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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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Two Changeable Risk Factors for Prostate Cancer Death

Hey, wait, come back!  This story sounds grim, but it’s actually hopeful!  There are two things you can do right now that raise your odds of not dying of prostate cancer: Stop smoking, and lose weight.  Both of these can make a big difference.

For several years now, doctors have known that there was a link between prostate cancer and smoking.  They couldn’t prove that smoking caused prostate cancer, but they knew that men who smoke cigarettes – if they developed prostate cancer – were more likely to have aggressive disease, and to die of it.

They know more now.  Scientists led by Johns Hopkins epidemiologist Elizabeth Platz, Sc.D., M.P.H., studied men who had prostatectomy for localized prostate cancer.  Those who continued to smoke after their diagnosis and treatment were more than two times more likely to have their cancer come back than men who never smoked.  But “men who had quit smoking had a similar risk of recurrence as men who never smoked.”

Let’s just stop for a second:  This is really important and hopeful, because it shows that when you quit smoking, your body starts to heal, and your risk of being cured of localized prostate cancer goes way up.

Platz puts it bluntly:  “Smoking is a risk factor for prostate cancer death.  If you start with a group of men who don’t have a diagnosis of prostate cancer, and they smoke, in the future they’re more likely to die of prostate cancer.  Men who have prostate cancer, if they continue to smoke, are more likely to die of prostate cancer.  Men who have been treated for prostate cancer, if they keep smoking, are more likely to die.  Even if they had surgery, the cancer is more likely to recur.”

Platz and other scientists know the connection between smoking and prostate cancer is powerful, but they don’t know exactly why and how smoking makes the body so susceptible to lethal prostate cancer.  “The reason why more is not known about the mechanisms at work here, frankly, is that nobody cares about smoking anymore —even though it accounts for most of the cancers in the United States and it really does explain a chunk of prostate cancer deaths.”   Smoking-related research funding is harder to come by.  “It seems like it’s an old story, so no one wants to talk about it anymore, despite it being so important: Smoking causes premature births, causes lung cancer, causes heart attacks, causes so many bad things.”

In a recent study, Platz and colleagues figured, “we know what’s happening to men who smoke who are followed as part of research studies.  What about larger groups – like entire states – where the prevalence of smoking has gone down?”  Several states have significantly lowered the number of people smoking, through cigarette taxes, indoor air pollution laws, workplace smoking bans, and “quit lines” (smokers call a number and receive many services, often for free, including nicotine patches or gum, counseling sessions, and a lot of help to quit – see below).  The investigators picked four states: Maryland, California, Utah, and Kentucky.  They found that in the states where smoking has decreased, the rate of deaths from prostate cancer has dropped, as well.

The bottom line:  At any point in your life, if you stop smoking, you are less likely to die of prostate cancer.

Note:  It is not clear how the “vape” or e-cigarettes figure in here.  There are a lot of chemicals in these products, and they haven’t been studied for very long, and as far as I know, there are no studies linking e cigarettes and prostate cancer.  That said, they may raise your general risk of getting cancer.

Fat and Prostate Cancer:  Another important risk factor may surprise you:  Obesity.  “Again, it sounds like old news, but we are a fat society,” says Platz.  The thing is, like smoking, obesity is “pretty convincingly associated with being diagnosed with more aggressive disease and death from prostate cancer.  For men who have prostate cancer, being obese and continuing to gain weight is associated with higher disease recurrence and death.”

Why is this?  People who are overweight tend to have higher glucose levels, higher insulin levels, and to produce cytokines – immune system boosters, which can encourage inflammation; sometimes inflammation is good, if it helps you fight off infection, but other times, it can put added stress on the body and perhaps tip the balance toward cancer.  “We need to understand the biology better, and then maybe if we knew the pathways affected, we could come up with ways to intervene directly,” says Platz.  “In the meantime, the better approach is to lose weight, even though it’s hard for many of us to do.”

The good news here is that at every phase of your life – just as with smoking – changing your lifestyle will help you.  If you’re a young man, losing weight might stop the disease from developing.  “If a tumor is already there, but very small, and not yet PSA-detectable, losing weight may delay the growth of cancer.  If you have a diagnosis of cancer, losing weight can slow or help prevent the cancer from growing to form metastases” (from spreading to other sites in the body).

“It’s never too late to lose weight or stop smoking.  If you quit now, or lose weight now, it will benefit you now and in the future.”

            For More Help:  It’s hard to quit smoking, and it’s hard to lose weight.  The good news is that there has never been more help available for both of these challenges.

For smoking: You can call 1-800-QUIT NOW (1-800-784-8669) for help; this is a state “quit line,” and the services offered here are free.  Under the Affordable Care Act, insurance plans must cover some services to help people quit smoking. Depending on your insurance, you may be able to get help for free.  A couple of links you might want to check out are:  Smokefree.gov. and http://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/quit-smoking

For weight loss:  Here, too, under the Affordable Care Act, insurance plans must cover screening and counseling for obesity, and depending on your insurance plan, you might be able to get help for free.  Here’s a link to the government’s website;  http://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/watch-your-weight#the-basics_1.  It helps to talk to somebody, and don’t worry:  They’re not going to judge you; they are there to help you. Just about every medical center has some type of weight management center.  They wouldn’t have these centers if there weren’t millions of people who need to lose weight.  “Intensive weight loss counseling has been shown to be effective,” says Platz.

Caution:  Beware of any radical or fad diet that offers drastic results very quickly.  Those almost universally fail.  Instead, look for gradual, proven plans.  It’s the Tortoise vs. the Hare approach: Slow and steady wins the race.

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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Boomers: Take Care of Your Brain!

Troubling news from a new study, published in the Journals of Gerontology: Social Sciences:  Baby Boomers’ brains aren’t aging well.  Compared to previous generations, Boomers in this ongoing study, of 30,191 Americans over age 50, are experiencing a sharper drop in cognitive function, and are more likely to develop dementia.  And… PAUSE!

Before we start wringing our hands in despair, I want to say right now that I don’t think that shuffling around with an adult diaper is our inevitable fate.  I don’t think that at all, and I don’t think the study’s author, Hui Zheng, Ph.D., from the Department of Sociology, Institute for Population Research, at Ohio State University, believes it.  I think, and I think these results suggest, that this can be changed.

I’m going to come back to this in a minute.  First, let me briefly recap this research project, an analysis of nearly 20 years of results from the Health and Retirement Study.  Among other things, the study’s participants get their cognitive function checked every two years.  Basically, they take a “cognitive battery” of tests:  they do things like remember objects and words they’ve been shown recently, and count backwards from 100 by 7s (If you can’t do this easily, don’t feel bad about yourself; it’s supposed to be a challenge – at least, it is for me!).

In this study, Zheng analyzed the results collected from 1996 to 2014, from people in these groups:  Greatest Generation (born 1890-1923); Early Children of the Depression (born 1924-1930); Late Children of the Depression (born 1931-1941); War Babies (born 1942-1947); early Baby Boomers (born 1948-1953); and mid Baby Boomers (born 1954-1959).  Every generation here born before and during World War II had better cognition scores than the generation before it.

Let’s repeat that:  War Babies did better than Late Children of the Depression, who did better than Early Children of the Depression, who did better than the Greatest Generation on these tests.

The Baby Boomers ended this positive trend.  They not only did not do better than the War Babies; they did worse.  “It is shocking to see this decline in cognitive functioning among Baby Boomers after generations of increases in test scores,” Zheng says.  “But what was most surprising to me is that this decline is seen in all groups: men and women, across all races and ethnicities and across all education, income and wealth levels.”

To make sure the results weren’t being skewed by older members of the Boomer generations, Zheng then looked only at the scores of people in their fifties – and again, Boomers did the worst.  Baby Boomers already started having lower cognition scores than earlier generations at age 50 to 54.  This decline “does not originate from childhood conditions, adult education, or occupation.”

So what’s causing it?  “It can be attributed to lower household wealth, lower likelihood of marriage, higher levels of loneliness, depression and psychiatric problems, and more cardiovascular risk factors – obesity, physical inactivity, hypertension, stroke, diabetes, and heart disease.”

Zheng concludes the study by saying this cognitive decline could become more common in future generations “if no effective interventions and policy responses are in place.”

Now, that’s academic speak; who’s going to make these interventions?  What policy will reverse the course of our brain health?  Let’s sit around with our thumbs and wait for the government and policy-makers to fix it.

Or, let’s see what we can do to make our own brains healthier.  I vote for that option.

As a people, we have never been fatter, had worse diets, or been more depressed and messed-up than we are right now.  We spend too much time on our phones and/or sitting on our butts watching TV.  We don’t exercise enough.  We don’t reach out enough.  We worry too much.  We eat too much processed food.

If you are sitting around watching the news and fueling hatred for one political party or another, you’re not doing your brain a favor.  Step back, turn off the news, and go outside.  You know what they do in Japan?  Take forest baths.  I linked to one story, but there are a bunch of them online, and videos, too.  It’s a “digital detox,” good for your physical and mental health.

If you are overweight, diabetic or borderline diabetic, if you have heart disease or high blood pressure, you are at a higher risk of cognitive impairment.  You have to fight it.  Talk to your doctor, make the effort to eat better, and start some mild exercise.  Every little bit helps.  Go for a walk.  If you can’t go outside, set a timer and walk around your home, or your room.  If you can’t walk, try chair yoga.  No matter your situation, there’s probably something you can do to help your heart, and what’s good for the heart is good for the brain.

I’ve written a lot about dementia on this website.  Just look in the right-hand column for categories, and click on Alzheimer’s (I know, all dementia is not Alzheimer’s; I did that because I thought more people might find my stories on dementia that way).   Here’s one of them, and here’s another, but there are several more.

In addition to diet and exercise, attitude can make a big difference.  Having a positive attitude is good for the brain.  Depression is a risk factor for dementia.  Getting a hearing aid if you need one is good for the brain, because with brain cells, it’s use it or lose it:  if you are just sitting there, not participating in conversation because you can’t hear, if you’re not engaging with other people, your brain figures you don’t need those cells anymore.  Reaching out, getting involved, and volunteering are good for the brain.  Staying connected is important.  Helping other people is important. 

Today I thought of a movie I haven’t seen in way too long, “Apartment for Peggy,” from 1948, starring Jeanne Crain, William Holden, and Edmund Gwenn.  At one point, Edmund Gwenn (Santa Clause in the original “Miracle on 34th Street) says:  “I find it singularly curious that if a doctor tells us that peanut shells are good for us, we eat them.  If a chemist maintains that one gasoline is better than another, we use it.  We’re guided by experts on everything from soap chips to foreign policy and yet on the most important thing of all, how to live, we pay no attention.  Ever since man began to think, great minds have been telling us that the pleasure in living is in helping, that happiness comes from a simple, useful, constructive life.  But yet, we call this kind of advice infantile, impractical and hopelessly idealistic.”

That movie came out just after World War II, and Edmund Gwenn was a member of the Greatest Generation – which means he might score better than today’s Baby Boomers on a cognitive test.  So, give a listen.

 

©Janet Farrar Worthington

 

 

 

 

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Cancer’s Sweet Tooth

Cancer loves sugar, and sugar really loves cancer.  Isn’t that sweet?  Actually, no, it’s more like a match made in hell – because sugar (glucose) makes many types of cancer grow faster.

Scientists have long known that cancers soak up glucose like a sponge; in fact, German physiologist Otto Warburg, who found that tumors extract glucose at a rate 20 to 50 times higher than do normal cells, won the 1931 Nobel Prize for for his research on metabolism.  Lew Cantley told me that.  Cantley, Ph.D., is a world-renowned scientist and Director of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine.  I recently interviewed him for the Prostate Cancer Foundation’s website, pcf.org.

Cantley has spent much of his career studying the interplay between sugar and cancer.  His studies suggest that it’s not so much the amount of glucose in your bloodstream that helps promote cancer, as it is the level of insulin, the hormone made by the pancreas that controls glucose.  Insulin helps turn glucose into immediate energy, and also helps your body pack it away for longer-term storage.  Briefly, when you eat, your blood sugar goes up; this causes your pancreas to say, “Hey! We need to make more insulin!”  Insulin, like Paul Revere, then travels rapidly throughout the land, telling the cells to let the glucose in, either to be used right away or saved in muscles, fat cells, and the liver.

Why does a tumor suck up more glucose?  “The main reason,” says Cantley, “is that insulin can turn on the glucose transporters (proteins on cell membranes that carry glucose into cells), similar to those in the liver, muscle and fat.  The presence of those glucose transporters on tumor cells is in part regulated by insulin.  That’s why I keep focusing on the insulin.”

Cantley began studying the insulin receptor in the 1980s, when he was on the faculty at Harvard University.  A few years later, after moving to Tufts University, he discovered an enzyme called phosphoinositide-3-kinase (PI3K); PI3K signals cells that insulin is present; the cells, in turn, open the valve that lets in sugar.  Normally, PI3K does good and vital work, helping cells survive, grow and proliferate.  But sometimes it goes awry; in Type II diabetes, this PI3K pathway becomes sluggish, cells don’t respond appropriately to insulin and become insulin-resistant.  But in cancer, even in someone who’s insulin-resistant, PI3K does its job too well; glucose floods in, tumor cells feast on sugar and grow faster.  “What we now know is that mutations in the PI3K pathway make tumor cells hyperactive in response to insulin.”

In many cancers – sugar-loving cancers; not all cancers are addicted to sugar, but many are – PI3K is like a power switch that drives growth.  “PI3K is the most frequently mutated cancer-promoting gene in humans,” says Cantley.  It may be involved in as many as 80 percent of cancers, including breast cancer, bladder cancer, and certain brain tumors.

What about prostate cancer?  Well, one of the most common genetic events in prostate cancer is the loss of a gene called PTEN; cancer just knocks this gene out.  “PTEN makes an enzyme that reverses what PI3K does.  PI3K makes a lipid, and PTEN destroys that lipid; you have to have a balance between those two enzymes to keep growth under control.  But in prostate cancer, and in breast cancer , the loss of PTEN activates production of this lipid that drives cell growth.

“This tells us we probably should try to keep insulin levels as low as possible if we have cancer, to try to keep the tumor from growing.   If we can keep the diet under control, or exercise to keep glucose levels and insulin levels low, we have a much better chance of slower growth of the tumor.  Our research would also argue that pharmacological intervention would be more effective if we keep insulin levels low.”

Even better:  Keep insulin levels as low as possible anyway, whether you have cancer or not.  “This is a powerful potential cancer-prevention mechanism,” says Howard Soule, Ph.D., Executive Vice President and Chief Science Officer for the PCF.  “Reducing processed sugar may turn out to be even more important for cancer prevention than treatment.”

Can we learn to use cancer’s sweet tooth as a weapon against it?  Cantley’s research has already led to the development of several PI3K-inhibiting drugs: idelalisib, approved by the FDA in 2014 for treatment of lymphoma and leukemia and alpelisib, approved in 2019 for treating breast cancers with mutations in PI3K.  But Cantley also believes that changing the diet – to one low in sugar, but also low in other carbohydrates, which can cause blood sugar to spike – can make cancer-fighting treatments work even better.  In a landmark 2018 paper published in Nature, Cantley and colleagues showed in mice that by severely restricting carbohydrates “and keeping the insulin level low, tumors would respond much more dramatically to drugs that are already approved to treat them.  Tumors we had never been able to shrink in mice, we could shrink with a low-glucose diet.

“That’s my obsession now, to get that message out there.  Endocrinologists tell patients to exercise more and eat less sugar to keep diabetes under control, but for me, it’s even more critical to keep insulin levels low in order to get better outcomes for cancer patients.”  Cantley’s research suggests that “if you have a mutation in the PI3K pathway that causes cancer, and you’re eating a lot of simple carbohydrates, every time your insulin goes up, it’s making the tumor grow.”

How can this knowledge help slow the growth of prostate cancer?  Here’s one example:  “For prostate cancer patients with low Gleason scores who are on active surveillance, it makes perfect sense to pay a lot of attention to what you eat.  Try to keep your consumption of sugary drinks as low as possible.  Keeping sugar down is the best thing you can possibly do.”  It used to be, Cantley notes, Japanese men hardly ever got prostate cancer.  “But second-generation Japanese Americans have prostate cancer in similar rates to Caucasians.  It’s clearly lifestyle,” the Western diet.  “The truth probably is that some Japanese men in their 90s had some level of prostate cancer, but didn’t consume enough sugar for the cancer to advance.”

Here’s another:  If you are on ADT for metastatic prostate cancer, you are more likely to gain weight, and also to develop insulin resistance.  One way to fight this is by limiting your sugar and simple-to-digest carbs.  Bonus: keeping insulin down may also help slow down the cancer.  Watch out for protein drinks, too; many are loaded with sugar.

What about the ketogenic diet?  It’s low in carbs and high in fats.  “I’m not preaching the ketogenic diet; I don’t eat it myself,” says Cantley, who says he weighs the same now as he did in high school.  “I eat what my grandparents ate:  a healthy diet, lots of raw vegetables, some animal fat, healthy vegetable fats, an intermediate amount of protein.  I don’t avoid fats, but I prefer olive oil on salads, and healthy fats from fish and avocado,” instead of loading up on butter and cheese.  “I eat more protein than the ketogenic diet would recommend, and I do occasionally eat rice and pasta.”

But here’s the kicker:  “The one thing I’m fanatic about is not drinking anything with sugar:  no orange juice, no apple juice, no soda.  I’ll eat an orange, but I won’t grind it up and drink it.”  Sugar in liquid form is rapidly digested, which results in “glucose peaks, followed by insulin peaks.”

What about alcohol?  “A dry martini is probably safer than wine; there’s not much sugar in there.”  However, Cantley adds, “I do drink wine, but as low in sugar as possible.”

Exercise is a great way to divert sugar into someplace safe:  the muscles.  “Muscle is where you store a lot of sugar in your body.  If you drink a sugary drink after exercising, your insulin goes up, and you drive all that glucose into your muscle.  Whether you’re exercising at the time you drink a sugary drink, or you just put on muscle from exercise in general, there’s still a benefit: insulin won’t spike.”   However, exercise doesn’t make it safer to drink a lot of sugary drinks, because…

Sugary drinks are bad.  It’s not just sodas; sweet teas and coffee drinks have more sugar than you may realize.  Even sports drinks are loaded with sugar.  In 2019, Cantley and colleagues published another landmark paper in Science, involving mice with polyposis syndrome (mice genetically predisposed to developing polyps in the colon).  They demonstrated that sugary drinks can dramatically drive the growth of intestinal polyps.  “We gave mice high-fructose corn syrup, and their polyps grew two to three times faster.”  Fructose is a different sugar from glucose, and although “fructose is not consumed by tumors, it goes straight to the liver and turns into fat.  Fructose makes you fat.  But the other issue is that intestinal epithelial cells can directly consume fructose.  We think this explains why there has been a doubling to tripling rate of colorectal cancer in young adults.”

Consuming sugar in liquid form is worse than having that same amount of sugar in solid form.  Cantley explains:  “If you eat an apple, it takes a long time to get to the colon.  By the time it gets there, all that sugar has leached out.  But if you have that same amount of sugar in a drink, that watery sugar gets to the colon pretty quickly.  That’s independent of the insulin elevation (discussed above), and it’s another scary reason why young people should avoid drinking sugary drinks, no matter how much you exercise.  You may be a champion marathon runner, but if you’re drinking sugary drinks all the time to keep up your energy, this is a real warning that you should pay attention to.”

Now, back to prostate cancer:  Would taking a PI3K-inhibitor help slow cancer’s growth?  As is often the case with prostate cancer, it’s not that simple.  It turns out that there are two different kinds of PI3K, an alpha and a beta form that can contribute to prostate cancer.  “When prostate cancer loses PTEN, it uses PI3K alpha and beta form redundantly to drive the tumor.”  This means that a drug that targets only the alpha form probably won’t be as effective in prostate cancer as in other forms of cancer, where only the alpha form of PI3K is involved.

However, “our preclinical findings are overwhelmingly supportive, and the retrospective data in patients strongly suggests” that one day, in addition to surgery, radiation, hormonal therapy or other treatments for prostate cancer, patients will be prescribed a precision diet to make the treatment more successful.  “The more we learn about cancer metabolism, we are understanding that cancers are addicted to particular things.  For many cancers, that thing is sugar.”

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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Stress and Prostate Cancer

Here we are in a global pandemic; we’re all stressed, and we all need to fight it.  If you have prostate cancer, you need to fight it even harder, because the stress hormone, cortisol, may be affecting your cancer, AND because lowering your stress may help your cancer respond better to treatment.  

Having prostate cancer is stressful, even today, when there is more hope of successful treatment than ever before.  But it’s not just the cancer itself.  It’s the hassle of wrangling with an insurance company, and the worry about medical bills or taking time off for treatment; it’s frustration over a slower-than-expected recovery of urinary continence or sexual potency.  It’s anxiety about the next PSA test.  It’s unanswered questions and uncertainty, and worry that life will never get back to normal.  Yes, there’s stress, and plenty of it.    

Does stress make prostate cancer worse?  This one’s not so easy to answer.  “Everybody has an individual response to stress,” says medical oncologist Suzanne Conzen, M.D., Chief of Hematology and Oncology at the University of Texas Southwestern Medical Center in Dallas.  And that’s the key, she adds:  it’s not so much the stress itself but the physiological response that can take a toll, and that may hinder our ability to fight cancer.  Conzen is studying stress pathways in cancers, including prostate cancer.  I recently interviewed her for the Prostate Cancer Foundation (PCF), which is funding some of this research.

The body responds to stress with a surge of corticosteroids; primarily cortisol.  When our ancient ancestors were running for their lives from a savage beast, it was this stress hormone, cortisol – along with adrenaline – that kicked in and saved their bacon.  “We are hard-wired to respond to stress with this ‘fight or flight’ response.”  Unfortunately, many of us react to everyday troubles with the same surge of stress hormone as if we were facing a sabertooth tiger – as if we were under attack.  Our hypothalamus, located in the most primitive part of the brain, tells our adrenal glands, “This is the big one! Go to Defcon 3.”  And cortisol, revving up in its effort to save us – a chemical version of someone running around in a panic, shouting, “Ohmygod, ohmygod,” can cause harm instead, affecting normal functions including the immune system, and even changing genes that are expressed in cancer cells.

“Some people have a higher stress response than others.  It could be an inherited tendency; or they haven’t necessarily developed effective ways of coping with exposure to stressors,” says Conzen.  “However, not all people who have a high stress response get cancer; and a lot of people are under stress and don’t get cancer.  But that’s the complexity: not everybody who smokes gets lung cancer, but smoking is a risk factor.  What you want to do is reduce your risk factors,” and your response to stress – like a bad diet, or smoking, or being overweight – is a risk factor for prostate cancer that can be changed.

“We think high cortisol levels are probably not a good thing in men who have prostate cancer.  At least a subset of those men may have tumors that respond to high levels of stress because the prostate cancer expresses a protein, the glucocorticoid receptor (GR), that is activated by cortisol,” and although Conzen is working on how to determine who these men are, right now, there’s no way to know for sure.

Cortisol, a hormone, attaches to a protein called the glucocorticoid receptor (GR) in cells throughout your body, and this is like flipping a switch that activates stress in all those cells, including cancer cells.  In ovarian cancer, Conzen has shown, higher levels of these receptors in the tumor tissue are linked to more aggressive, even lethal, disease.  And in prostate cancer, she has found that the GR “is more highly expressed in cancer that is resistant to androgen deprivation therapy (ADT).”

But it’s complicated, she adds:  “We think it’s not only how much GR your tumor has, it’s how active it is.”  With PCF funding, Conzen and colleagues in her lab are working to find a way to measure how active cortisol and GR are in a prostate tumor, “whether it’s turning on and off a lot of genes, or just a few genes.  The amount of GR does not necessarily correlate with the activity of the protein.”

So, how to fix it – if a man has aggressive prostate cancer, and high cortisol/glucocorticoid receptor activity?  “One hypothesis would be, deprive that tumor of your body’s stress hormone receptor activity, by keeping the stress hormones relatively low.”  This could happen with some type of medication – or, it could happen with stress reduction.  What is that, exactly?  It could mean making changes in your life, so there are fewer stressful factors in it.   It also could mean making changes in you – with the help of such things as exercise, yoga, meditation, and counseling, and other things to help reduce stress, like having a pet, and reaching out to family, friends or a support group, so you’re not coping with this alone.

Note:  Conzen does not believe that stress, all by itself, causes prostate cancer.  “My guess is that GR-mediated stress signaling in the tumor cells probably has more to do with promoting aggressiveness and progression of cancer,” and perhaps recurrence of cancer.   When Conzen talks about stress, she doesn’t mean a single traumatic incident, such as a car crash:  “The kind of stress we’re talking about is daily unremitting stress.”  Those countless little things that add up, day after day.

Also with PCF funding, Conzen and colleagues are working to identify which genes in prostate cancer cells are involved with the stress response, and what those genes are doing when the tumor cell GR is activated in a man who already has prostate cancer.  “If we knew that, we would know when it would be useful to give a drug (a GR-modulator) to block it,” especially if they could find a drug that would only work in prostate cancer cells.  Glucocorticoid receptors are expressed in a subset (about 20 percent) of castration-resistant prostate cancer.  Conzen and colleagues have initiated clinical trials testing GR-modulating drugs in breast cancer, prostate cancer, and other cancers. In advanced prostate cancer, there are at least three ongoing clinical trials testing GR-modulators: 1) enzalutamide alone vs. with the GR-modulator mifepristone; 2) the GR-modulator CORT125134 plus enzalutamide; and 3) the GR-modulator CORT125181 plus enzalutamide.

In the meantime, stress reduction may help achieve similar results for men with prostate cancer, by lowering circulating cortisol activity.  Clinical trials are needed, Conzen notes, to show the effectiveness of stress response-reducing measures including cognitive behavioral therapy, medication, yoga, and mindfulness in prostate cancer patients.  Such trials have been done in breast cancer, she says, “and have shown that there is a beneficial effect.”

 

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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The Long, Wet Road: Conquering Incontinence After Prostatectomy

Incontinence after prostatectomy is one of the most feared complications.  The good news is that for nearly all men, it goes away.  For the very small percentage in whom it doesn’t, there is help.  This story is a very strong case in point.

In my work for the Prostate Cancer Foundation’s website,  I was lucky enough to interview JP Mac, who has had a particularly difficult struggle with incontinence after prostatectomy.  JP (real name: John P. McCann) is a novelist and an Emmy award-winning animation writer who worked for Warner Bros. and Disney.

He is also very funny.  So, when he wrote a short ebook (coming soon in paperback form) about his experience with prostate cancer – including his diagnosis in 2014 at age 61, the rush to find the right treatment and get it done before his health insurance was going to expire, his laparoscopic-robotic prostatectomy and the complications afterward, and his five-month battle to recover urinary continence after the surgery – he could legitimately have written a soap opera, or maybe even a tear-jerker; but he didn’t.

Instead, his ebook has a title that sounds like 1950s pulp fiction: They Took My Prostate: Cancer, Loss, Hope.  It’s not “Prostate Cancer Lite,” and it doesn’t minimize what he or anyone else has gone through to get back to normal after radical prostatectomy.  Far from it; in fact, his “short, hopeful essay” is a testament to what it takes to recover from this difficult but life-saving surgery: a balanced perspective, a good sense of humor, a great support system, and plain old hard work and persistence.

Here’s a message you hardly ever hear about prostate cancer, or any illness, for that matter:  It’s okay to laugh!   That doesn’t mean it’s not scary, and that it doesn’t wear you down, or that you’re not afraid you won’t ever get back to normal.

But if it’s laugh vs. cry, Mac would rather laugh.  Although no cancer is great, he says, prostate cancer is “especially seedy,” and in his case, it involved  “bloody urine, black feces, incontinence, impotence, vomiting, and various other bodily malfunctions that shouldn’t be discussed before supper.”  But he does discuss them, with the hope of helping other men and their families.  Mac knows that talking about what’s happening gives the cancer less power over your life, and helps you focus on the light at the end of the tunnel – getting your life back after the cancer is cured.

Mac is speaking out about one area, in particular, that doesn’t get talked about much: urinary incontinence.  For many men who suffer from it, in fact, there might as well be a Cone of Silence over this subject, and that’s a shame, because there is always help for urinary incontinence after radical prostatectomy.

When Mac was diagnosed with prostate cancer, his surgeon told him to buy our book, Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer.  Mac did, and he referred to it a lot – especially our review of the male plumbing, which explains why at least some temporary incontinence is just about inevitable for men after radical prostatectomy.

Note: Long-term urinary incontinence is very rare after radical prostatectomy.  Results differ depending on the surgeon; also, some men have quirky anatomy — very subtle anatomical variations (not like a leg where an arm should be, or anything like that, but even tiny differences can be important in surgery, and good surgeons know this and look for such variations).  This is why, if you are considering radical prostatectomy, it is essential to find out how many of that surgeon’s patients have long-term complications.  If your surgeon doesn’t know, consider this a red flag.

The best surgeons keep track of their patients after radical prostatectomy. “In young (men in their forties, fifties, and early sixties), healthy men operated on by an experienced surgeon,” Walsh says, “about 80 percent should be wearing no pads – or at most, a security pad to catch the occasional drop – by three months after surgery, and at 12 months, 95 to 98 percent should be continent.”  Walsh considers a man continent “if he wears no pad or if he wears a pad that is dry.  “Many men continue to wear a small pad just to be safe,” he explains.  Your surgeon may have a different definition of continence, and you should find this out before surgery.  “Most men, even at three months, are not very wet.  It’s hard to believe, but urinary control does continue to improve over two years, and occasionally, even longer than that.”

But don’t lose hope, he adds:  “For many men, the recovery of urinary control is a slow process. The most important thing you can do is not get discouraged.  If your doctor told you there is only a 2 percent chance that you will have a long-term, serious problem with urinary control, believe it.  This means there’s a 98-percent chance that you’ll be back to normal someday, even if nobody can say exactly when.”

From Three Sphincters to One

Why is urinary control an issue after surgical removal of the prostate?  Normally, Walsh says, men have not one, not two, but three separate anatomical structures to control urine.  There is a sphincter in the bladder neck, one in the prostate itself, and then there’s the external sphincter (also called the striated sphincter), below the prostate. Radical prostatectomy knocks out two of these, leaving only the external sphincter to do the work of three.

Because of the other two sphincters, in most men this external sphincter is never tested or even used much; there is no way to know before radical prostatectomy how strong it really is.  Also, like every other muscle, this sphincter loses its tone with age.  A complicating factor is that older men are more likely to have some benign enlargement of the prostate (BPH), too. This could make the bladder thicker and more muscular – and much more powerful than a sphincter that may not have been that effective to begin with.

Mac didn’t really think about this in a lot of detail until his catheter came out after the surgery.  “A nurse handed me a thick cotton pad to put in my underwear.” Mac’s urologist “warned me that the urine was coming, as surely as a Cambodian rice farmer predicting the monsoon. Little could be done, he explained, until I underwent physical therapy. There I’d learn exercises to strengthen the underused muscles of my external sphincter.”

Mac was so happy to have the catheter out that he thought the worst was over.  Cotton pad in place, he made an appointment to come back in three weeks, and took his wife out for breakfast.  “Rising an hour later after three cups of coffee,” he gushed urine “as if putting out a fire in a wastebasket.”  It turns out that the worst was just beginning.  “Basically, the bladder holds urine until a series of reflexes causes a bathroom urge.  Bladder and sphincters then receive a message from the brain to check flow until an appropriate time. When you’re incontinent, any time is just dandy.  You can experience stress incontinence with activities that suddenly increase pressure inside the abdomen, like lifting or standing. Then there’s urge incontinence, which is a sudden uncontrollable need to leak.  Finally, there’s overflow incontinence when you can’t sense if the bladder was filling.  I had all three.”

Suddenly, Mac’s new normal was a life with absolutely no bladder control.  “Movements gross and subtle, lying on my back, it didn’t matter. Everything ended in a demoralizing urine surge. I really needed that physical therapist. But our new insurance had other ideas.”

While he “moped around home like the Incredible Surging Man,” his wife, Joy, spent hours on the phone wrangling with the old and new insurance companies, whose bureaucracies were “sharp as a paper cut,” Mac comments. Meanwhile, he experimented with leakage protection:  “I tried packing my regular underwear with cotton pads. That idea cratered in less than a day. Not only were ‘man diapers’ necessary, but they required cotton pads inside as well. I was soaking through three pads a day minimum. Each morning, I’d wake up drenched, smelling like an interstate washroom.”

Days passed until, Joy finally convinced the insurance company that “we were, indeed, customers and had paid for a specific plan.” Then, the insurance company insisted that the physical therapist wasn’t covered by the plan.  Mac was desperate; his urologist’s office staff stepped in to wrangle with the insurance and finally got the go-ahead for the physical therapist. While all this was happening, “I lived the life of the urine free spirit.  Avoiding coffee or soda mattered little. No internal spigot staunched the constant flow.”  Mac got sick of smelling urine, of feeling that he was “marinating in pee.”

Three or more times a night, he says, “I’d awaken with man diapers soaked and pressure on my bladder. Sitting up, I’d whiz into a hand urinal, change, clean myself, then lie back down and hope for a little sleep before the next voiding.”

At last, Mac could see a physical therapist.  Mac drove to the appointment – his first time behind the wheel since the operation – hopped out of the car, and soaked himself again.  Then he met Eva, his physical therapist, who used biofeedback to help him identify the right muscles to use.

“She hooked my perineal and abdominal muscles to a laptop via adhesive pads, and for the next hour, gave instruction in finding, then clenching and unclenching my striated sphincter in order to control urination. On the computer screen, I could monitor my efforts. A moving graph alerted me when I targeted the correct muscles.”  Mac learned how to do Kegels – clench-and-release exercises to strengthen the pelvic floor muscles below the bladder.

“I found biofeedback to be of great value,” and for Mac, it helped him start to regain bladder control.  “I know a guy who underwent the same radical robotic prostatectomy,” he says.  “Afterwards, his urologist tossed him a few sheets of diagrammed Kegel exercises and said ‘Vaya con Dios.’ No one told my friend you could overdo these exercises. While other factors may’ve been in play, his continence recovery turned out to be longer and messier than mine. Maybe a little biofeedback could’ve improved his condition quicker.”

Eva gave Mac daily exercises with frequency and duration goals.  She also encouraged him to walk daily.  Psychologically, the Kegels were important,” he notes.  “I lived with a constant dribble that could transform into a flood. Eva’s exercises provided me concrete specific actions. She also warned me against overtraining that could fatigue the striated sphincter, rendering it too tired to work.”

Five days later, at his next PT session, “I saw progress.”  For the first time, he could stand up without urinating.  Next, he learned to anticipate the “go” urge – and not wait until he felt pressure in his bladder.  “I could then reach the toilet with something left in the bladder.”  Mac discovered that, in order to stand up without putting excess pressure on his bladder, he had to walk bent over, “like Groucho Marx.” At first, he could go maybe three or steps without a surge.

Joy noticed improvement before Mac did; so did his urologist, who told him, “a lot of the discomfort you’re feeling now will pass. Once you strengthen the striated sphincter, your bladder urges will stabilize.”

There was some good news:  Two months after surgery, Mac’s PSA was undetectable.  His cancer was gone!  And finally, after much hard work, his bladder control began to return.  “With persistence, I sensed how to locate and activate my new bladder-control muscles.  Eva suggested I aim to eliminate jug peeing (with the handheld urinal at night) and excessive bathroom visits.  Using the striated sphincter, I should school the bladder, aiming for fewer, but more productive, bathroom trips. In the meantime, I discovered a cost-effective method of cutting down on cotton pads out in public. By inserting several sheets of double-ply toilet paper into my man diaper, I caught the wild leaks. Just toss and replace the tissue. It was easier than finding a stall and swapping out cotton pads.”

Then, for two nights in a row, he only urinated once. By mid-November, nearly two months after his surgery, “I’d slept an entire night without awakening to pee.  In the morning, I loped ape-like to the bathroom and urinated. Just after Thanksgiving, I stopped wearing man diapers and returned to underwear, albeit with a cotton pad and toilet paper inside.”

For Christmas, Mac and Joy flew to the Pacific Northwest to visit his sister.  Traveling was “an adventurous time, with me unable to cross forty feet of airport concourse without running into a washroom jackknifed over.  I grew to be an expert at identifying tile patterns.”

But even his “odd potty walk” would not last forever. By March 2015, “ I could check flow and walk upright to the bathroom.  My newly discovered striated sphincter knew the routine and exceeded expectations.  I’d finally turned a corner.”

It might not seem like it now, if you’re going through the worst of what Mac endured, but remember: only about 2 percent of men have long-term incontinence after radical prostatectomy, and if you’re in that percentage, there is still hope. Talk to your urologist about biofeedback, which made all the difference for Mac.  Other options include collagen injections, a mesh sling to help take some of the pressure off of the sphincter, and for severe incontinence, an artificial urinary sphincter.

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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