Vitamins and diet (again and again…)

Drop in PSA on stopping B12 and folate

Why is it that this topic is so popular among most patients? I think it is because we have some sort of intrinsic belief that cancer has been caused by our not eating the right things and that (as Americans…) we can fix almost anything by taking a pill or altering our diet. I’ve got some news for you/us – it is probably true that diets have an effect on cancer development, but it is most likely over a lifetime, not in the 3 months of “whatever comes next” in our struggles with an ailment. I’m as guilty as the next person in not eating enough vegetables and in liking the taste of a fine New York strip steak, so consider this a missive from the “do as I say, not as I do” camp.

I have written in this and the old blog (link to the left) several times about multiple vitamins. I was inspired to write this blog because of an article that appeared in Medscape today on pretty dramatic changes in PSA in a patient who stopped taking folate and B12. The figure above (reproduced without permission) shows a pretty dramatic effect. The fact that the patient was on docetaxel the whole time may also have something to do with it, but it is hard to make a story out of a single patient.

The authors of this article referenced a study you can read here, in which men who received folate supplements over a ten year period had almost a 3 fold increase in prostate cancer. My thought is this: when your friends or neighbors tell you that there is a new supplement you can take, or a new diet, or a “detoxification program”, for the most part there are NO studies to support the claims. Worse yet, our baseline feelings of “why not, it can’t hurt anything” may be terribly wrong as illustrated by the study and the figure above. My advice really isn’t very different from others. The core things about diets that I think have merit are low fat, high soy, great exercise, and balance. In terms of supplements that have been studied, I tend to think there are a FEW patients who may benefit from adding lycopenes, pomegranate juice, perhaps green tea extracts, and fish oil. (the latter also made the news last week and you can read about that here) The best thing to do, however, may be to eat a balanced diet and avoid most supplements. The ones I list are generally supported by only one or two trials. Don’t forget that 15 years ago, everyone was touting selenium as preventing prostate cancer based on a single study. A subsequent study of selenium, vitamin E or both found no effect unfortunately, and the update actually showed that vitamin E supplements increased the risks.

Happy Thanksgiving and enjoy a bit of turkey and your family. Most of us have lots to be thankful for, even if we are fighting an uphill battle with prostate cancer whether as patients or physicians!