Note: I’m not fat shaming!  I am excited, because here is something you can do to lower your risk of dying of prostate cancer!

Fat is flammable.  There’s so much fat in bacon grease, you can use it as a fire starter.   You can also take a can of Crisco, stick a wick in it, and make an emergency candle    

Unfortunately, the same is true for us:  excess body fat is like lighter fluid for prostate cancer.   Visceral fat, that “spare tire” around the abdomen, is even worse.  It’s not subcutaneous fat – the surface fat you can “pinch an inch” with.  It’s deep inside the belly, an evil pillow that settles over and wraps itself around our abdominal organs.

Visceral fat is the Jabba the Hutt of fat: a notorious villain in several important health problems.  Visceral fat raises your risk of heart disease, diabetes, metabolic disturbances, dementia, and in women, breast cancer.

Now, for the first time, it’s also been shown to raise your risk of getting prostate cancer – the aggressive kind that needs to be treated.  The kind of prostate cancer that kills.

Why is visceral fat so bad?  Because it’s like a blobby smokestack, polluting our bodies with its troublesome emissions.  “Visceral fat is a living, biologically active entity,” says medical oncologist and molecular biologist Jonathan Simons, M.D., CEO of the Prostate Cancer Foundation (PCF).  Like the chest-bursting alien in Ridley Scott’s iconic movie, it’s alive! And it’s up to no good.

Among other things, visceral fat messes with your hormones.  It lowers testosterone and raises estradiol, a form of estrogen.  It churns out inflammatory chemicals called cytokines, which can raise your blood pressure, affect blood clotting, and raise your risk of heart disease and stroke.  Cytokines also have a bad influence on your insulin resistance; this rising tide of glucose raises your risk of getting diabetes.

Like Charlie Brown’s friend, Pigpen, visceral fat also sheds – not dust, but fatty acids, which go right to the liver.  These fatty acids lower your good cholesterol and raise your bad cholesterol.

No one had connected visceral fat to prostate cancer until very recently.  In a study published in Cancer, which I recently covered for the PCF’s website, scientists led by Lorelei Mucci, Sc.D, of Harvard’s T.H. Chan School of Public Health, and Sarah Markt, Sc.D., now at Case Western, investigated body fat distribution and the risk of prostate cancer.  You might say that their study, of Icelandic men in the Age, Gene/Environment Susceptibility-Reykjavik Study, has shaken up the apple cart of what we understand about body fat.

Speaking of apples, visceral fat goes with the “apple” body shape.  This is bad, because the fat surrounds so many vital organs.  But what if you’re a “pear?”  If you’re a pear shape, you carry your fat lower, in the hips and thighs. This fat is usually subcutaneous fat, usually not thought to be as dangerous as visceral fat.

Guess what?  For prostate cancer, thigh fat is bad, too.  This study found that men with greater visceral abdominal fat as well as men with greater thigh subcutaneous fat are more likely to get advanced or fatal prostate cancer.  Visceral fat even raises the risk of advanced or fatal prostate cancer in men with a lower body mass index (BMI – for how to calculate yours, see below); this suggests that the location (even for a modest pot belly) is more important than the overall amount of body fat.

            Risk Goes Up with Higher BMI:  Each BMI increase of 5 was associated with a 52 percent higher risk of advanced prostate cancer, and a 56-percent higher risk of fatal prostate cancer.  Obese men – with a BMI of 30 or higher – were 2.5 times more likely to develop advanced disease, and 2.6 times more likely to die of prostate cancer.  For about every four-inch increase in waist circumference, the risks of getting advanced prostate cancer and dying of it went up significantly – by 40 percent and 45 percent, respectively.

This study may lead to important changes in medical practice.  “We are working very hard to save the lives of men who have advanced, aggressive prostate cancer, notes Simons.  “To do this, we are trying to understand in depth the genetics and consequences in the biochemistry of the disease, and are looking for ‘’druggable” targets for new classes of drugs.  Here is a risk factor for aggressive disease that can be changed!  If this applies to you, we want you to know what a difference you can make in your risk of dying of prostate cancer.”

Note:  Stress makes it harder for you to lose weight.  If you are stressed, your body makes more cortisol, and cortisol makes your body store more visceral fat.  On some ancient level, your body may be thinking:  “Oh, no, times are hard! We’re going to starve!  Better hang on to this fat!”  So, in addition to other ways to lose the fat – exercise and eating a smarter diet with fewer carbs and sugar – you might consider stress management strategies like meditation, relaxation techniques, and deep breathing.  It might help your body let go of the fat.


What’s My BMI? 

BMI, or body mass index, is a measure of body size – and whether you’re at a good weight for your height.  It’s pretty simple, and requires just these two things: your weight and your height.  That’s it.  You can do it yourself with this formula:  BMI = weight in pounds x 703/in2. 

Or, you can use a BMI calculator.  There are plenty of them online.  The National Heart, Lung, and Blood Institute has a BMI calculator and even a free BMI calculator app you can download.  A BMI of 18.5-24.9 is considered the healthy range; between 25.0 and 29.9 is considered overweight, and a BMI over 30 is considered obese.  Also, men with a waistline that measures 40 inches or more are more likely to have too much visceral fat.


In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, 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


In 1993, I actually wrote that sugar and carbs were fine. Want to be healthy? Eat more pasta and healthy grains, I wrote. Fats were the big evil. I was so wrong – but this was what the studies showed. This is what many doctors believed. Fat was our enemy. Fat was the reason we were becoming – not nearly so much as we are now, I might add – a nation of lard butts.

For decades, this was reflected in packaged “healthy” foods. Eat as many cookies as you want: yes, they’re chock full of carbs and junk calories, but no worries! They’re LOW FAT. This was the new food gospel, and we saw it proclaimed on our grocery store shelves – low-fat chips, ice cream, cakes. Guilt-free! Breakfast cereal – great! It’s got NO FAT! We saw the birth of olestra, which not only had no fat – it was indigestible! Side effects included gas, cramps, bloating, diarrhea, and, most appalling of all, “anal leakage.” Lays potato chips, Ruffles, and Doritos at the time that were “FAT FREE” and contained olestra had the word “WOW” in huge letters right there on the bag. I guess they meant the taste, but maybe they were referring to what happened when you ate it, as in: “Wow! I just pooped my brains out!”

In 1967, Nancy Sinatra had a hit song called “Sugartown.” She sang, “I got some troubles, but they won’t last. I’m gonna lay right down here in the grass, and pretty soon all my troubles will pass” (most likely, she did not mean “pass” in the olestra way) “ ‘Cause I’m in shoo-shoo-shoo, shoo-shoo-shoo, Sugar Town.” There were about five more “shoos” in that line, but you get the drift.

Sugartown was the place to be. We believed it because of review articles like one that appeared in the New England Journal of Medicine (NEJM) the same year as “Sugartown” – 1967. It discounted evidence that linked sucrose consumption to coronary heart disease. Doctors believed it. They told their patients. Their patients believed them.

It turns out that this particular study was secretly funded by the Sugar Research Foundation (SRF). Now we know, thanks to a bombshell article recently published by University of California-San Francisco scientists in the journal, PLoS Biology, that the SRF (now defunct) was completely evil. It manipulated the science.

It not only “discounted evidence linking sucrose consumption to blood lipid levels and hence coronary heart disease,” report the study’s authors, Cristin Kearns, Dorie Apollonio, and Stanton Glantz. It also “withheld information from the public” linking sugar to changes in the microbiome that can lead to bladder cancer.

But it’s not just the SRF, which later became the International Sugar Research Foundation (ISRF); it’s a bunch of sugar industry trade associations. And it wasn’t just back in the 1960s. All of these groups have “consistently denied that sucrose has any metabolic effects related to chronic disease beyond its caloric effects,” Kearns, Apollonio and Glantz state. In other words, the main side effect these groups are willing to acknowledge is that sugar makes you gain weight.

Let’s take a moment here for me to say that I love sugar. I do. I love cookies, and chocolate cake, and coconut custard pie, and Mexican Coke with real cane sugar instead of corn syrup.  But I really limit it.  I don’t like food Nazis, who tend to be snarky and condescending and who alienate people who really could benefit from what they’re trying to say by making snide statements like, “What’s next, a deep fried stick of butter?” (I actually read that this week in a nutrition magazine that means well, but its tone is so snotty that it’s off-putting.)

That’s not what I’m trying to do at all. What I’m writing about here is the disturbing idea that sugar has been linked to serious illnesses and that the sugar industry has suppressed this information. If we had known six decades ago, maybe a lot more people would be alive now, and maybe our country wouldn’t be struggling so hard with obesity, heart disease, and diabetes.

In case you’re wondering, Kearns, D.D.S., M.B.A., is an assistant professor at the University of California San Francisco (UCSF) School of Dentistry. Stanton Glantz, Ph.D., is Distinguished Professor of Tobacco Control in the Department of Medicine at UCSF. He’s seen this same kind of twisting and distorting of medical evidence a lot; the tobacco industry did it for years. Dorie Apollonio, Ph.D., is an associate professor in the Department of Clinical Pharmacy at UCSF. Together, these UCSF researchers make a formidable team.

Now, back to the 60 years of manipulating the science and hiding the harmful effects of too much sugar. As recently as 2016, the Sugar Association issued a press release blasting findings from a study published in Cancer Research. In that study, done in mice, scientists found that dietary sugar induces increased tumor growth and metastasis when compared to a non-sugar starch diet. But instead of saying, “Hey, you know, maybe you might want to consider not eating so much sugar – all things in moderation,” the Sugar Association doubled down, stating that “no credible link between ingested sugars and cancer has been established.” Nothing to see here, move along, move along. Look over there – doughnuts with sprinkles!

In this PLoS paper, the UCSF scientists lay out a trail of damning evidence. In that first project in the 1960s, one group of rats was given a diet of 75 percent fat but no sugar. A second group of rats ate a diet of less fat, just 15 percent, but 60 percent sucrose, and their little bodies metabolized all that sugar as a carbohydrate. The sugar-eating rats developed thiamine deficiency, which then led to heart failure. But in the rats that ate more complex carbohydrates and no sugar, the gut bacteria, or microbiome, changed and actually started synthesizing thiamine.

This study intrigued SRF scientists, who thought that maybe, if the microbiome could be adjusted, the gut could tolerate sugar better. This idea led to Project 259, in which scientists led by W.F.R. Pover at the University of Birmingham in the UK studied the effect of sugar in the gut between 1967 and 1971. Pover’s team showed, in rats and guinea pigs, that eating more sugar led to higher levels of triglycerides; in turn, this led to higher levels of beta-glucoronidase in urine a finding that’s linked to bladder cancer and in an internal document, scientists described this research as “one of the first demonstrations of a biological difference” between rats that eat a lot of sugar and rats that don’t.

Project 259 didn’t just link sugar consumption to cancer, but to hypertriglyceridemia, an elevated level of triclycerides (a type of fat) that raises the risk of heart disease, say the UCSF scientists, and these findings stayed hidden for decades until the UCSF scientists uncovered them. Also suppressed was evidence linking higher doses of sugar to other “renal disorders, urinary tract infections, and renal transplant rejection.” Eat sugar – reject your donor kidney!

Even worse, the sugar industry did what every good magician knows how to do: misdirect. In previous research, published in the Journal of the American Medical Association (JAMA), Glantz and Kearns, with colleague Laura Schmidt, examined SRF internal documents and historical reports and found that the SRF secretly funded studies, including one published in 1965 in the NEJM, “promoting fat as the dietary culprit in coronary heart disease.”

Imagine there’s a gunshot, and the killer quickly places the murder weapon in somebody else’s hands and starts shouting, “He did it! It’s that guy!” and then slinks away. That’s what the sugar industry did.

For six decades, we have blamed fat – and as a society, we now look more and more like the tubby earthlings on the big spaceship in the Pixar movie, “Wall-e.” We’re huge, and we’re unhealthy.

Sugartown is not so sweet.

©Janet Farrar Worthington


If an illness can have a stereotype, gout has one: its poster boy is a portly, wealthy gentleman who drinks too much red wine and eats too much rich food. In literature, gout is an Epicurean affliction, the runoff of opulence and “disease of kings.”

In fact, gout attacks the poor as well as the rich; it’s more like a creepy shadow that follows other diseases, piggybacks off of their risk factors, and kicks sick people when they’re down. It is also becoming more common. Read more