A new PCF-funded trial (see Part 1 of this story here) is aimed at men who begin ADT when they are already carrying around excess weight (men with a body mass index [BMI] of 27 or higher). “If you’re overweight and you have prostate cancer, you have a worse prognosis,” says Weill-Cornell medical oncologist David Nanus, M.D. He is Principal Investigator of this study, along with medical oncologists Channing Paller, M.D., of Johns Hopkins, and Mark Stein, M.D., of Columbia University. “Your prostate cancer is more likely to be aggressive, and you’re more likely to die of it. More than that, when we put men on ADT, we make things worse. Even if you’re thin, our therapies make you gain weight and lose muscle mass.”
Men on ADT are more likely to develop a set of conditions known as metabolic syndrome: higher blood pressure, a rise in blood sugar, extra fat around the midsection, higher triglycerides and lower amounts of the “good” cholesterol, high-density lipoprotein (HDL). “As your blood sugar goes up, you’re more likely to get diabetes and heart disease – and the number one cause of death in men with prostate cancer is cardiovascular disease,” says Nanus.
This weight gain and loss of muscle mass happens even in men who are only on ADT temporarily, Nanus adds. “It happens pretty quickly. As doctors, we will say, ‘You need to lose weight. You need to exercise.’ But it’s the occasional man who loses weight. Most men try, but they’re not so successful and they gain weight.”
This may be because the average American diet is rich in processed food – everything from packaged lunchmeat to breakfast cereal to canned soups, sloppy joe and pasta sauces, to boxed “helper” meals (just add meat) and cake mix, to frozen entrees and pizzas. “If it’s got more than five ingredients, don’t eat it,” advises Nanus. “It’s full of preservatives.”
The study includes “a lot of coaching,” he continues, “explaining to the patients what they should be eating, and how to break that 11 o’clock bedtime craving for snacks, cookies, or ice cream.”
How the Study Works
This is a randomized trial, divided into a control arm and an intervention arm. The men in the control arm are encouraged to eat a healthy diet, and they, too, receive several weeks of nutritional counseling. “In both arms, we keep in touch with the patients to see how they are doing. Both groups have free access to a nutritionist.”
The men in the study’s intervention arm get extra help in the form of prepared whole-food, plant-based meals. “For the first month, they get 12 meals a week,” says Nanus. “That’s lunch and dinner six days a week.” For the second month, the men receive six meals a week with more coaching. For the next four months, “you’re basically on your own, with a lot of literature on what to eat for meals and snacks, and then at six months, we reassess. Did this intervention stick? Did you continue to lose weight?”
The meals contain “a lot of whole grains, soups, whole grain pasta, no additives – very healthy meals,” says Nanus. In addition, “you can eat as much salad as you want.”
But what about when the rubber hits the road – when men have to come up with and prepare their own meals? No worries! There’s plenty of support: suggestions and recipes for easy meals that men can make themselves. Here, for example, is a sample breakfast with just three ingredients: Avocado toast made with Ezekiel whole-grain bread (available in the refrigerated or frozen section of many grocery stores), smashed or cut-up avocado, and diced tomato. Optional: dress it up with a diced clove of garlic, a squeeze of lime, some chopped basil, dill, or parsley, and a thin-sliced radish. It’s not only delicious; it’s filling!
Good news for wine drinkers: men in both arms of the study can still drink wine, but are asked to limit to one or two glasses a week. Also, men are asked not to increase their normal level of exercise. If they are fairly active, fine; if not, that’s fine, too – “just keep doing what you’re doing,” says Nanus. This is so investigators can determine whether the weight loss and other changes are actually coming from the diet, and not from another other major lifestyle change.
Read next: Part 3: Is a Plant-Based Diet Life-Changing for Men on ADT?
