Flax and Prostate Cancer Risk

Image Credit: AlishaV/ Flickr

Might flax seeds (ALA) increase prostate cancer risk?

There are a lot discussions and articles online about the supposed connection between flax seeds (ALA) and prostate cancer – suggesting that more flax consumed = increase chance of prostate cancer. I haven’t found this issue addressed on your website (sorry if I missed it). Can you comment? Thanks!

DSikes / Originally posted below Just the Flax, Ma’am


The latest meta-analysis of prospective studies found that, if anything, alpha-linolenic acid (ALA, the omega-3 fat in flax) was protective against prostate cancer. Men consuming more than 1.5 g/day appeared to have significantly lower risk (the amount found in about a tablespoon of ground flax seeds).

One of the reasons there’s been so much conflicting data is that ALA is found in great foods (dark green leafies) and less than great foods (meat), and so ALA intake is not necessarily a marker of healthy eating. What you want is a randomized controlled study of men with prostate cancer. Give half of them flax and see what happens. And that was done! (full text here)

Researchers at the University of Texas Anderson Cancer Center took a bunch of men with prostate cancer about a month before they were to go into surgery. Half were put on a few tablespoons of ground flax a day and after surgery their cancerous prostates were examined. The proliferation rates of the cancer in the flax-eaters were only half that of the controls, confirming the test-tube studies done on prostate cancer cells suggesting that flax can indeed slow prostate tumor growth.

For more on the effect of flax nutrients see videos such as:

Image credit: AlishaV/ Flickr


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

44 responses to “Might flax seeds (ALA) increase prostate cancer risk?

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  1. Table 11 of veganhealth.org’s Omega-3 article at http://www.veganhealth.org/articles/omega3
    says that the Nurse’s Health Study found that more than 1.25 – 1.5
    grams per day of ALA can possibly cause eye problems. One tablespoon of
    flaxseeds contains of 1.6 grams of ALA (see Table 8). So taking just
    one tablespoon of flaxseed a day could
    possibly be dangerous to your eyesight, unless flax is exempt from the
    Nurses Health Study findings. So is flax exempt from those findings?

  2. I was wondering if anyone knew of anything to help with dandruff. I have a dry flaky scalp, and not sure if it is eczema, seborrhea dermatis or etc.

    I know people recommend that this suggests a lack of omega 3’s. I have trying to eat 2 tablespoons of flax seed a day and have also been taking two vegan omega 3 supplements. Do I need both EPA and DHA and how much should I be consuming per day?

    1. apparently a shampoo with selenium used to be very popular, I wonder if selenium itself has anything to do with the effectiveness. Just a thought…

    2. Omega 6 deficiency is the cause of dry skin.

      Omega 6 fatty acids from whole foods like nuts and seeds though.

      Avoid oxidized seed oils.

        1. Omega 6 deficiency is known in families where extra virgin olive oil is consumed and where seed oils, nuts and seeds aren’t consumed. I grew up like this.

          Omega 6 fatty acids from whole foods are converted by intestinal bacteria into conjugated linoleic acids which promote the burning of fat as fuel.

          I get your point though. Its just that Omega 6 fatty acids are superior from whole foods and it is unfortunate that they are slandered just because most people consume them in oxidized form from them oils.

          I think his problem could be caused by gluten. I’ve noticed now that I haven’t had dandruff since I quit gluten.

          1. Actually, Omega 6’s are converted to arachidonic acid once absorbed and competitive enzymes do the rest. Even a high olive oil diet provides more then enough omega 6. All foods are rich sources of omega 6, it isn’t possible, unless undernourished, to not get enough omega 6.

            1. Not all the Omega 6 fatty acids that are absorbed are converted right away into arachidonic acid. Excess linoleic acid is stored in adipose tissue and is known to lower cholesterol(lipoprotein) levels however most people consume oxidized lipids from seed oils which cause inflammation in the body. Read up on “Linoleic acid hydroperoxide”. Or they consume arachidonic acid directly from animal foods loaded with toxins that set off inflammation.

              Olive oil doesn’t provide sufficient quantities of quality Omega 6 fatty acids. The WHO recommendations are WAY underestimated because we have omega 6 alarmists that DON’T understand the science.


              Omega 6 fatty acids from whole foods are required to increase cranial size and produce our own THC.

              1. What you are arguing goes completely against public health concerns. Please research from reputable health resources. From the national academy of science.

                “Linoleic acid is the only n-6 polyunsaturated fatty acid that is an essential fatty acid; it serves as a precursor to eicosanoids. A lack of dietary n-6 polyunsaturated fatty acids is characterized by rough and scaly skin, dermatitis, and an elevated eicosatrienoic acid:arachidonic acid (triene:tetraene) ratio. The AI for linoleic acid is based on the median intake in the United States where an n-6 fatty acid deficiency is nonexistent in healthy individuals. The AI is 17 g/d for young men and 12 g/d for young women. While intake levels much lower than the AI occur in the United States without the presence of a deficiency, the AI can provide the beneficial
                health effects associated with the consumption of linoleic acid (see Chapter 11). There is insufficient evidence to set a UL for n-6 polyunsaturated fatty acids…Linoleic acid is the precursor to arachidonic acid, which is the substrate for eicosanoid production in tissues”

                As I have been saying with the conversion rates “Thus, high intakes of n-3 fatty acids or arachidonic and linoleic acids will reduce the efficiency of conversion of linoleic acid to arachidonic acid and α-linolenic acid to its products…n-6 Fatty acids are almost completely absorbed and are either incorporated into tissue lipids, utilized in eicosanoid synthesis, or oxidized to carbon dioxide and water.”

                You yourself have fallen into a false idea that omega 6 is rare and a deficiency is rampant. The opposite is true, lets not invent false health issues among Americans.

                1. This is what happens when nutritionists try to be biochemists. I am seeing the earth as a sphere and everyone is seeing the earth as flat.

                  The ratio science doesn’t exist because it was done using oxidized seed oils. Therefore it is pure wishful thinking.

                  The deficiency is rampant because the Omega 6’s found in oils have be oxidized during production and serve no purpose other than cause disease. Seed oils give me cystic acne on my forehead while consuming large amounts of nuts and seeds with leafy greens increase my mental processing.

                  1. Not all seed oils have gone rancid, and I am not talking about seed oils here. I am talking purely about whole foods.

                    Where is your evidence that seed oil omega 6’s function differently in the body from omega 6’s in nuts and other foods? Please use scientific studies, not wikipedia or blog posts.

                    1. Omega 6


                      Omega 3

                      “It is further possible that a large part of the electrophysiological effects attributed to n-3 PUFAs may be dependent on their oxidation. An interesting study led by Sébastien Judé of Nutrition, Croissance et Cancer in France showed that the electrophysiological effects of DHA on the transient outward current in cardiomyocytes were only present when the DHA was oxidized with a small amount of hydrogen peroxide; DHA on its own was much less effective.10 This finding led the authors to speculate that perhaps it is oxidized derivatives of DHA that are responsible for many of the electrophysiological effects of DHA observed to date—primarily in culture dishes, where DHA is exposed to room air and thus likely to be oxidized.”


                    2. These papers do nothing to address the question of “Where is your evidence that seed oil omega 6’s function differently in the body from omega 6’s in nuts and other foods?” Namely, where is your data that omega 6’s from oil depends on the omega6:3 ratio while omega 6 from nuts do not depend on the ratio? Yes oxidized oils are carcinogenic, this is not new information.

                    3. Show me studies that used Omega 3’s and 6’s from WHOLE FOODS. Since the omega ratio studies used oxidized carcinogenic oils, they are automatically invalid. Flawed scientific studies don’t count.

                      Whole foods also contain vitamins and minerals which play a major role in regulating everything regardless of the quantity of whole food consumed.


                      Another reason why most people think that Omega 6 fatty acids are “inflammatory” is because the majority of people breath in air pollution and other airborne toxins like cigarette smoke that cause the inflammation in the first place.


                    4. It is not up to me to prove that a fat from a food extract functions the same as the fat from the food, you are the one with the outlandish claim. There is no evidence or reason to assume that omega 6 from oils does not metabolize to arachidonic acid. It is total nonsense. You clearly have a bias or have invested too much time reading a flawed blog post.

                      To claim that “Since the omega ratio studies used oxidized carcinogenic oils, they are automatically invalid” is totally false. Arachidonic acid is inflammatory, DHA/EPA is anti inflammatory. These are facts, not invented opinions by “flawed scientific studies”. The ratio is still valid because it applies to non pre formed omega 6 and 3. Whether the oil becomes oxidized or not is not important when discussing the ratio. Again, present real EVIDENCE for your claims. Lets not invent reasons without a base.

                    5. Your bases for believing omega 6 as anti inflammatory is based on a youtube video? Frankly I find that quite ridiculous. This is not how one should come to conclusions. I am not a paleolithic dieter, I am a whole foods plant based vegan. It is a sound fact the Arachidonic acid is a pro inflammatory and DHA/EPA is an anti inflammatory. They balance each other out, which is why the ratio is important to get a good amount of both.

                      The biochemistry speaks for itself. “Arachidonic acid is a precursor to a number of eicsanoids (e.g.,thromboxane A2, prostacylcin, and leukotriene B4). These eicosanoids have been shown to have beneficial and adverse effects in the onset of platelet aggregation, hemodynamics, and coronary vascular tone. EPA has been shown to compete with the biosynthesis of n-6 eicosanoids and is the precursor of several n-3 eicosanoids (e.g., thromboxane A3, prostaglandin I3, and leukotriene B5), resulting in a less thrombotic and atherogenic state”

                      As this conversation has gone on it has become more clear you are not interested in the science but have your own philosophy of how things work rather then how they actually do work. It is ok to examine the evidence and come to conclusions based on it rather then continue to debate this non issue that you simply cannot prove because no evidence exists supporting your claim.

                    6. Correction: Arachidonic acid is a pro(promotes) inflammation and DHA/EPA is an less (promoting) of inflammation.

                      “Arachidonic acid is a precursor to a number of eicosanoids (e.g.,thromboxane A2, prostacylcin, and leukotriene B4). These eicosanoids have been shown to have ***BENEFICIAL*** and adverse effects in the onset of platelet aggregation, hemodynamics, and coronary vascular tone. EPA has been shown to compete with the biosynthesis of n-6 eicosanoids and is the precursor of several n-3 eicosanoids (e.g., thromboxane A3, prostaglandin I3, and leukotriene B5), resulting in a less thrombotic and atherogenic state”

                      When do the cells produce these eicosanoids?

                      You are a blockhead and it is pointless trying to explain to you science that is clearly over your head.

                      You can remain brainwashed by the Paleo pseudoscience because that is where the omega ratio myth originated.

                    7. Ah, I am the one who is the blockhead. This conversation has made that clear. Especially since the national academy of science are made up of paleo proponents. Yes I am the one who is misunderstanding basic concepts.

                    8. Again, the ratio science is just that: both omega-3 and omega-6 fatty acids are
                      on the same pathway competing for the same elongase and desaturase
                      enzymes that will convert them to EPA/DHA and AA, respectively. The more
                      omega-3 than omega-6, the more EPA/DHA, the less AA. The more meat and
                      junk in the diet, the more omega-6 and the more AA, consequently less
                      EPA/DHA. Not wishful thinking, just your basic REALITY.

                  2. The ratio science is just that: both omega-3 and omega-6 fatty acids are on the same pathway competing for the same elongase and desaturase enzymes that will convert them to EPA/DHA and AA, respectively. The more omega-3 than omega-6, the more EPA/DHA, the less AA. The more meat and junk in the diet, the more omega-6 and the more AA, consequently less EPA/DHA. Not wishful thinking, just your basic REALITY.

          2. We should also note that because people get so much omega 6 in the diet, the 4:1 ratio of omega 6:3 is disrupted. too much omega 6 and you wont convert ALA to DHA and EPA. One should not strive to get MORE omega 6, one should try to lower omega 6 and raise omega 3. It is unfounded to do the opposite.

            1. This ratio nonsense only applies when consuming processed seed oils and animal products loaded with toxins. Both these types of foods initiate inflammation.

              The desaturase enzymes that convert ALA to EPA and DHA or LA to ARA and DGLA are regulated by Retinoic Acid(Vitamin A metabolite). We should strive to consume more leafy greens rich in Vitamin A and not worry about the consumption of Omega 6 fatty acids from whole foods.

              Raising Omega 3 fatty acids and lowering Omega 6 fatty acids from whole foods will lead to a decrease in cranial size, depression, addiction, smaller penis size in male generations, and I can go on and on about how Omega 6 fatty acids from whole foods are extremely beneficial.

              1. Again, what you are arguing is not true on a biochemical standpoint and is nonsense. Non preformed omega 6 is part of the ratio unless you bypass it by consuming pre formed arachidonic acid found primarily in eggs and other animal products. As I mentioned in the paper from the national academy of science, the ratio is not negligible and is an important player.

                1. The ratio doesn’t apply when consuming nuts and seeds because linoleic acid is also converted to various conjugated linoleic acids by intestinal bacteria and the various CLA’s play a major role in regulating where lipids are stored and promote the utilization of fat as fuel. When someone consumes seed oils, these seed oils cause inflammation in the intestine and kill the bacteria required for this bioconversion.


                  1. “There is limited evidence to suggest that the trans-10,cis-12 isomer reduces the uptake of lipids by the adipocyte, and that the cis-9,trans-11 isomer is active in inhibiting carcinogenesis. Similarly, there are limited data to show that cis-9,trans-11 and trans-10,cis-12 isomers inhibit atherogenesis”
                    I would not call this role major, I would not even consider CLA as a major player in disease prevention.

                    You are twisting the real issues at hand and inventing non issues.

                    1. When did I say anything about disease prevention?

                      I am pointing out that non-oxodized linoleic acid will be converted into various conjugated linoleic acids in a healthy intestine by intestinal bacteria and that CLA’s promote the storage of fats inside muscle tissue instead of adipose tissue. Hence the body works totally different on a whole foods diet.

  3. Hello, Dr. Greger. I posted a question on your YouTube site, but another viewer claimed that you were more inclined to answer questions here. I have researched high and low for an answer to whether the phytoestrogens in flax seed improve or worsen gynecomastia (in men obviously), but have not been able to find a conclusive answer. I would love to get the benefits from flax, but am afraid that I will just worsen the condition (aquired during adolecence) which I still have in my mid-30s. I’m asking you because you are so thorough in your research and therefore I trust your response. Please take a moment to detail your findings on this. Thank you.

    1. I would not worry about the phytoestrogens. I have never seen any studies associating the two and based on current understanding of human metabolism can see no credible hypothesis. The condition has many causes as I’m sure you are well aware. Given the length of time you have had the condition I’m sure the appropriate tests have been done and medication causes have been excluded. I would suggest maintaining ideal body weight which will lower your estrogen production by your fat cells. Of course it might make your condition a bit more prominent. Plant based diets generally increase the amount of steroid binding protein in the blood so there is less free estrogen and testosterone in the blood. I’m not aware of any long term studies on the course of gynecomastia acquired in adolescence. Sorry I couldn’t be of more help.

  4. I’ve been consuming flax oil stored at room temperature with minimal light for a while now. I just realized that it might be getting oxidized, and the oxidized oil might be harmful. The flax oil that I buy is cold pressed, and nitrogen purged. From now on, I am going to store most of it in the freezer (the stuff that’s still nitrogen purged), and 1 open container in the frige.

  5. Not sure where the best place to post this question is…so here goes…
    Appreciating the value of adding ground flax seeds to one’s diet, one wonders regarding the benefits of sprouting flax seeds in the manner of broccoli seeds…

    I have read various articles that claim that sprouted flax seeds lack a factor that retards their ability to be digested (assuming they are ground), but the sources seem as much belief based as grounded in actual science.

    Has anyone conducted a reliable analysis of ground versus sprouted flax seeds?

    And would adding sprouted flax seeds to sprouted broccoli seeds to our daily regimen be productive as say the addition of broccoli sprouts?

    And as always, Thanks MUCH for your invaluable service and information!

  6. Does anyone have any advice for an obese vegan, please? I have been vegan for over a year and a lifelong vegetarian and yet I am really very large (5,7″, 300lb {just writing this makes me cringe}) and have been told my cholesterol levels are high also. I eat less than 1200 calories a day and take exercise daily too (most days about 20 minutes, but swim for a few hours per week). I am really quite a happy person but being large can cause great social discomfort these days and I would really love to be less conspicuous. Thank you.

  7. Dr. Greger, my husband read an article that showed an increase of estrogen in men who consumed Flax, and that it caused breast “growth.” Do you have a video that I can show my husband stating that it is safe for men to consume flax?

  8. Healthy fat? I am taking 2 tablespoons of ground flax seed daily to address my omega 3 needs (as suggesting in one of your lectures), while adopting a whole foods plant based diet. However, I do understand that omega 6 is also important (in limited amounts). Given that I am excluding all seed oils from my diet, how do I get the ideal amount of omega 6 needed for optimum health (what sourc(s) do I go to and how much DHA should I be looking for)? Can one ‘over do it’ when it comes to omega 3’s (free radical damage, etc. as well as the omega 3 to omega 6 ratio being skewed the other way too much)? Regarding other ‘healthy’ fats, I understand monounsaturated fats (nuts, avocado, olives) are ‘good’ to include in a diet. Can you please provide some guidance as to roughly how much to include daily (for someone trying to lose weight and reverse metabolic syndrome). I just don’t want to overdo things. Would one ounce of walnuts or almonds, or 15 olives be reasonable? In a non-related question, what is your recommendation for vitamin D. Dr. Furhman recommends 4000 IU – is that too high/risky? Thank you very much, Dr. Greger – I wish “How Not to Die” was out on the bookshelf already! Cheers.

  9. Ive been vegan for about a year now and I am concerned that I am not getting enough EPA, DHA omega fatty acids. I get plenty of ALA from flax seeds since I am eating about 6 tbsp or more of ground flax seeds each day. Is it necessary for me to supplement with algae based EPA, DHA? Where are other vegans getting their EPA, DHA from?

    Also is the information on this site true???: http://www.whfoods.com/genpage.php?tname=george&dbid=76

    The webpage mentioned above states:

    While flaxseeds are rich in a type of omega-3 fat, they may not serve as a good source of omega-3s overall for some people. Understanding some of the basic issues involved with flaxseeds—and in fact, any kind of plant food—and omega-3 nourishment can help you to optimize your nutritional intake and your overall health.

    Flax oil composition

    While flaxseeds are an excellent source of omega-3 fat, they only contain one basic member of the omega-3 fat family. In the case of flaxseeds, virtually all of the omega-3 fat is found in the form of alpha-linolenic acid (often abbreviated “ALA”). This specific kind of omega-3 fat makes up about 50% of the oil in flaxseeds.

    The omega-3 assembly line starts with ALA

    So that you can better understand how flaxseeds that feature a concentration of ALA impacts their potential ability to be an overall good source of omega-3s, let’s start with a basic chemistry review of the omega-3 family of fats.

    Omega-3s are a very diverse group of fats. Yet, all of the members fall into a basic pattern that can be imagined as a kind of metabolic assembly line.

    Fats can be measured in length according to the number of carbon atoms that they contain. The omega-3 fatty acid ALA, featured in flaxseeds, contains 18 carbons, making it the shortest of the omega-3 fats, and hence the simplest. It retains a position at the beginning of the assembly line with our omega-3 metabolism starting with this compound as a building block.

    ALA gets elongated into other omega-3 fatty acids

    If another pair of carbon atoms gets added on to ALA (a process called “elongation” in biochemistry, and a process that is carried out by enzymes called elongases), it gets ready to become EPA (eicosapentaenoic acid), another important member of the omega-3 family. If yet another pair of carbons are added to EPA, it in turn gets ready to become DHA (docosahexaenoic acid), a third important member of the omega-3 family.

    ALA gets desaturated into other omega-3 fatty acids

    The reason I say that these omega-3 fats “get ready” to turn into other forms is because getting longer is not the only requirement for conversion of one omega-3 to another. A second requirement is what’s called “increased desaturation.” During this process, the omega-3 fat gets altered chemically so that its carbon atoms are connected together in a new way that provides more reactivity to the fat. This new kind of connection is called double-bonding. For ALA (our starting point for the omega-3 assembly line) to become EPA, two new double bonds must be added in addition to the 2-carbon atom increase in length.

    The role of other nutrients in omega-3 metabolism

    The process of lengthening and changing, of elongating and desaturating, the chemical bonds in omega-3 fat is complex, and many nutrients are required to bring it about. To get from ALA to EPA, for example, the required nutrients are: vitamin B3, vitamin B6, vitamin C, zinc, and magnesium.

    Nutrient deficiencies can block omega-3 metabolism

    What happens if an individual is deficient in one or more of the above nutrients? The answer is simple: that individual cannot convert linolenic acid very efficiently into the other longer-chain omega-3 fats. A person with known deficiencies in most of the above-cited nutrients (vitamins B3, B6, C, and the minerals zinc and magnesium) would not be able to get maximum benefit from flaxseeds’ omega-3s because he or she would not be able to effectively convert the ALA upward into the other omega-3 fats. Being able to effectively convert ALA upward into these other omega-3 fats is very important to our health, and when we cannot effectively accomplish this task and don’t compensate by eating foods that are high in EPA and DHA, we can significantly increase our risk of health problems.

    In the above situation, many healthcare practitioners would ask for an increase in the omega-3 supportive nutrients (the B complex vitamins, vitamin C, zinc, and magnesium) while at the same time also recommending a different source of omega-3s than flaxseeds, such as preformed EPA and DHA found in cold-water fish such as salmon and sardines, until the nutrient deficiencies were resolved. Yet, in cases where the assembly line seems to be functioning properly, many healthcare practitioners opt for flaxseeds and other ALA-rich foods since providing the body with the compound that is at the beginning of the assembly line allows the body to best decide the exact types and proportions of omega-3s it wants to create.

  10. Are there any concerns with high ALA intake?

    I consume about 6.8 grams of ALA per day and about 16.8 grams of LA a day, giving a ratio of 2.5 to 1. This is all from whole food, plant-based sources. Given the ratio and sources I thought I was good.

    However, reading comments such as the following have raised some concerns:
    “Increasing ALA to 3 – 4 g/day has some concerns. Three studies looking at age-related eye damage and fatty acids, all coming from the Nurse’s Health Study, have associated modest ALA intakes with age-related eye problems.”

  11. I used to love adding flaxseed to all kinds of dishes for its high Omega 3’s …

    But I was shook after reading an article on how Sweden’s NFA found that ground flaxseed aside containing beneficial fatty acids, also contains a substance called linamarin, which the body converts into hydrogen cyanide and sometimes prussic acid.

    Thus, they discourage their citizens from further flaxseed consumption.

    What is your esteemed opinion over this? Is it too much if flaxseed is used moderately (few teaspoons daily over cereals and such across three meals)?

    Thank you.
    Best regards.

  12. As one of the moderators on this site, I saw your question and thought a previous moderator’s response would be helpful to you:

    “The following answer from Tuffs University is helpful in evaluating this question:
    Lynne M. Ausman, DSc, RD, director of the Biochemical and Molecular Nutrition Program at Tufts’ HNRCA Cardiovascular Nutrition Laboratory, says you have nothing to worry about. Many foods, including not only flax but cashews, almonds, some beans and other plant products, naturally contain very small amounts of cyanide compounds. You’re more likely to ingest these trace amounts of cyanide when such foods are consumed raw, as heat breaks down the compounds. Even when flaxseed is eaten raw, the body has a natural capacity to break down a certain amount of these cyanide compounds. A 1994 study found that, in healthy individuals, daily consumption of as much as 60 grams of raw flaxseed—more than eight tablespoons—was safe” http://www.nutritionletter.tufts.edu/issues/7_8/ask-experts/ask-tufts-experts_1157-1.html
    Since Dr. Greger recommends only 1 tablespoon of ground flaxseed in his Daily Dozen recommendations, it seems to me that it is all good – a large safety margin and a huge amount of potential benefit from the flax. For the gritty details, check out: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754328/” This should provide you with reassurance that you can enjoy your flaxseed without undue worry. I think I’d look into that study you mentioned and see how much flax seed was being consumed to warrent the warning.

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