DIETARY SUPPLEMENTS LIFESTYLE MANAGEMENT NUTRITION FOR MEN WITH PROSTATE CANCER POWER SNACK BALLS Serves. Ready in 20 min. Inactive time 1h. Recipe credit: www.nourishonline.ca Nutrition Facts Serving Size 2 balls Amount % DV Calories 220 Fat 12 g 18% Saturated 2 g + Trans 0 g % Cholesterol 0 mg Sodium 60 mg 3% Carbohydrate 25 g 8% Fibre 4 g 16% Sugars 14 g Protein 8 g Vitamin A 0% Vitamin C 0% Calcium 2% Iron % INSTRUCTIONS 1. Soak the dates in water for 5 minutes. INGREDIENTS 2. Grate the apple and cut the dates in small pieces. 3. In a bowl, mix all ingredients together until well combined. 4. Take 2 tablespoons of the mixture at a time and roll into a ball. Place them on a plate lined with parchment paper. 5. Roll the balls in ground pumpkin seeds before chilling (optional). 6. Refrigerate for 1 hour before serving. ½ cup peanut butter (ingredients should say just peanuts) 1 cup apple, grated (or ½ cup apple Sauce) 1 cup (6 8) large dates, pitted 2 tbsp honey ½ tsp ground cinnamon (optional) ½ tsp ground ginger (optional) 1 cup large flake oats 1 cup shelled pumpkin seeds (Pepitas)
DIETARY SUPPLEMENTS Use of dietary supplements is common after a diagnosis of cancer. In general, it is estimated that 71% of all Canadians take some form of dietary supplements. Dietary supplements can be seen by some people as a way to take a more natural approach to coping with or treating cancer, or to help regain a sense of control. Sometimes people will start taking supplements because of recommendations of well-meaning family and friends.
What are Dietary Supplements? Dietary supplements go by many names, and refer to any packaged product (capsule, tablet, liquid, powder, etc) that contains a nutrient or blend of nutrients. They can also include other agents. For example, vitamin E, or a combination of calcium, vitamin D and magnesium and/ or other ingredients such as glucosamine, gingko biloba, St. John s Wort, etc. In Canada, dietary supplements are also referred to as Natural Health Products, or NHPs. NHPs include vitamins and minerals, herbal remedies, homeopathic remedies, traditional medicine such as Traditional Chinese Medicine (TCM), probiotics and other products such as amino acids and essential fatty acids. They are sold over the counter in health food stores, pharmacies and grocery stores and by definition you do not need a prescription to purchase them. Many are made from plants but they may also include microorganisms, animal or marine ingredients or a combination of these.
Types of Dietary Supplements There are NHPs that are marketed for general health, bone or heart health, as well as those to promote better prostate health. Each NHP needs to be evaluated as to whether it is safe, effective and overall whether it s a good idea to use. In many cases, you can get all of the nutrients you need from food. Health Canada Among other tips, Health Canada recommends that consumers be skeptical of health-related claims for NHPs that seem too good to be true and to not rely on information from ads. Do your own research and talk to your health care provider before taking supplements.
A CLOSER LOOK AT COMMON DIETARY SUPPLEMENTS Vitamins and Minerals Vitamin E: Men need 15 mg of vitamin E (or about 22 IU) per day. The upper limit is set at 1,000 mg (about 1,500 IU) but adverse effects are seen with supplement doses greater than 400 IU, particularly for people with pre-existing conditions such as diabetes or heart disease. Calcium: Men need 1,000 mg of calcium per day (under 70 years of age) or 1,200 mg (over 70 years). Harmful side effects can be seen with long-term intakes greater than 2,500 mg per day (in men under 50 years of age) and at 2,000 mg (in men over 50 years).
Lifestyle Management Nutrition Good to Know: Each vitamin and mineral has a unique Recommended Daily Intake (RDI) which is the amount that is needed for most people to maintain good health. It is the total amount of that nutrient from all sources, including your diet (and any fortified foods) as well as any supplements you take including multivitamins. A good rule of thumb A good general rule of thumb if you take vitamin and/or mineral supplements is to limit the dose to up to 0% of the Recommended Daily Intake (RDI). The exception would be if you have been prescribed a vitamin or mineral supplement by your doctor. In that case it is important to take it as directed. One Brazil nut easily provides the daily requirement of selenium (200 ug/nut). Vitamin D: (the sunshine vitamin): Men need 600 IU of vitamin D per day (800 IU if over 70 years) for bone health. Health Canada recommends people over the age of 50 take a supplement of 400 IU each day. While vitamin D is currently being investigated for having a role in the development and treatment several cancers, there are no studies that show men taking vitamin D supplements (at any dose) have any prostate cancer-specific benefits. A supplement of vitamin D may be needed if exposure to sunshine is limited, as there are few foods that are a good source. The upper limit for vitamin D is 4,000 IU per day. See Session 9 on Managing Side Effects. Selenium: Men need 55 ug of selenium per day, and should not exceed 400 ug from all sources. Selenium supplements do not appear to prevent prostate cancer and in higher doses may increase the risk. For men with prostate cancer, selenium-rich foods should be sufficient for any benefits in delaying prostate cancer progression. One Brazil nut easily provides the daily requirement of selenium (200 ug/nut).
OTHER DIETARY SUPPLEMENTS Soy: Soy foods have been the most studied food or supplement in prostate cancer. Even so, the exact form and amount to take to delay prostate cancer progression is not known. Evidence suggests men may benefit from consuming 1-2 servings of soy per day of minimally processed foods (rather than a soy-based supplement). This includes cooked soybeans or roasted soy nuts, edamame, tofu or a soy beverage that is made from whole soybeans. Soy has other important health benefits, so find a favourite way to include in your diet. Lycopene: This is a component of tomatoes, pink grapefruit and watermelon that gives them their red and pink colour. It is thought to play a role in delaying prostate cancer progression but results are mixed. Tomato-based foods are the richest source (cooked tomatoes, tomato sauce, juice or soup) and easily provide enough lycopene without the need for a supplement. Food sources also provide a wide array of additional nutrients.
Fish oil capsules: Despite their popularity, fish oil capsules do not appear to have an effect on treating prostate cancer. Instead, it s recommended you eat fatty fish such as salmon, herring, mackerel or sardines twice a week. One serving is 4 oz (0 g) of fish. Fish oil capsules may play a role in treating heart disease (by lowering a fat in the blood called triglycerides). Speak to your doctor about whether you may benefit from a supplement and at what dose. Green Tea capsules: Capsules of green tea extract don t appear to offer any health advantages over the brewed beverage. The findings are also mixed as to whether green tea is truly beneficial in preventing cancer or its progression. Regardless, green tea as well as black tea have a number of promising compounds that have anti-cancer properties. Enjoy a cup or two per day. See Session 6 on Foods to Fight Prostate Cancer/Food as Medicine for information on antioxidants and dietary supplements that may contain hormones. See Selected References for additional information on NHPs and Session 1 where we discussed daily requirements for calcium, vitamin D, vitamin E and selenium.
Safety of Supplements Each nutrient has a margin of safety that varies a point where more is not better. For some nutrients, harmful effects can occur at doses of around twice the RDI (e.g. calcium) and for other nutrients the safety margin is much wider (e.g. 6 or more times for vitamin D). It s best not to guess when choosing whether to take a supplement, or its dose. About 12% of Canadians who use Natural Health Products have reported unwanted side effects. The number is likely higher when you consider that not all side effects are reported or even recognized as being related to supplements. But isn t all natural good? Dietary supplements can have negative side effects, particularly at higher doses. They can also interact with the prescription medications that you may be taking. These negative effects of dietary supplements are often overlooked because of the popular belief that they are natural. Natural is not the same as safe. Also, to avoid any potential side effects of large doses be aware of all the sources of vitamin or mineral supplement you are taking (as even once-a-day multivitamins can contain 0% of the RDI). A dietitian, pharmacist or doctor at your regional cancer centre or in your community can help you decide what is best for your individual situation.
Resources Health Canada s Natural Health Products information website http://bit.ly/1ojhddx Eatracker (free diet tracking and nutrient analysis software) This software has a unique feature that provides users with an estimate of their nutrient intake from dietary sources, and dietary supplements, or a combined total. https://www.eatracker.ca/ WHOLE FOODS BEFORE SUPPLEMENTS Integrative Medicine (supplement database and FAQs - Frequently Asked Questions) http://bit.ly/1hrqvaf Dietary Reference Intakes http://bit.ly/2m64bxh Health Canada NHPs Licensed products have an 8-digit Natural Product Number (NPN) or Homeopathic Medicine Number (DIN- HM) on their label. Just recently the Canadian government has included non-prescription drugs in this category. http://bit.ly/2aqbnnk It is best to meet your vitamin and mineral needs with food rather than supplements. Foods contain other beneficial ingredients (fibre and phytonutrients) that are not found in supplements. Also, research shows that vitamin and mineral supplements do not have the benefits that were expected. Ironically, supplements are often used by people with good diets who need them the least, possibly just as nutrition insurance. Natural Medicines Comprehensive Database (available as an internet based tool or book. A subscription required, or visit your local regional cancer centre) http://naturaldatabase.com
Tips for a nutrient-rich diet Follow the guidelines from earlier sessions and include a variety of fruits, vegetables, whole grains (breads, cereal, rice), legumes (beans), lentils, nuts, seeds, lean meats and lower fat dairy products. The following tips will also help you get more nutrients in your diet: Focus on whole, minimally processed foods whenever possible (e.g. an apple instead of apple juice); Combine at least 3 of the 4 food groups at meals and 2 at snacks (e.g. cereal, banana and milk); Choose a variety of foods (no single food can supply all the nutrients you need); Buy locally grown produce in season when possible; Track what you eat. You may discover you are meeting the RDI with foods alone, or be inspired to find ways to eat more of some foods (or eat them more often) to increase the nutrients in your diet. Use a diet tracker, such as Eatracker (a free, diet tracking software introduced in Session 1) to enter your food intake for 3 or more days. Eatracker has a feature in the nutritional analysis to show what contribution your diet vs. vitamin or mineral supplements have in meeting the daily RDI for key nutrients.
Ask the Dietitian Why aren t more dietary supplements recommended for men with prostate cancer? You re right, most are not recommended. The issue with most dietary supplements is that they have not been studied in men with prostate cancer. Many health care professionals will opt against a therapy in order to do no harm when there is no or very limited evidence to determine the possible benefits and risks. Are there dietary supplements I should avoid if I have had prostate cancer? It is likely safest to avoid vitamin and mineral supplements in doses much larger than 0% of the RDI (unless prescribed to you by your doctor), antioxidants at large doses (particularly during cancer treatment) and supplements containing hormones that could stimulate prostate cancer cell growth. Most experts agree there is no reason to take supplements of beta-carotene or selenium due to past studies that have shown an unexpected link with increased cancer.