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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2005Pomegrate Juice
This looks very promising: NEW YORK (Reuters Health) - In men with recurrent prostate cancer, drinking 8 ounces per day of pomegranate juice significantly increases the time it takes for prostate specific antigen (PSA) levels to rise, according to research presented Monday at the annual meeting of the American Urological Association in San Antonio. Before the men in the study began consuming pomegranate juice, the average PSA doubling time, a measure of tumor activity, was 15 months, lead author Dr. Allan J. Pantuck, from the University of California at Los Angeles, told Reuters Health. "The average time after treatment was 37 months. So, there was almost a 2-year increase in the doubling time." Pomegranate juice contains a number of antioxidants thought to have anti-cancer effects, Pantuck noted. In addition, the juice contains estrogen-like plant substances called phytoestrogens that could be useful in combatting prostate cancer, in particular. Based on encouraging results in cell culture and in animal models of prostate cancer, Pantuck said his team decided to conduct a clinical trial of pomegranate juice in 48 men with rising PSA levels after surgery or radiation therapy for their malignancy. As noted, the subjects were instructed to consume 8 ounces of pomegranate juice daily. Pomegranate juice therapy was well tolerated and no serious adverse effects were reported. In addition to the beneficial increase in PSA doubling time, in vitro testing showed decreased cancer cell division and proliferation and increased cancer cell death. Urine testing confirmed the presence of pomegranate antioxidants in all men. Given these promising findings, Pantuck noted that a multicenter phase III randomized trial is now in the works. The study was funded by the Stewart and Lynda Resnick Trust, which own the POM Wonderful pomegranate juice company. http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=8578145  SignatureA merry heart doeth good like medicine: but a broken spirit drieth the bones. (Proverbs, 17:22) > Pomegranate juice contains a number of antioxidants thought to have > anti-cancer effects, Pantuck noted. In addition, the juice contains > estrogen-like plant substances called phytoestrogens that could be useful > in combatting prostate cancer, in particular. I almost always now drink at least 8 ounces of pomegranate or blueberry juice every day. The POM brand is, in my opinion, too expensive and I found a Knutsen concentrated pomegranate juice that I have to dilute down is the best value. I drank it in the hospital after surgery. My urologist saw it on my table and we discussed it. He was aware of some of the studies of the juice and he asked where I had heard of it. Good stuff. OCL I wonder if this is similar to the red wine studies. >I wonder if this is similar to the red wine studies. I would say it is similar. But the antioxidants in pomegranate juice are much more powerful and concentrated than those in red wine. Red wine is also pretty variable from brand to brand in how much reservatrol is present. I suppose that could happen with pomegranate juice as well. It's good stuff. So is red wine! OCL > ... In men with recurrent prostate cancer, drinking > 8 ounces per day of pomegranate juice significantly > increases the time it takes for prostate specific > antigen (PSA) levels to rise ... I've read similar things about tomato juice - which contains about 20 mg of lycopene in an eight ounce glass. I've been drinking a glass of tomato juice every day. It's reasonably cheap and (to me) good tasting. Alan Alan, are you sure about tomato juice? I thought the tomatos had to be cooked in a oil for the body to absorb and receive the benefits of the lycopenes. > Alan, are you sure about tomato juice? I thought the tomatos had to be > cooked in a oil for the body to absorb and receive the benefits of the > lycopenes. Good question. I don't know how tomato juice is prepared. Some of the bottlers advertise the lycopene content, but we all know the worth of advertising as a source of useful information. I do take gamma vitamin E with it, which may assist the absorption. I was following the advice of another poster on both of those supplements. There is at least some evidence for tomato juice helping. See: http://www.organicdownunder.com/researchers_suggest_five_serving.htm http://www.lef.org/magazine/mag2003/aug2003_itn_02.html Apparently heat processed tomato juice is better than unheated juice. See: http://www.lycopene.org/documents/htm/3957Lycopene%20&%20reduce%20oxid%20damage% 20&%20chr%20disease.htm But are all the juices heated? I'm guessing that all the canned and bottled juices are, but they who knows if they're heated in the presence of any oils? I'm guessing not. Maybe someone who knows more can weigh in? Alan These are important questions to find the answer for before someone sets a 10 year journey of trying to prevent PCa. I thought I saw a table somewhere that had lycopene content from various sources of tomato products. Dick Smith wrote: >> Alan, are you sure about tomato juice? I thought the tomatos had to >> be cooked in a oil for the body to absorb and receive the benefits >> of the lycopenes. Dick and Alan: From what I have read there are a couple of factors with lycopene and tomato products and you're both on the right track from what I've read and understand about body chemistry. Cooked tomato products make the lycopene more bio-available than the lycopene in fresh tomatos. Almost all tomato juice that you would buy in the store that is canned or bottled is cooked at some point. So that makes the lycopene more available. But, the advanatge to consuming it with oil is that the lycopene is soluble in oil and, as I understand it, is even more bio-available. But, the key is that it is cooked. I don't think that the Vitamin E with it enhances its absoprtion because the lycopene isn't in solution with the oil in the Vitamin E. The lycopene would have to be solubilized with oil in order to help it enter the lymphatic system bypassing the usual portal into the liver and bloodstream. A German study found that the absorption of lycopene is affected by what form the tomato is in and what is cooked with the tomato. Fresh tomato and tomato juice do not raise the blood lycopene level as high as does tomato sauce with oil cooked in the sauce--such as spaghetti or pizza sauce. . Lycopene content in mg/100g is Tomato paste 42.2 Spaghetti sauce 21.9 Chili sauce 19.5 Ketchup 15.9 Pink grapefruit 4.0 Raw tomato 3.0 I try to add tomato sauce and/or tomato paste to anything that I am cooking during the week where it won't detract from the recipe. OCL >> Alan, are you sure about tomato juice? I thought the tomatos had to > be [quoted text clipped - 13 lines] > canned and bottled juices are, but they who knows if they're > heated in the presence of any oils? I'm guessing not. I've never read that oils are a factor, just that cooking activates the lycopene. OTOH, antioxidants CONTINUE to be knocked off their hypothetical pedestal with each new study, almost every week. I doubt modest quantities of cranberry juice or marinara sauce or pomegranate juice will do us any harm, but such stalwarts as A and E look more harmful with each new study. It is repeatedly and increasingly emphasized that VARIETY in our diets is a key to health, that reliance on single foods diplaces that variety, and that no pill maker packages nutrients as well as Mother Nature does. I.P. > ... > OTOH, antioxidants CONTINUE to be knocked off their > hypothetical pedestal with each new study, almost every [quoted text clipped - 6 lines] > packages nutrients as well as Mother Nature does. > ... Making intelligent decisions about nutrition and supplements is remarkably difficult. The scientific information is both inconclusive and incomplete. However, that there is a positive effect of lycopene seems to be well established. A search of Pubmed on the terms (lycopene "prostate cancer") got 134 hits. Lots of them are just reviews of others, not original research reports, but there is at least some clear evidence of lycopene's anti-cancer capability in a test tube, in mice, and in humans. Green tea is also looking useful. I figure that things like tomato juice and green tea have been in diets for years and years and is not known to cause a problem for anyone, so I'm thinking it's safe to take them. I do take them. On the other hand, vitamin E has established benefits and established risks, so I use it, but in moderation. What else can we do? It seems to me safer to use supplements that we know can be beneficial even though the full analysis of them is incomplete, than to not use them. In other words, on balance, the risk of not taking the supplements seems a bit higher than for taking them. Your statement that variety in diet is beneficial is unimpeachable. Your statement that pill packagers may not be packaging nutrients as effectively as nature is more impeachable (for example, cooked, i.e., human processed, tomatoes appear to be more useful against cancer than raw tomatoes.) It's one of those decisions like radiation or surgery. You look at the evidence, but you know it's incomplete. You can't tell exactly what's going to happen. You don't know for sure that doing X or eating A is absolutely better than doing Y or eating B. You don't know how the test tube and mouse models apply to your case. You don't even know how the clinical trials apply to your case. But you're facing a life or death situation so, as the old saying goes, you pays your money and makes your choice. I'm choosing tomato juice, green tea, and moderate amounts of gamma vitamin E and ibuprofen. That _seems_ to be in accord with the evidence we have and _seems_ to be safe in light of the evidence we have. Alan > that there is a > positive effect of lycopene seems to be well established. > Green tea is also looking useful. Neither I nor the University of WA Dept. of Oncology has seen any proof. Can you offer some? > What else can we do? It seems to me safer to use supplements > that we know can be beneficial even though the full analysis [quoted text clipped - 7 lines] > with the evidence we have and _seems_ to be safe in light of > the evidence we have. Just today yet more authoritative condemnations of Vit E and NSAIDS such as ibuprofen, even in moderation, crossed my desk. I threw mine out long ago, especially since three days on any NSAIDS doubles me over in pain. > Your statement that pill packagers may not be > packaging nutrients as effectively as nature is more > impeachable (for example, cooked, i.e., human processed, > tomatoes appear to be more useful against cancer than raw > tomatoes.) I'm talking pills (i.e., extracts), not cooking. I don't know which of us, if either, is "right", but I would like to alert others who may read less that there are controversies even in such "old reliables" as these. I.P. > > that there is a > > positive effect of lycopene seems to be well established. > > Green tea is also looking useful. > > Neither I nor the University of WA Dept. of Oncology has > seen any proof. Can you offer some? Proof - no. Evidence - yes. Go to pubmed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) Search for "prostate cancer" and your supplement of interest, for example lycopene, green tea, vitamin E, or whatever. You'll see what the experimental evidence is. What you'll get will include a fair number of in vitro studies (treating PCa cells in a petri dish), a smaller number of mouse studies, and a few human studies including case reports, retrospective studies (e.g. interviewing men about their nutrition in the past) and even one or two honest to goodness clinical trials.) Dr. Kramer of the NCI has developed a categorization of "levels of evidence" for the efficacy of treatment. I'm guessing that he'd rate the level of evidence for all of these supplements at well below the top levels. But I'm also guessing he'd rate them above zero. [But that's my guess, not his rating.] > ... > I'm talking pills (i.e., extracts), not cooking. Understood. But cooking isn't quite raw Mother Nature either. > I don't know which of us, if either, is "right", but > I would like to alert others who may read less that > there are controversies even in such "old > reliables" as these. I completely agree. Anybody who gets into this stuff should have their eyes open and their bullshit scanners on high alert. Alan > I completely agree. Anybody who gets into this stuff > should have their eyes open and their bullshit scanners > on high alert. Mega dittos to this Alan!!! OCL Thanks for the lead. I already eat a fair amount of stewed tomato products, but it sounds worth eating more. I'll keep digging on the others. I agree we don't need proof as long as a supplement or food is safe. I.P. "Alan Meyer" <ameyer2@yahoo.com> wrote >> >> Neither I nor the University of WA Dept. of Oncology has >> seen any proof. Can you offer some? > > Proof - no. Evidence - yes. "Dr. Kramer of the NCI has developed a categorization of "levels of evidence" for the efficacy of treatment." Where would I find that, Alan? > "Dr. Kramer of the NCI has developed a categorization of > "levels of evidence" for the efficacy of treatment." > > Where would I find that, Alan? Here's one web page that discusses levels of evidence for adult cancer treatment studies: http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment If you put "levels of evidence" in the search box, you'll also be led to publications on levels of evidence for complementary and alternative medicine, screening, and other topics. Alan > OTOH, antioxidants CONTINUE to be knocked off their hypothetical pedestal > with each new study, almost every week. I doubt modest quantities of [quoted text clipped - 3 lines] > a key to health, that reliance on single foods diplaces that variety, and > that no pill maker packages nutrients as well as Mother Nature does. I.P.: As I understand it the problem with antioxidants is that some of them do "too good" a job at protecting cells. Some of them actually protect the cancer cells themselves from threats to their life. So, Vitamin E and even Vitamin C, for example, appear to protect cancer cells from dying. I think that a key in taking supplements is to zero in on those that lead to aptosis - which is the process of programmed cell death or cell suicide - and anti-angiogenesis agents - which stop the process of creating blood vessels to "feed" the cancer cells with oxygen and nutrients. So, for example, lycopene and green tea, Paw-Paw twig extract and quercetin, and the ellagic acid in pomegranate juice and black raspbeerries all have a role in helping cancer cells to die. They don't protect cells. But antioxidants protect even cancer cells. It's why I take no Vitamin C or E at all. OCL Copied to my Cancer folder. Thanks. I.P. >> OTOH, antioxidants CONTINUE to be knocked off their hypothetical pedestal >> with each new study, almost every week. I doubt modest quantities of [quoted text clipped - 25 lines] > > OCL > I.P.: As I understand it the problem with antioxidants is that some of them > do "too good" a job at protecting cells. Some of them actually protect [quoted text clipped - 11 lines] > But antioxidants protect even cancer cells. It's why I take no Vitamin > C or E at all. OCL: You offer a lot of very informative info on nutrition. My question is if you stop with Vitamin E and C, are you not protecting healthy cells in other internal organs too? I see the logic in not wanting to protect the PC cells, but can E & C still be useful to the body? When and how does one really know if you are protecting PC cells more than helping healthy cells? I, like IP, have lived a healthy lifestyle for quite sometime. I ate lots of cooked tomatoes because I love to cook and marinara sauce is high on my list as one of my favorite foods. I drank red wine with meals. (My father and grandparents were from Italy) I took vitamins daily. I worked out and exercised regularly since I was 15, and I was never overweight. I'm 53 now and can still bench press 200lbs 10 times and squat with over 300lbs with the Olympic bar at the gym. (I'm about 184lbs and 5'11 tall). All of this gets really, really confusing! There are lots of conflicting advice in some of the PC books, Internet, etc. I'm getting a headache thinking about it! B.A. > My question is if you stop with Vitamin E and C, are you not protecting > healthy cells in other internal organs too? I see the logic in not wanting > to protect the PC cells, but can E & C still be useful to the body? When > and how does one really know if you are protecting PC cells more than > helping healthy cells? Bob: That's a tough call, I know. It sounds even almost counter-intuitive. You'd want to protect healthy cells. But, the catch is that in protecting them there is some evidence that the "cell protectors" protect the very cancer cells you want to kill. It's why when I started down this PCa road I had to distinguish clearly between supplements and foods and all of that which help maintain and protect my health and those which have some evidence of actually killing cancer or helping cancer to die. For now, for me, even though I have had what appears to have successful surgery (no post-surgery PSA yet because it's too early), I regard the possibility of some errant cancer cells as more of a threat to my life than not protecting healthy cells. The cancer killing *stuff* is going to work throughout my body and that is more important for me than taking things things that would normally protect me from cancer. I already have cancer. The issue is killing it or helping it to die. > I, like IP, have lived a healthy lifestyle for quite sometime. I ate lots > of cooked tomatoes because I love to cook and marinara sauce is high on my [quoted text clipped - 6 lines] > advice in some of the PC books, Internet, etc. > I'm getting a headache thinking about it! I hear you Bob. I really do. I'm sure that your diet and physical health are all big pluses for you. You've done good stuff. I can only tell you what my approach has been. I don't ever settle for anything second-hand when it comes to nutrition and supplements. I dig until I can find the clinical study or the research study. I've read every single National Cancer Institute study or trial reeated to prostate cancer and every Complementary study or trial related to cancer in general. It's taken hours. I already had a decent background in some of this so that was a plus. I steer away from any website or any writting that comes from a seller or manufacturer. If someone stands to gain then I insist on finding what's behind their claims. The other way that I look at it is from the perspective of a really wise doctor who treated my wife. My wife is disabled and lives with chronic severe pain caused by degenerative joint disease (osteoarthritis) in her temporomandibular joints (jaw). She takes 90 mg of morphine a day for the pain and a host of other meds to help manage it. But this doc said that his approach was to not put all your eggs in one basket. If you have some modality of treatment that maybe gives you a 5 percent edge then you do it and you add on another one that gives you another 10 percent and a third that maybe only gives you 2 percent. But if those modalities don't have adverse side effects and don't diminish your quality of life then you add them together and maybe they give you that 50 percent that you need to live a decent life. I take the same approach with PCa. I had surgery which could have been a 100 percent thing. But, I don't and won't know for some time, maybe a long time. In the meantime I can do smaller things that together might be sufficient to give me the edge that I need to kill any cancer in me or to give me sufficient time for other modalities of treatment to be developed. So things that have some clearly demonstrated properties in apoptosis and anti-angiogenesis - knocking off those cancer cells - like green tea or quercetin or ellagic acid or paw paw or melatonin - then I will find the best and purest sources at decent prices and will take them. And I'll eat a ton of tomato sauce and drink pomegranate juice and eat black raspberries, cut way down on cholesterol and animal products with hormones that could feed cancer cells. And I'll see how my PSA turns out in July. And if it's bad, then I'll take the appropriate steps. If it's good - great! Over time, if my PSA is nonexistent, then I am sure that I will ease up on the dietary restrictions some and cut back on some of the supplements and move more towards a preventive mode than a killing mode. Sorry for the lengthy response. I got a little carried away! Have a great day! OCL > B.A. Hi OCL: Very sorry to hear about your wife and thanks for the informative reply! I wish I had healing powers and could fix everyone's health troubles with a just thought. It really gets me down to read about the situations some of our members are in on this newsgroup. I know what you mean about your approach to PC and nutrition. If I remember correctly, I think that we are similar in Gleason scores and that we are both relatively young. I had my PSA test in April, the first after surgery. It was <0.01 as I'm sure that yours will be too. I am now taking green leaf tea extract as well as melatonin. Do you think that I should concentrate more on the B complex vitamins instead of the multiples that contain E & C in fairly high doses that I am taking now? I too would like to see those PC cells dead for good and not help them survive in any way, it just gets kind of confusing at times. Thanks again! B.A. > even though > I have had what appears to have successful surgery (no post-surgery [quoted text clipped - 4 lines] > that would normally protect me from cancer. I already have cancer. > The issue is killing it or helping it to die. This begs the question, "Why aren't you on adjuvant ADT?" I.P. > This begs the question, "Why aren't you on adjuvant ADT?" I.P.: I am not aware of ADT being a standard protocol or even advised for post-surgical care when the surgical pathology is clear margins and no extra prostatic extension. Bone Scan and CT negative. I suppose one could pursue ADT, but I doubt that my urologist or many others would go for it without some indication of need. After a post-surgery PSA that's positive there would be a clear need, but not before, I don't think. OCL >> This begs the question, "Why aren't you on adjuvant ADT?" > [quoted text clipped - 6 lines] > > OCL Right. If vitamin C and E are risky because of side effects, ADT is downright dangerous by comparison. Getting ADT is really manipulating body chemistry big-time. I have arthritic symptoms that I attribute to ADT over a year and a half since my last injection. I think they're probably permanent. Stavros and others have reported the same thing. I'm not against ADT. It's keeping some of us alive and has apparently been shown to be useful as a neoadjuvant and adjuvant therapy with radiation. But we don't want to use it unless we've seen a clear indication that it's needed. Alan Except that E kills some people (cardiovascular disease). I must admit I haven't seen THAT as an ADT SE. I.P. > If vitamin C and E are risky because of side effects, ADT > is downright dangerous by comparison. Getting ADT is [quoted text clipped - 3 lines] > permanent. Stavros and others have reported the same > thing. All my docs and many others very strongly recommended it despite clear margins, N=0, M=0, CT & bone scan = 0, post-op PSA = 0.006. They consider early adjuvant ADT very important to minimizing the odds of recurrence with my Gleason 7/8. All them undetectable micromets, don'cha know? Certainly more proven than any supplements or foods in the eradication of micromets. Many docs disagree, too, based largely on the SEs, even when PSA rises again without symptoms. I.P. >> This begs the question, "Why aren't you on adjuvant ADT?" > [quoted text clipped - 5 lines] > that's > positive there would be a clear need, but not before, I don't think. >> OTOH, antioxidants CONTINUE to be knocked off their hypothetical pedestal with each new >> study, almost every week. I doubt modest quantities of cranberry juice or marinara [quoted text clipped - 20 lines] > > OCL OCL, I've done some browsing of Pubmed abstracts on vitamin E. My impression is that E really does induce apoptosis (cancer cell death) and is useful to cancer patients. I thought the problem with it was that it protects against radiation and, therefore, should not be taken by radiation patients while they are undergoing radiation therapy. But it's okay before and after (though I have no information about what intervals are desirable.) Lycopene too is an anti-oxidant. I'm not sure that anti-oxidant properties need to be avoided in general, just in relation to their protective effect against radiation. Have you got some info on more general problems with anti-oxidants in general or E in particular? Here's a related question: We have some evidence in favor of lycopene, green tea extract, quercetin, vitamin E, and some other compounds. The question is, do these do more if taken together, or is it the case that all have anti-oxidant qualities and taking any one of them in a sufficient dose gives you the anti-oxidant benefit so that taking all of them provides no additional benefit? I know that none of us knows the full answers to these questions, but I'm open to any thoughts on the subject. Alan |
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