Many men are interested in (or are already taking) supplements and vitamins for their prostate cancer. How effective are these alternatives compared to traditional medicine and treatments? Sifting through the massive amounts of information on supplements and natural medicine is no easy task. PROSTATE PROS examines current trends and explores which supplements may help men with prostate cancer and which they should avoid.
Dr. Scholz: [00:03] We’re guiding you to treatment success and avoiding prostate cancer pitfalls. I’m your host, Dr. Mark Scholz.
Liz: [00:09] And I'm your cohost, Liz Graves.
Dr. Scholz: [00:13] Welcome to the PROSTATE PROS podcast.
Liz: [00:20] Alternative, natural therapies appeal to many people, but when it comes to prostate cancer, how much of this is just hype and how much is rooted in science? On this episode, we'll dive into supplements, minerals, and other natural options as they apply to prostate cancer.
Dr. Scholz: [00:37] Liz, at the beginning, I think we ought to give credit to a good friend of mine and professional colleague, Mark Moyad, who wrote a wonderful book called The Supplement Handbook. I am using some of the clinical trials cited in that book as we go through our discussion today. It is an excellent book, you can get it at Amazon, of course. It covers more than a hundred different conditions and prostate cancer is a small portion of it, but people are always interested in supplements and how they affect a wide variety of issues.
Liz: [01:09] We see this a lot with our patients. I would say you get at least an email a week from a patient asking if they should try the latest, this or that. We recently had a patient email about using mushrooms to treat prostate cancer. What do you reply when you get these emails?
Dr. Scholz: [01:26] Well, one thing I'm excited about is that they're testing the concept. So much of what's out there is based on someone saying “I felt better,” or some company has a strong marketing program. Supplements, if they're effective, should show an effect in randomized, placebo controlled trials. There's a big placebo effect. We're all susceptible to positive thinking, which is a wonderful thing, but you can give people a sugar pill and 25% to 30% of people improve. So when you do a test, you have to check the new substance against the placebo and you have to show a better outcome than the placebo accomplishes. Otherwise you're just giving another placebo.
Liz: [02:11] So in judging the efficacy of these supplements and minerals, you suggest trying to find studies?
Dr. Scholz: [02:18] Either to try to find studies, if you want to participate, but more importantly, know the studies or find supplements that are backed up by clinical trials that have been shown to be efficacious.
Liz: [02:30] Now, let's talk about some popular trends for your patients. One of those is a vitamin C infusion.
Dr. Scholz: [02:37] Vitamin C infusions have been around for a long time. Linus Pauling popularized this 30 years ago, 40 years ago. Vitamin C has been shown to shorten the duration of colds, it's been shown to improve healing after surgery, and it has been tested as a treatment for cancer. I've had a number of patients that have come to me wanting to do vitamin C infusions. And because I haven't seen convincing evidence that it works, I've been unwilling to do it in my own office. But they have gone to other offices and we check their PSA monthly. I asked them to stop their other treatments so we can tell what's working without any confusion. So far in over a half a dozen men, I have not seen a single case where the PSA has stabilized or dropped. It's been disappointing. Vitamin C is well tolerated, so they're not having any side effects, we're just not seeing results.
Liz: [03:36] So how long are people getting vitamin C infusions? Is it three weeks or five weeks?
Dr. Scholz: [03:41] Because prostate cancer tends to react slowly, if you look at PSA responses to other well-known treatments, hormone therapy, chemotherapy, it can take two or three months before the PSA will start to decline. So what we'll often do is ask them to come in monthly for a PSA. If after two, three or four months, the PSA is not budging, in other words, if it's continuing to rise, then patients actually quickly become convinced that this really isn't working.
Liz: [04:14] So getting your PSA tested regularly is important when trying to decide if a vitamin or supplement is working for your prostate cancer.
Dr. Scholz: [04:22] Yes, this is one of the unique things about prostate cancer: We have PSA. PSA is derided because it's sort of nonspecific for screening the general population, but it is a tool to monitor known prostate cancer, in particular, men that have had previous surgery. 75,000 to 80,000 men a year have radical prostatectomies for prostate cancer and about 25 to 30% percent of those men relapse. Their relapse is signaled by a rising PSA. We measure the doubling time: How quickly is it rising? That gives us an indication of how serious it is. So it's a great place to do clinical research to find out what is effective in controlling the cancer progression.
Liz: [05:09] Other natural products that are associated with prostate cancer are soy, selenium, vitamin E, broccoli, blueberry, green tea, and pomegranate. I know there was a lot of controversy around pomegranate. Can we talk about if that works for prostate cancer?
Dr. Scholz: [05:26] I think pomegranate is a great illustration because all the early trials, which were not placebo controlled, showed a benefit. 25%, 30%, 40% of men whose PSA levels were rising after surgery seemed to stabilize for at least a period of time. Later someone did a randomized placebo control trial, and that trial showed that pomegranate worked just as well as the placebo did. So this is why, without good quality trials, it's easy to come across small human trials showing that something slows or stabilizes PSA, but if it's not compared with a placebo, you get the false impression that it's efficacious. Sometimes things even turn out to be worse. Not that many things are studied in controlled clinical trials because it's expensive to do. But, both selenium and vitamin E have been studied in multimillion dollar studies because of early indications that they had anticancer efficacy. It turned out that the patients on those products either had unexpected side effects or did worse with the vitamin E and selenium as compared to a placebo.
Liz: [06:38] I think something everyone is susceptible to, you and I have talked about this is, is getting excited about these. You think vitamin E is going to work and it's like, great. I don't have to do chemo. I just gotta take this vitamin. Like, that's so wonderful! But the thing is, is there's no magic bullets.
Dr. Scholz: [06:57] Yeah. I think there's a whole industry that feeds off the woeful state of cancer patients and big marketing budgets and selling supplements. So it's not that some supplements don't have a role, it's that the industry behind it is profit driven and patients who have cancer are very vulnerable.
Liz: [07:18] Is it true Dr. Scholz, that if you take a lot of these supplements, it can actually increase your risk of prostate cancer?
Dr. Scholz: [07:25] Yeah, clinical trials have been done that convincingly show that people that take various minerals like zinc, iron, and copper can accelerate prostate cancer and for people with known prostate cancer, multivitamins can as well. It kind of makes sense if you think about it because prostate cancer cells are very similar to our human cells and are derived from our human body. The very things that help us to grow big and strong (minerals and vitamins, animal protein) all these things can also fortify the cancer and enable it to grow. Unexpectedly, because the prostate cancer cells can grow, just like our human cells can grow, they need minerals and vitamins to grow more quickly. Depriving the cancer cells of these substances, retards cancer growth, giving extra amounts can accelerate the growth of the cancer. People oftentimes are taking these supplements because they think it will strengthen their immune system. Strengthening the immune system, of course, it's a very important and good thing, but oftentimes the cancer cells are flying under the radar of the immune system. It's not a weak immune system, it's a blind immune system. So some new pharmaceuticals coming out in the future that are going to awaken the immune system to attack cancer cells, but in the meantime, these multivitamins and minerals are probably doing more harm than good.
Liz: [08:52] A couple of these are zinc, iron, and copper, but my question is: Zinc is something we take for a common cold, should prostate cancer patients avoid that entirely, or is it okay in small doses?
Dr. Scholz: [09:07] Excellent question as we're facing the issue, of course, with the COVID virus, which is similar to a common cold. So zinc can shorten the duration of the cold virus. Once the cold virus gets into our bodies, say in the throat area, it multiplies, and then it spreads to other areas of the body like the sinuses, the nose, and the lungs. What zinc does is it stops it from spreading further. Taking zinc on a daily basis is not going to help prevent a cold, but once people develop cold symptoms, they should take zinc lozenges and bathe their mucosal membranes, with zinc until the cold symptoms go away. And there's certainly no harm in that for prostate cancer patients.
Liz: [09:52] So we've mentioned a lot of things that don't necessarily work. But there are things that work and again, Dr. Scholz and I both referenced The Supplement Handbook by Dr. Mark Moyad. The subtitle is A Trusted Experts Guide to What Works and What's Worthless for More Than 100 Conditions. So this book was really, really helpful, and I'm sure if you get it, it'll help you too. One thing Dr. Moyad mentioned in the prostate cancer section were statin drugs and Metformin.
Dr. Scholz: [10:25] Yeah, someday, I hope we have a pill for exercise, but statins and Metformin think of them as pills for diet. No one likes to exercise and no one likes to diet, but statin drugs and Metformin mimic the effects of the diet on the human metabolism. Stains drugs by lowering cholesterol levels, Metformin by lowering insulin levels. Both of these medicines are relatively safe. Of course they need to be supervised and your blood tests need to be followed to make sure there's no side effects. But as everyone knows these are used very commonly for heart disease and diabetes, so there's broad familiarity with these substances. The studies have shown that statin drugs and Metformin are useful for prostate cancer patients have been done in men with High-Risk prostate cancer, Gleason 9, or 10, or 8 and undergoing radiation. Studies that were performed comparing outcomes for men that have radiation for High-Risk prostate cancer and those that are taking statin drugs and/or Metformin show improved survival in the men that are taking those pills compared to the ones that don't. So it seems like a good trade off—they're relatively inexpensive, easily accessible, and generally well tolerated. The preliminary data, these are not randomized prospective trials, but the preliminary data does look quite intriguing.
Liz: [11:51] Another thing Dr. Moyad mentioned is red yeast rice. This needs a couple more trials, but it does work like a statin.
Dr. Scholz: [12:00] Yeah, it does. One of the problems with supplements in general is that cancer doctors, such as myself, are really not looking for halfway measures. We want to find the most potent and efficacious agents. One of the nice things about supplements is that they typically don't have much in the way of side effects. That's a beautiful thing. On the other hand, oftentimes they're not nearly as potent as what prescription pharmaceuticals can accomplish. So if you look at red rice yeast, the potency compared to a common cholesterol drug, like Lipitor is probably about 10 to 20% of Lipitor. So instead of taking 10 milligrams of Lipitor, you're taking one milligram of Lipitor. For totally healthy people that are just fine tuning, and don't want to go see a doctor, red rice yeast is great but if you're trying to squeeze the maximum juice out of the orange for getting cured of High-Risk prostate cancer, I would probably go towards a statin drug rather than red rice yeast.
Liz: [12:59] One of Dr. Moyad’s key phrases, he says this a lot at PCRI conferences and it's also in this book is heart healthy is prostate healthy. One drug he mentioned for this is aspirin.
Dr. Scholz: [13:11] So baby aspirin was given almost universally in tele trial in the New England Journal of Medicine came out a couple of years ago showing really no improvement in overall outcome in the general population without any heart disease. So taking it, or putting it in the water, or everyone taking it, doesn't make any sense, but people that have heart disease and people that have High-Risk prostate cancer do appear to benefit by taking a baby aspirin. The method of action is purely speculative, but one of the scary and dangerous things about cancers of course, is that they can spread and it's possible because aspirin is a mild anticoagulant that it makes it more difficult for cancer cells to get out of the prostate, to land, put down roots, and grow in other parts of the body. So for whatever reason, just as is the case for statin drugs and Metformin, baby aspirin seems to, in fact, any dose of aspirin seems to reduce the risk of relapse in people undergoing radiation for High-Risk prostate cancer.
Liz: [14:13] Two vitamins and supplements I hear you talk to your patients a lot about are vitamin D and calcium.
Dr. Scholz: [14:20] This comes up because we give hormone therapy to some of our prostate cancer patients, which causes accelerated calcium loss from the bones and osteoporosis. When osteoporosis gets out of hand, people can have a bone fractures. So vitamin D is fascinating because a number of years ago, large clinical trials looked at adding super high-dose vitamin D to chemotherapy called Taxotere. Preliminary trials, once again, showed that it would likely prolonged survival and increased the anticancer effects of the chemotherapy. Unfortunately, that trial didn't pan out. It might've been due to poor trial design, not through the fact that vitamin D failed, but beyond the fact that vitamin D can treat prostate cancer, there are a lot of reasons to consider its usefulness: to build bones, not just men with low testosterone develop osteoporosis, but all aging people do. Calcium is usually given at the same time. Now calcium is pretty high in our diets already. So calcium deficiency is not common, but if people want to take small doses of calcium, it's important to remember to take it in the evening because your bone metabolism, your bone remodeling, occurs at night while you're sleeping. If you take your calcium in the morning, it'll just be urinated out during the day and have little, if any impact. Studies have shown that super high doses of calcium can be deleterious for prostate cancer patients. Taking grams and grams of calcium every day in men that have advanced prostate cancer actually accelerated mortality. So calcium should be used judiciously in small doses, probably at bedtime. Vitamin D blood levels can be tested, and that's the best way to guide appropriate dosing. People often start with a thousand units a day and then see, after a few months, what the blood levels have arrived at. It takes about three months for vitamin D levels to equilibrate in the blood.
Liz: [16:22] So you can have too much of a good thing. So while you're doing these things, it's important to partner with your doctor and make sure that you're doing everything safely and that it is helping. You can actually get a lot of your vitamins just from eating a healthy diet. How else can diet impact prostate cancer, Dr. Scholz?
Dr. Scholz: [16:42] Well, earlier we talked about how we can monitor PSA levels monthly in men that had previous surgery and are facing a relapse. The same measuring methodology can be used for people who change their diet. I've had a number of patients come to me through the years, not at my recommendation, but who wanted to go on a diet and see how powerful that would be for inhibiting cancer progression. Typically they would pick very stringent, vegetarian diets, macrobiotic diets, lose weight as a result, although that wasn't the goal, and lo and behold PSA levels that were previously rising steadily would stabilize and stop rising for as long as they were carefully following their diets. It didn't make the cancer go away, but it's certainly slowed down its growth.
Liz: [17:33] Well, let's say you have a patient who's on a vegan diet, has a healthy weight, is taking the right amount of the correct supplements. Like will they not get prostate cancer, or if they have prostate cancer, will it prevent it from being aggressive?
Dr. Scholz: [17:50] My personal belief, which is all we can really go on, is that those good practices will reduce the incidence of prostate cancer and they will inhibit the prostate cancers that do occur and postpone their development. I don't think we can point to any one magic methodology to ensure that we won't get any kind of health problem including cancer, but I think we can definitely reduce our risk.
Liz: [18:18] Where's the line between going too far with all of this and also not trying enough?
Dr. Scholz: [18:25] Well, the most stark examples I've had are patients who've come to me for consultation and then made a decision to move to Mexico and undergo regular treatment with coffee enemas. The idea that alternative medicine is on par with what modern technology can offer is rather ridiculous. I see these supplements and diet and exercise as ancillary to all the other available treatments. Not to say that standard treatments can't be overused and incur unnecessary toxicity, everything has to be done skillfully, but I think it's the either or thinking that some people adopt that can really hurt them.
Liz: [19:12] So when you're in a consult and someone brings up supplements, what do you say?
Dr. Scholz: [19:17] Well, oftentimes it's a matter of cutting back because if people have a real prostate cancer, of course, many people have innocuous, prostate cancers and their dietary and supplement behavior may not matter that much for small Gleason 6 prostate cancer, but for people that have the higher grade cancers the usual policy is to warn them that they're multivitamin, multi-mineral preparations may be actually enhancing cancer growth. Just as we would advise them to stay away from fatty foods and high protein, animal protein based diets, which could also accelerate cancer growth.
Liz: [19:58] As you can imagine, this is a huge topic. For instance, Dr. Moyad’s book is about 500 pages and only about a page and a half of that is about prostate cancer. What we focus on is individualized care, treating the whole patient. We've been focusing on just prostate cancer today, but there are supplements for fatigue, for nausea, for men's health. The list goes on and on.
Dr. Scholz: [20:23] So one thing we've learned today is that some supplements and excess minerals can be deleterious. Another thing we've learned is that you need to have clinical trials to back up what you're recommending. The third thing is that supplements tend to be milder than normal medicines and have fewer side effects, but may not have the same horsepower. A good illustration of this is a problem that occurred more than 10 years ago with a supplement called PC-SPES which was some sort of herbal derivative that had estrogenic activity, a combination of Chinese herbs. Lo and behold, this supplement could really cause PSA declines and maintain them. What was also seen is that testosterone levels dropped, breast enlargement occurred, and some men developed blood clots. I think this illustrates that things that are really going to move the needle in treating cancer are going to also have a potential for side effects. The day when we have something that will kill all cancer without any side effects would be truly miraculous. As of now that day hasn't arrived.
Liz: [21:38] This was a really great topic. I learned so much in researching this. Next time we're going to talk about testosterone, a little bit about testosterone replacement, and maybe about testosterone using testosterone in patient’s partners. Thank you for listening. Remember to subscribe, rate, and review on Apple Podcasts and visit our website at podcast.prostateoncology.com.
