cancer recurrence or death by 60 percent.”  Chan’s earlier studies in this field, funded by PCF nearly a decade ago, showed a benefit to an hour of jogging six days a week – the level of exercise most of us can’t or don’t want to sustain.  But don’t get discouraged!  In more recent studies, she and colleagues have been looking at more doable levels of exercise – walking 30 minutes a day, or three or more hours a week, at a brisk pace (3 mph or faster).  The brisk pace is important:  One study found that men who walked three or more hours a week after diagnosis had a 57-percent lower risk of having prostate cancer recur than men who walked at a slower pace, for less than three hours a week.

“Just walking, not running!  Walking is so common.  During these Covid times, when we’re confined to small spaces, people might find it difficult to walk the way they would prefer,” says Chan.  “But I would say, just use it as a break to get fresh air – even if you’re just going up and down the same block.  Any little bit of walking, as opposed to sitting.  Movement is good for your overall bone health.  Don’t push yourself to injury; just get in a good habit.  It’s something you can do when you’re doing something else;” for example, “when I’m walking, often I’ll grab my phone, and use it as a chance to catch up with somebody.”  Don’t focus on the number of steps, or the time.  “If you’re always looking at your watch, you’re not enjoying the walk as much.”  And don’t overdo it:  “If you get injured, you might lose all interest in continuing.”

Note:  the key here is giving the cardiovascular system a good workout, not necessarily the act of walking itself.  So, apply this to your own needs:  if walking that much is not a good option for you, swimming and riding an exercise bike – whatever you are able to do – are good, too.  Studies by Chan and others have provided so much proof of the benefit of aerobic activity, in fact, that “we’re actually at the stage now that the updated Physical Activity Guidelines put out by the American College of Sports Medicine specifically note that exercise is recommended for men with prostate cancer to avoid the risk of dying from prostate cancer.  We’re really excited that we got to contribute to that work.”

What is it about exercise?  Chan and colleagues are still tapping the surface of all the ways exercise is good for the body.  “It improves energy metabolism, lowers inflammation and oxidative stress, helps boost immunity, and is beneficial for androgen signaling pathways.”  It is good for the heart and lungs, improves muscle strength and muscle mass, burns fat, lowers fatigue, anxiety, stress, and depression.  “It just improves your overall quality of life,” says Chan.  Bonus:  exercise also may help slow down prostate cancer’s growth.

Chan is investigating the underlying biological mechanisms for “why exercise has these benefits for prostate cancer and overall health.  Is it a systemic effect, or an anti-androgenic effect?  Is it acting on oxidative stress pathways?”  Her group is looking for insight from blood and tissue samples taken from men with prostate cancer before and after exercise interventions.  In another large, phase 3 clinical trial funded by Movember, Chan and epidemiologists Stacey Kenfield and Lorelei Mucci, with principal investigators Rob Newton and Fred Saad, are studying high-intensity exercise in men with metastatic prostate cancer, at more than a dozen sites worldwide. “It’s a two-year, tailored intervention, with both strength and aerobic components,” to see if exercise can help men with metastatic prostate cancer live longer and better.  What else lowers stress?  Meditation.  Stress may play a role in the growth of prostate cancer, so lowering stress is a strategy worth pursuing.

Speaking of strength training:  We all lose muscle mass as we get older.  Strength training (lifting weights or using resistance bands, and doing muscle-building exercises) fights this loss.  Strength training can be especially helpful in men on androgen deprivation therapy (ADT) for advanced prostate cancer, who are at higher risk of loss of muscle mass, osteoporosis, and also of weight gain, metabolic syndrome, and diabetes.  Note:  If you have advanced prostate cancer, check with your doctor to make sure strength training is safe, and also for some guidance about the weights you should be lifting.

Final note on exercise:  Start out slow.  “If you have not exercised regularly for a long time, consult with a physician or personal trainer, to get a program tailored to fit you,” says Chan.  “Start small, and go up by five- or ten-minute increments.  Then see if you can pick up the intensity.  Just make little changes.”

Look to the long haul:  “Thank goodness I ate that broccoli on Thursday.  Now I won’t get prostate cancer,” said no one ever.  It’s not just one good food choice, but many years of erring on the side of healthy.  The other side of that, however, is reassuring:  It’s not just one bad food choice, or being a couch potato last weekend, but many years of not eating things that can help your body fight prostate cancer, many years of not exercising.  “Diet is something you have to do every day,” says Chan.  So is exercise.  That said, “we’re all balancing so many things with food.  Food is part of our culture, taste, our family habits, celebrations.  I feel like the recommendations should just be like filters.”  In other words: many good decisions, over time, will help fight prostate cancer more than the occasional lapse will help promote it.

 

Thumbs Up, Thumbs Down:  Quick Takes on Food

            I asked Lorelei Mucci for her expert opinion on some foods you may be wondering about for their cancer-fighting powers.  Here’s the rundown, in no particular order:

Extra virgin olive oil (EVOO):  Yes!  More than 2 tablespoons a day.  Among other things, EVOO contains hydroxytyrosol, which scientists now recognize as a natural means of cancer chemoprevention.  It is a powerful antioxidant, and it has been shown to protect against cancer by slowing proliferation of tumor cells and increasing apoptosis – “suicide” – of cancer cells.

Tomatoes:  Yes!  Especially when cooked in, or drizzled with, olive oil, which helps you absorb a key component of tomatoes, lycopene.  “The prostate accumulates a lot of things,” including cholesterol.  “It accumulates lycopene.  When a man eats a diet high in lycopene, for some reason, lycopene levels in the prostate go up.  Lycopene makes sense biologically, because it does accumulate in the prostate.  It is an antioxidant.  This is one of the individual dietary components that seems pretty promising.”

Don’t like tomatoes?  Good news:  Lycopene is in watermelon and grapefruit, too!

Coffee:  “Coffee is looking more and more promising .  There are now a number of studies that suggest drinking coffee regularly, one to two cups a day, can help prevent aggressive forms of prostate cancer.  Some studies say three to four cups offer even more of a benefit, but there’s an initial benefit with one to two cups.  Coffee may also lower the risk of diabetes, liver cancer, and Parkinson’s disease.”

Tea:  Sure, what the heck.  There are far fewer studies on tea than on coffee, but tea has antioxidants.  People in Asia, which has less prostate cancer than the U.S., drink a lot of green tea.  “Tea lowers inflammation, but has not been shown to have an effect on insulin levels.”  However, and this is important:  it doesn’t seem to raise your risk of getting prostate cancer.

Note:  If you go to a fancy coffee shop and get a 1,500-calorie coffee with not only cream but whipped cream, and loads of sugar, or if you drink a super-sweet tea loaded with sugar or high fructose corn syrup, the effects on insulin resistance and risk of weight gain will probably cancel out the antioxidants.

Fish:  Yes.  “We published a meta-analysis of epidemiologic studies that looked at fish and prostate cancer death, and there was a pretty good benefit with regular consumption of fish.”  Particularly “dark-meat” fish rich in omega-3 fatty acids, like salmon and red snapper.

Devil’s advocate:  Are men healthier because they eat fish, or because if they choose fish, they’re not eating a big old ribeye steak cooked in butter?  Talk amongst yourselves, but fish is not nearly as pro-inflammatory as red meat.

Nuts:  Sure.  “There’s not much evidence one way or another with prostate cancer death, but they really seem to lower the risk of cardiovascular disease and overall mortality.”  Also, if you’re eating a handful of nuts as a snack, maybe you won’t be eating a bag of chips.  “In one of our studies,” says June Chan, “we observed that substituting 10 percent of calories from carbohydrates for calories from healthy, plant-based fat (nuts) was associated with a 29-percent lower risk of prostate cancer death, and a 26-percent lower risk of all-cause death.”

Pasta:  In moderation.  However, non-traditional pastas, made from cauliflower or chick peas, are another way to sneak in vegetables.  They may also help you manage your weight.  “Excess body weight, particularly the visceral fat around the abdomen, is associated with worse outcomes from prostate cancer.  Anything men can do to help reduce their weight – limiting bread and pasta, and increasing things like cauliflower pasta and vegetable intake – is beneficial.”

Charred meat:  Try to limit it.  When food is charred, it makes a chemical compound called PhIP, that is a known carcinogen.   Even worse: those beautiful (charred) grill marks combined with a pro-inflammatory food, like red or processed meat.

Soy:  sure.  “Consumption of soy is much higher in Asia, where the incidence of prostate cancer death is lower.  Soy is probably part of a strategy for maintaining healthy weight, and it’s a way of replacing red meat.  Does it lower prostate cancer death?  I don’t know that we have that evidence.”  Another complicating factor:  “Men who eat more healthy diets tend to get screened for prostate cancer.  If you get regular PSA testing, you’re five times more likely to get diagnosed with prostate cancer.”  And, if you get diagnosed early, you are more likely to get early treatment while the disease is confined to the prostate.  It’s like the children’s book, If You Give a Mouse a Cookie, a domino effect.

Vitamin D:  Yes.  “There’s really promising data on vitamin D and prostate cancer mortality.”  One randomized trial, the VITAL study, showed “specifically in black men who have low levels of vitamin D, there’s a reduction in prostate cancer mortality.  Evidence from many studies suggests that this makes sense; there’s a lot of genetic data on inherited vitamin D pathways; this pathway seems to be very important for prostate cancer.”  Vitamin D is found in some foods, such as fatty fish and egg yolks, and your body makes vitamin D when you get out in the sunlight.  However, most people don’t have sufficient levels of vitamin D.  Thus, your best strategy is to take a vitamin D3 supplement:  2,000 IU daily.  It’s not a case of “more is better.”  2,000 IU is what you need.

Final thought on food:  In the words of the title song on Al Jarreau’s 1977 breakthrough album:  Look to the Rainbow.  Build your diet around an array of colorful, plant-based fruits and vegetables: green, red, yellow, orange and purple.  Those colors reflect the good nutrients in them.  Eat less red meat, and have restraint with sugar and carbs, and go for EVOO instead of butter.

In addition to the book, I have written much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 ©Janet Farrar Worthington

 

 

 

 

 

 

 

 

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Worried About Prostate Cancer?  Be Proactive! Part One

Part One:  Live Your Best Life!

What can you do to live your best life?  You might say, quite reasonably, that your best life does not include prostate cancer.  True.  But no matter where you are in your journey – prevention, treatment, recovery, or survivorship – what can you do to maximize the good, to help your physical and mental wellbeing?  There’s actually quite a lot!

For example: Exercise not only helps you lose weight; it helps fight depression, and it even can help slow down prostate cancer!  And eating the right diet – as opposed to eating a lot of junk and chemicals – can boost your spirits, your energy level, and just generally make you feel better.  Even better:  it can help lower inflammation and insulin, and this can help your body fight prostate cancer, and can help prevent diabetes, cardiovascular disease, and other chronic illnesses.

There is growing evidence that the lifestyle choices that help prevent or fight other diseases – like, eating low sugar for diabetes, or exercising for your heart – can also help prevent or slow down prostate cancer.

Here are three basic principles:

What lowers inflammation helps fight prostate cancer.

What fights diabetes and insulin resistance helps fight prostate cancer.

What is good for the heart is good for the prostate.  We will cover all of this here and in part two.

Studying Diet is Hard

For the Prostate Cancer Foundation (PCF), I interviewed two scientists who study lifestyle factors and their effect on prostate cancer:  Epidemiologist June Chan, Sc.D., of UCSF, and epidemiologist Lorelei Mucci, M.P.H., Sc.D., of Harvard.

Right off the bat, both of these experts note that studying food is hard, and the answer to staying healthier is not one single thing.  There is no dietary magic bullet, and if you see one advertised and choose to take it, do so with a huge proverbial grain of salt!  In many studies over the years, scientists have tried to isolate specific foods to see if they promote or prevent cancer – but they did it by asking people to recall what they ate over certain periods of time.  And most people don’t have ideal memories:  “Yes, I ate that fairly regularly.  No, I didn’t eat this – wait, maybe I did.”  See the difficulty?

Okay, so what if people keep a food journal?  That’s more helpful, although these kinds of studies, done right, take many years.  Even then, if you isolate certain foods that seem promising, you still don’t know exactly what’s happening!  Let’s say you are studying what people eat and you notice a trend in those who didn’t get cancer:  they eat apples (hypothetically).  What kind of apples?  Is it all apples, or just Granny Smiths?  Were they all grown in the same type of soil?  Were they cooked, or eaten raw?  Peeled or not?  Organic or not?  How many did people eat a day?

But wait!  Did these people even have an actual benefit from eating the apple – say, one they brought to work from home – or did they benefit from not eating a bag of cheese puffs or Twinkies from the vending machine instead?

And wait some more!  Do the people who benefited have genetic or molecular differences that make them more likely to be helped by apples?  Or… are people who eat apples also more likely to exercise and take better care of their health in general – so maybe it’s not even the apples but their whole lifestyle that made the difference, and we’re back to the drawing board!

This is why science around nutrition takes time.  Remember back in 2010 when coffee was bad?  And now, here we are in 2020 and coffee is good?  This stuff evolves.  The good news is, we’ve learned a lot.

Broad Strokes are Better

Scientists don’t have a Paint-by-Number approach to food science, with every single food accounted for.  But they are able to paint with broad, but definitive, strokes.

In our interviews, June Chan and Lorelei Mucci both cited work led by Harvard scientists Fred Tabung, Ph.D., M.S.P.H., and Edward Giovannucci, M.D., Sc.D., that look at the relationship between diet and inflammation.  In one, the scientists tracked inflammatory markers in the blood and whether inflammation was raised or lowered by what people ate, based on data from thousands of participants in the Nurses’ Health Study and the Health Professionals Follow-Up Study.  The key for us is the foods they found that reduce inflammation:  dark yellow vegetables (carrots, winter squash, sweet potatoes, etc.); leafy green vegetables (like spinach, broccoli, kale, etc.), coffee, and wine.  Beer (one bottle, glass, or can) was in this category, too.  So was tea, but its effect was not very strong.

The pro-inflammatory (bad) category, included processed meats (hot dogs, bacon, pepperoni, lunch meat, etc.), red meat, refined grains, high-energy beverages (with additives and sweeteners), and “other vegetables,” like potatoes and corn.  Interestingly, not all fish is equal:  canned tuna, shrimp, lobster, scallops, and “other” fish were more inflammatory than “dark-meat” fish like salmon or red snapper.

But if you love canned tuna, and if you love a baked potato or corn on the cob, don’t freak out:  remember, broad strokes!  The key seems to be to make sure you do eat the anti-inflammatory foods.  For example, the anti-inflammatory effects of leafy green vegetables, dark yellow vegetables, wine and coffee are more powerful than the very mild, pro-inflammatory effect of “other fish” or “other vegetables.”  If you feel that you just can’t give up meat entirely, that’s okay – just aim for smaller portions of meat, surrounded by anti-inflammatory vegetables.  Example:  instead of regular fries, try sweet potato fries.  They’re really good, and they fight inflammation!  You can have your burger, but still help counteract inflammation:  it’s a win-win!

So:  what about foods that are bad for diabetes and insulin resistance?  Tabung and Giovannucci led another study, also using data from the thousands of participants in the Nurses’ Health Study and Health Professionals Follow-Up Study, to assess the “insulinemic potential” of diet and lifestyle – basically, how foods and exercise affect blood sugar and insulin resistance, as measured by certain biomarkers in the blood.  Foods that did not raise blood sugar or insulin resistance included wine, coffee, whole fruit, high-fat dairy (whole milk, sour cream, a half-cup of ice cream, a slice of cheese, etc.), nuts, and leafy green vegetables.  Physical activity was also good for lowering insulin resistance and blood sugar.

What do the experts make of this?  Benjamin Fu, a postdoctoral fellow in Lorelei Mucci’s lab at Harvard has been looking at these two different dietary patterns: “a diet associated with hyperinsulinemia, and a hyper-inflammation diet.”  The two diets have some overlaps, but are not identical.  Neither is good for men worried about prostate cancer, Mucci says, “particularly the hyper-insulinemia (blood sugar-raising) diet, which is associated with a 60-percent risk of more advanced or fatal prostate cancers.”  Let’s just let that sink in for a second:  if you eat a lot of carbs and sugar and you get prostate cancer, you’re more likely to have a serious form that could kill you.  Okay, let’s go on:

Mucci continues:  “The hyper-inflammatory diet also is associated with an increased risk of prostate cancer,” particularly in men who develop cancer at a younger age, in their forties and fifties.  “It may be that earlier-onset cancers are more susceptible to the effect of diet and lifestyle.”

What does heart health have to do with it?  A lot, for many reasons.  It turns out, says Mucci, that “cardiovascular disease and other chronic diseases are the major cause of death in many men who have prostate cancer.  If you look at men with localized prostate cancer and survival outcomes over 10 years, three-fourths of the deaths in those men will be due either to cardiovascular disease or another chronic disease.  Only one-fourth of the mortality is due to prostate cancer.”  Now, you may be thinking, we all have to die of something, right?  This is true, but “these men are dying sooner than they should, and eating a plant-based diet rich in cruciferous vegetables will help lower that risk of cardiovascular disease.”

Which brings us to the Mediterranean Diet:  Not only do people in Mediterranean countries, as compared to Americans, eat more vegetables and fruits, fewer fatty foods, less processed junk, and less red meat – “which increases insulin resistance, increases inflammation, raises cardiovascular risk and also is part of a dietary pattern that may increase obesity, as well,” as Mucci notes.  You know what else they eat a lot of?  Olive oil.  Greater than 30 ml a day, which is a little over two tablespoons.  “There’s really good evidence that extra virgin olive oil (EVOO), either on its own or as part of the Mediterranean diet, substantially lowers the risk of cardiovascular disease and lowers the risk of overall mortality.  The evidence specifically for men with prostate cancer is much more limited, but given the strong benefits for overall death and cardiovascular death in particular, not only using EVOO, but using it to replace butter or margarine, is something that is worth doing.”

 

Coming up:  Part 2:  What’s Good for the Prostate is Good for All of You!


In addition to the book, I have written much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 

 ©Janet Farrar Worthington

 

 

 

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How to Stay Healthy: Simple Changes, Big Results

It’s the dream for getting older:  stay healthy, don’t get decrepit, keep all your marbles, and have a good life.  The four horsemen of the anti-apocalypse.  Nobody can guarantee this, and if anyone does, don’t trust that person any farther than you can chuck him or her!  However:  You can give it your best shot, and it’s not that hard!  With some simple changes, you can achieve big results! 

Here to help with some good advice is Elizabeth Platz, Sc.D., M.P.H., an epidemiologist at Johns Hopkins, who does a lot of research on factors that raise and lower your risk of cancer and other health problems.  I interviewed her recently for the Prostate Cancer Foundation’s website.  These tips aren’t prostate cancer-specific, and they will help you to get and stay healthier – so you won’t just be another year older, but another year better! 

Are you ready to start fresh?  Now is the perfect time:  it’s the Chinese year of the Rat – the first in the 12-year rotation of zodiac signs, which means that this is a year of renewal.  Let’s see what we can do to feel better and look forward to a healthier, happier, more active life!  First…

Don’t bother looking for a quick fix.  There isn’t a magic pill or miracle supplement or treatment, no matter what they may say on TV and the internet.  Getting healthier can’t be achieved by anything hawked in an infomercial.  “For healthy living, for good well-being, for avoiding premature mortality,” says Platz, “the right things to do are the things you have to work at,” like eating right and getting exercise.  But take heart:  you can make big changes by doing lots of small things, if you do them steadily.  You can also live it up sometimes – eat that slab of birthday cake, or have pizza night – if, in general, you practice moderation most of the time.

Be active.  Good news!  This doesn’t mean that you must haunt the gym! One of the best things you can do for your health, says Platz, is easy:  avoid sitting all day.  “In the modern world, people tend to sit.”  We sit in the car.  We sit when we’re on our phones.  We sit at the computer.  “We have protracted periods of time where we’re just stationery.  Build intentional activity into your day.”  Get off the old tuchus!

This doesn’t mean you have to spend hours on the treadmill or elliptical; remember, we’re talking about small changes here:  Don’t park right next to the building; park farther out and walk a little longer.  Take the stairs instead of an elevator to go up one floor.  Set a timer and walk around your house.  Take the dog for an extra walk.  Just move around.

Focus on the “big three macros,” proteins, carbohydrates, and fats.  “Macromolecules” is a trendy word, but it describes something very basic: “these major, fundamental components of our diets,” says Platz.

            Protein:  “As we get older, we need more protein to help keep from losing muscle mass.”  How much?  This varies a lot; one study recommends 1.2 to 1.5 grams per kilogram of body weight; this could mean 123 grams for a 180-pound man; the minimum amount recommended by the U.S. government for the average 160-pound man is 56 grams.  Bottom line:  You need more protein than you think, and more than you’re probably getting.  Make a point of eating protein with every meal.  Instead of just having a piece of toast or some cereal for breakfast, for example, add some Greek yogurt (which is higher in protein) or an egg.   Protein doesn’t just come from meat; it’s in fish, beans, dairy products, eggs, and soy products, too.  It’s also in meal replacement drinks like Ensure and Boost, and in protein bars.

            Carbs: Again, moderation:  “Don’t overdo simple carbohydrates,” the kinds of sugars found in sweets, white bread, and even plain old potatoes:  yes, the humble potato, minding its own business and serving as a dietary staple to millions, now finds itself on the nutritional naughty list of “simple carbohydrates,” because it takes less energy to digest a spud than, say, a sweet potato, which is a more complex carb.  “Whole grains can be delicious,” notes Platz.  “They’re more than just what’s in whole-wheat bread” (which, admittedly, can taste like cardboard).  “Many grains can be mixed into your diet without a lot of effort.”  On the pasta aisle in the grocery store, check out faro – a nutty-tasting grain.  There’s also quinoa, barley, and bulgur, to name a few.

            Fats:  “Good fats are good for you.  Try cooking with olive oil instead of butter,” suggests Platz – who is quick to add:  “You don’t have to remove butter from your diet; olive oil just tastes good.”  And watch out for calorie-rich dressings, sauces, and gravy.  Again, this doesn’t mean don’t eat them; “just make sure it’s the right serving size – which is often more like a tablespoon, rather than a quarter-cup.”

Indeed, watch your portions.  One basic strategy to make sure you’re not getting more than you need:  use a measuring cup.  “Even when you’re eating something that’s healthier, make sure you’re not overdoing it from a calorie perspective.”  Those pesky calories add up, and this is how you gain weight: consuming more calories than you burn.

Weigh yourself.  As we get older, sadly, the weight we gain “tends to be fat,” says Platz, “at the same time as we are losing muscle mass.  Loss of muscle mass is particularly worrisome, and is linked to premature death.  It’s not just how much you weigh, but the proportion of lean mass – muscle and bone.”  What’s a good way to maintain and build muscle mass?  “Weight-bearing or resistance exercise.  Lifting weights.”

Weight-bearing exercise.  Again, this isn’t as hard as you may think.  Nobody’s suggesting that you need to bench press the weight of a Saint Bernard, or dead lift the equivalent of Dwayne “The Rock” Johnson.  “I’m talking about hand weights.  Light-weight weights.  You can even use your body weight,” by doing planks, push-ups, or yoga-type exercises.

An engaged brain functions better.  Thus, get a hearing aid if you need one.  “There is solid, very sound research showing that people who have greater hearing loss tend to have greater cognitive decline,” says Platz.  If you can’t hear, “your engagement with others tends to wane.  When your brain is no longer stimulated to the same extent, it’s associated with cognitive decline.”  This is the “use it or lose it” idea; if your brain isn’t actively engaged – if you’re not hearing conversation, or the TV, or the sounds of nature, or a sermon in church, or your friends and family members talking to you – those un-engaged brain cells can shut down.  Isolation is bad for the brain, and bad for your health in general.

So:  Stay active.  Volunteer, play poker, meet friends for coffee, take a class.  Keep your brain working.  Talk to people.  That kind of engagement is good for your brain, and it prolongs life.  We are hard-wired to talk to other people, and to listen to them, and hey!  If we can help others while we’re doing it, it’s a win-win.  “You’ve accumulated wisdom, experience, and expertise, and if you can share that with others, including the next generation, so much the better.”  For more things you can do to prevent dementia and keep your brain engaged, see this post, and this one.

            Take care of your liver.  If you drink too much alcohol, or if you are overweight to the point where you are at risk of becoming pre-diabetic or diabetic, your liver can pay the price.  “Fatty liver disease is emerging as an epidemic in the U.S.,” says Platz.  If the liver is overloaded, it accumulates fat, becomes inflamed, and several things can happen:  the liver can develop fibrosis, or scar tissue, that may even lead to cirrhosis.  “If you feel like you’re starting to go down that path, now is the time to reassess your diet and lifestyle.  The best analogy is foie gras, where we force-feed ducks to create fatty liver and make good pâté.  When you accumulate fat in your liver, it’s the same thing that happens with those ducks.”

Make it your life’s mission not to fall.  The older you get, the harder it is to bounce back from a fall.  A toddler can face-plant and spring back up.  An older man can fall and break a bone, wind up in the hospital, and if he doesn’t push the physical therapy and exercise afterward, not ever fully recover all his flexibility and strength.  So, let’s do our best to avoid this scenario!  Here’s where yoga and some very simple exercises can help you maintain balance and flexibility.  “This needs to be a huge focus for men as they age,” says Platz.   It’s not so much about strength – again, nobody’s asking you to heft a giant barbell – as it is about stretching and working on your balance.  And, keep your bones strong:  make sure you get enough calcium.  Calcium doesn’t have to come from milk and cheese.  You can get it from leafy green vegetables, and some foods you might not expect – like sardines, and even tofu.  However:  “The recommended dietary allowances for men aged 51-70 are 1,000 mg a day of calcium; and for men age 71 and older, 1,200 mg.  A half-cup of raw broccoli has 21 mg.  But if you’re trying to get to 1,000 mg, you’d have to eat an awful lot of broccoli.”  In a perfect world, you would achieve dietary perfection by eating an exceptionally well-rounded diet.  Most of us don’t achieve that, and if you’re not getting enough calcium, you may need a supplement.  Don’t go overboard!  With dietary supplements, it’s not a case of, “if a little is good, more must be better.”  Just getting enough is fine.

Fasting?  Intermittent fasting, in various forms, has been in the news lately, and “some studies suggest there is a biological benefit.”  However, there is an easy way for you to take a break from food every day:  Cut out the late-night snacks.  “If you get the munchies at 10 at night, you’re basically having the calories of another meal.  Just not having food after dinner can make a big difference.  Sometimes, half the battle is simply recognizing what we’re eating.”  Are you eating more than you think?  An easy way to find out is to write it down, or use an app on your phone to record everything you eat.  Keeping a record – just for a few days, even – might make you think twice before saying yes to that late-night piece of pie.

Try to get more sleep.  Most of us don’t get enough sleep, or don’t sleep well.  There are some simple things you can do for better “sleep hygiene,” including not being on your phone or the computer right before going to bed; the blue light these devices produce messes up your body’s clock.  Drinking caffeine or alcohol too late in the day can affect your sleep, as well.  Herbal tea, with lavender or chamomile, or other natural remedies can help; so can taking melatonin, a hormone your body naturally produces.  We make less melatonin as we get older; ask your doctor about taking an over-the counter melatonin supplement.   Also:  “Many men tend to snore as they get older.  If your partner tells you that you’re snoring, maybe you should do something about it.  Losing weight can help.”  If it’s severe, talk to your doctor.

 

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

 

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Little Bursts of Exercise, Big Rewards

Two recent studies bring good news for those of us who either don’t have a lot of time to exercise, or just don’t like it and don’t want to spend an hour working out: bursts of cardiovascular activity matter. A lot.

For those of us who are getting older (which, unless you’re dead or cryopreserved, or both, is everybody), nothing is better at delaying aging than exercise, say Mayo Clinic investigators, who recently published a very interesting study in the journal, Cell Metabolism.  In other words, there is no magic bullet pill or thing you can eat that will do as much as exercise to keep you living longer and healthier.

Well, we kind of knew that. But the really good news here – especially for those of us who don’t just have scads of time or willpower to spend at the gym – is that it doesn’t have to be for a huge chunk of time every day.

The Mayo researchers didn’t just look at the things we usually think of with exercise – weight loss, better endurance, muscle mass vs. fat, maybe improvements in mood or functioning. Instead, they looked at the effects of exercise in younger and older adults at the molecular level. Particularly, they were interested in the effects on the mitochondria – the battery packs that produce energy in our cells.

The study’s volunteers – 36 men and 36 women in two age groups: young (18-30) and “older” (age 65-80) – were healthy but sedentary. They underwent tests to establish baseline levels for their aerobic fitness, blood sugar, and the gene activity and health of the mitochondria in their muscle cells. Then they were randomly assigned either to a control group (no exercise) or one of three different exercise programs: high-intensity interval biking (pedaling hard for four minutes, resting for three, and repeating three more times); vigorous strength training with weights; and a combined program of light weights and exercise bike-riding (at a moderate pace for 30 minutes, a few times a week).

After 12 weeks, all the participants had repeat lab tests. As you may expect, everybody who exercised had better fitness and blood sugar levels. The people who did weights gained more muscle mass, and the people who did interval training had better endurance.

But the really significant changes were invisible to the naked eye. In the under-30 people who did the interval training – the vigorous bike-riding for four minutes, four times – 274 genes showed increased activity; those who did the more moderate exercise had changes in 170 genes, and the weight-lifters had changes in 74 genes.

Think that’s exciting? Well, it is, but it’s not nearly as exciting as what happened to the seniors who did the interval training: nearly 400 genes showed higher activity, compared with 33 genes in the weight-lifting group and a sad 19 genes in the people who just did the moderate exercise. The oldsters who did the bursts of exercise had healthier mitochondria, too.

What do we take away from this study? That you’re never too old to benefit from exercise, for one thing. And for another, just because you’re older doesn’t mean you are past the point of vigorous exercise – especially if it’s just for a few minutes at a time.

If you aren’t already exercising, you should talk to your doctor to make sure it’s okay. Then, if you’re cleared for takeoff, don’t be like that guy at the gym who’s reading a book or watching the TV on the wall and cycling about one mile a minute, pedaling so slowly that if he were on a regular bike, he would fall over because he’d have no momentum. That barely even counts, and I see people like this at the gym all the time. They have no problem carrying on a full conversation, either; they certainly aren’t short of breath.

Now, how can you apply this to your own life? If you ride a bike or use a treadmill, the timer is your friend. You don’t have to program anything; you can just increase the speed to a comfortable running level, and lower it to a brisk walking level. Do it for one minute. If you can’t do it for a minute, start with 30 seconds of running or pedaling harder, then work your way up. My favorite thing to do on the treadmill is walk at a brisk pace for a minute and a half, then run for a minute, then walk for a minute and a half, then run for a minute, etc., for 20 minutes. When I started, my speeds for walking and running were pretty pokey. Then one day, I was running at my customary pace and I thought, “Hmm. I can go faster,” so I did. I was walking at my customary pace, and I thought, “I can go faster,” so I did. You will be amazed at how much better you get over time.

This is similar to the kind of exercise our ancient ancestors got. I’m not talking about grandpa or even great-grandpa, but way back to the hunter-gatherer days. They didn’t go out jogging for the heck of it, and they certainly didn’t spin or do Zumba – but what they did do was put on bursts of speed when they had to, so they could bring down the animal they were hunting. Thus, I think that at some level, we are hard-wired to do this. Try it. Start small – just a few minutes total, at first – and see how you do.

This brings us to the next study, published in the Journal of the American Heart Association.

Scientists from the National Cancer Institute and Duke University looked at records of nearly 5,000 people over age 40 from the National Health and Nutrition Examination Survey from 2003-2006, and followed them for more than six years; during that period, there were 700 deaths. Then they looked at the amount of time those people who died had spent in moderate-to-vigorous physical activity (MVPA).

They found that all MVPA counted: even if it was just a few minutes here and there. It all went toward the daily total.

This is huge, because it goes against all the guilt-inducing exercise recommendations we have been treated to for decades. The conventional medical wisdom has been that exercise only counts if it’s sustained – for 20 or 30 minutes, or more. And the worst result of this is that many people have thought, “Well, I don’t have much time today, so I’ll just have to try to get in a good workout tomorrow,” or the next day, or next week.

Au contraire, say the results of this study: All exercise contributes to helping you not die. “For about 30 years, guidelines have suggested that moderate-to-vigorous activity could provide health benefits,” said the study’s senior author, William E. Kraus, M.D., of Duke University School of Medicine,” but only if you sustained the activity for 10 minutes or more. That flies in the face of public health recommendations, like taking the stairs instead of the elevator, and parking farther from your destination. Those don’t take 10 minutes, so why were they recommended?”

Why, indeed? Because every little bit helps. In this study, Kraus and colleagues at the National Cancer Institute found that the length of each period of exercise was not related to the overall benefit of living longer. Five minutes of jogging counts. Five minutes of riding an exercise bike counts.  Or five minutes of swimming a couple laps, or whatever.

The participants in the survey wore an accelerometer (similar to a Fitbit or the activity tracker on a smart phone) for up to a week. Looking at the data, the researchers looked at the people in two groups: those who had bouts of MVPA for about five minutes at a time, and those who exercised for longer than 10 minutes at a time.

People who got about an hour a day of MVPA – not an hour at a time, mind you, but an hour of little bits of exercise here and there, all added up – were half as likely to die. Those who got 100 minutes of exercise a day cut their risk of dying even more, by about 75 percent. Again, it was the total time they spent moving, not how long at a time they exercised, that mattered.

In this study, there was no distinction between intentional exercise and just plain old physical activity, like walking up a flight of stairs, or vacuuming the floor, or running to catch a bus.

“Despite the historical notion that physical activity needs to be performed for a minimum duration to elicit meaningful health benefits,” Kraus and colleagues reported, “we provide novel evidence that sporadic and bouted MVPA are similarly associated with substantially reduced mortality.”

In other words, it’s all good.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

 © Janet Farrar Worthington

 

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