Prostate Cancer Survival: The A/V Ratio

Prostate Cancer Survival: The A/V Ratio
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Reducing the ratio of animal to plant protein in men’s diets may slow the progression of prostate cancer.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

It is now eight years since the famous Ornish study was published, suggesting that 12 months on a strictly plant-based diet could reverse the progression of prostate cancer.

Wait a second. How were they able to get a group of older men to go vegan for a year? They home-delivered prepared meals to their door, figuring men are so lazy they’ll just eat whatever is put in front of them.

But, what about out in the real world? Realizing that you can’t even get most men with cancer to eat a measly five servings of fruits and veggies, researchers settled on just trying to change their A/V ratio (the “ratio of animal to vegetable proteins”), and, indeed, were successful in cutting this ratio in half at least—from about two to one, animal to plant, to kinda half-vegan, one to one.

How’d they do? Looks like their cancer was slowed down. “The average PSA doubling time [an estimate of how fast the tumor may be doubling in size]…in the [half-vegan group] slowed from 21 months…to 58 months…” So, the cancer kept growing, but with a part-time plant-based diet, they appeared to be able to slow down the tumor’s expansion. What Ornish got, though, was an apparent reversal in cancer growth. The PSA didn’t just rise slower, it trended down—which could be an indication of tumor shrinkage. So, the ideal A/V ratio may be closer to zero.

If there’s just no way grandpa’s going vegan, and we just have half-measures, what might be the worst A, and the best V? Eggs and poultry may be the worst—respectively doubling, and potentially quadrupling, the risk of cancer progression in this study, out of Harvard. Twice the risk, eating less than a single egg a day; quadruple the risk, eating less than a single serving of chicken or turkey.

And, if you could only add one thing to your diet? Cruciferous vegetables. Less than a single serving a day of either broccoli or Brussels sprouts, cabbage, cauliflower, or kale may cut the risk of cancer progression more than half—defined as cancer coming back, spreading to the bone, or death.

This animal-to-plant ratio might be useful for cancer prevention, as well. For example, in the largest study ever performed on diet and bladder cancer, just a 3% increase in the consumption of animal protein was associated with a 15% higher risk of bladder cancer, whereas a 2% increase in plant protein intake was associated with a 23% lower risk. Even little changes in our diets can have significant effects.

Please consider volunteering to help out on the site.

Images thanks to ccPixs.com, Mike Saechang, and Farmanac via flickr. Thanks to Ellen Reid for her keynote help.

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

It is now eight years since the famous Ornish study was published, suggesting that 12 months on a strictly plant-based diet could reverse the progression of prostate cancer.

Wait a second. How were they able to get a group of older men to go vegan for a year? They home-delivered prepared meals to their door, figuring men are so lazy they’ll just eat whatever is put in front of them.

But, what about out in the real world? Realizing that you can’t even get most men with cancer to eat a measly five servings of fruits and veggies, researchers settled on just trying to change their A/V ratio (the “ratio of animal to vegetable proteins”), and, indeed, were successful in cutting this ratio in half at least—from about two to one, animal to plant, to kinda half-vegan, one to one.

How’d they do? Looks like their cancer was slowed down. “The average PSA doubling time [an estimate of how fast the tumor may be doubling in size]…in the [half-vegan group] slowed from 21 months…to 58 months…” So, the cancer kept growing, but with a part-time plant-based diet, they appeared to be able to slow down the tumor’s expansion. What Ornish got, though, was an apparent reversal in cancer growth. The PSA didn’t just rise slower, it trended down—which could be an indication of tumor shrinkage. So, the ideal A/V ratio may be closer to zero.

If there’s just no way grandpa’s going vegan, and we just have half-measures, what might be the worst A, and the best V? Eggs and poultry may be the worst—respectively doubling, and potentially quadrupling, the risk of cancer progression in this study, out of Harvard. Twice the risk, eating less than a single egg a day; quadruple the risk, eating less than a single serving of chicken or turkey.

And, if you could only add one thing to your diet? Cruciferous vegetables. Less than a single serving a day of either broccoli or Brussels sprouts, cabbage, cauliflower, or kale may cut the risk of cancer progression more than half—defined as cancer coming back, spreading to the bone, or death.

This animal-to-plant ratio might be useful for cancer prevention, as well. For example, in the largest study ever performed on diet and bladder cancer, just a 3% increase in the consumption of animal protein was associated with a 15% higher risk of bladder cancer, whereas a 2% increase in plant protein intake was associated with a 23% lower risk. Even little changes in our diets can have significant effects.

Please consider volunteering to help out on the site.

Images thanks to ccPixs.com, Mike Saechang, and Farmanac via flickr. Thanks to Ellen Reid for her keynote help.

Doctor's Note

For those unfamiliar with that landmark Ornish study, see Cancer Reversal through Diet?, which the Pritikin Foundation followed up on with Ex Vivo Cancer Proliferation Bioassay

What else might help men with prostate cancer? See Flax Seeds vs. Prostate Cancer and Saturated Fat & Cancer Progression. What about preventing it in the first place? See:

 Poultry and eggs may be related to cancer risk in a variety of ways:

Crucifers may also help with other cancers. See:

I’m going to highlight it in the next video Breast Cancer Survival Vegetable

Update: In 2017, I released two important videos on prostate cancer. Treating Advanced Prostate Cancer with Diet Part 1 and Part 2

For more context, check out my associated blog post: Cancer & the Animal-to-Plant Protein Ratio.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

27 responses to “Prostate Cancer Survival: The A/V Ratio

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  1. Vegan means no animal products and is not open to interpretation.
    Thus, I disagree with the narrator’s claim that the Ornish prostate cancer study used a vegan diet or a “strictly plant-based diet”. You can at best call it near vegan.

    The error can be found on page 2 where you see that fish oil was consumed in addition to several other lifestyle changes:

    “Experimental group patients were prescribed an intensive lifestyle program that included a vegan diet supplemented with soy (1 daily serving of tofu plus 58 gm of a fortified soy protein powdered beverage), fish oil (3 gm daily), vitamin E (400 IU daily), selenium (200 mcg daily) and vitamin C (2 gm daily), moderate aerobic exercise (walking 30 minutes 6 days weekly), stress management techniques (gentle yoga based stretching, breathing, meditation, imagery and progressive relaxation for a total of 60 minutes daily) and participation in a 1-hour support group once weekly to enhance adherence to the intervention.10 The diet was predominantly fruits, vegetables, whole grains (complex carbohydrates), legumes and soy products, low in simple carbohydrates and with approximately 10% of calories from fat.11 The diet is intensive but palatable and practical. In earlier studies most patients were able to adhere to this diet for at least 5 years.”




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    1. Has anyone found a vegan food option yet that has a source of DHA/EPA and astaxanthin in it? I still have a serving of salmon once a week and would like to cut it out of my diet if I could replace it with another wholefood that were plant based.




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      1. There is no plant food that exists that has preformed DHA/EPA unless you get algae oil supplements which is not technically a plant.

        There is no need to consume preformed DHA and EPA. If you consume omega 3 in plant foods in the form of ALA your body will convert it to DHA and EPA if your omega 6:3 ratio is adequate, adequate being 4:1. The best way to do this is to eat plenty of fruits and veggies and minimize nuts and seeds. What nuts and seeds you could eat that have plenty of omega 3 are Flax, walnuts and chia seeds. Other nuts and seeds have very poor omega 6:3 ratios and should be eaten more in moderation.

        The National Academy of Sciences does not recognize EPA and DHA as essential. This means there is enough evidence for them to conclude that we can make enough of it without eating it in its preformed state.

        “Comparison of the PLLC n23 PUFAs:DALA ratio between dietary-habit groups showed that it was 209% higher in vegan men and 184% higher in vegan women than in fish-eaters, was 14% higher in vegetarian men and 6% higher in vegetarian women than in fish-eaters, and was 17% and 18% higher in male and female meat-eaters, respectively, than in fish-eaters This suggests that the statistically estimated conversion may be higher in non-fish-eaters than in fish-eaters.”

        http://www.ncbi.nlm.nih.gov/pubmed/20861171

        In addition, another study showed that despise this “theoretical” low conversion rate, there is no evidence of any harm so, the problem may not be in the conversion rate, but in the assumption that it is low.

        “There is no evidence of adverse effects on health or cognitive function with lower DHA intake in vegetarians”

        “In the absence of convincing evidence for the deleterious effects resulting from the lack of DHA from the diet of vegetarians, it must be concluded that needs for omega-3 fatty acids can be met by dietary ALA. ”

        http://www.ncbi.nlm.nih.gov/pubmed/19500961




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        1. Interesting arguments suggesting that taking algae oil supplements may be superfluous for vegetarians/vegans.

          They may even turn out to be worse than useless. In ‘Becoming Raw’ (2010), Davis and Melina argued on page 127-128:

          “DHA is the most highly unsaturated fat in the diet and also the most unstable (meaning it is easily oxidized by free radicals in the blood). Oxidized fats are bad news; they contribute to all sorts of disease processes, including cardiovascular disease. It’s possible that our bodies are smart enough not to bother making DHA when it’s not needed. In addition, it’s possible that when DHA is in our bloodstream, it’s rapidly transported to locations where it’s needed and incorporated into tissues, such as the brain and the retina of the eyes.”

          As you probably know, the supporting articles for algae DHA sources are often financially supported by algae oil manufacturers such as Martek Biosciences. I doubt authors of such articles would be objective. Until more thorough research on long-term effects is done, I would not favour consuming algae oil.




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      2. Sorry Brandon for my repetitive information regarding the ratio, I forget that I already discussed this with you. Either way, I am sure others who have not seen this information will appreciate it.




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      3. The red stains on the bottom of dried out birdbaths are the astaxanthin-rich cysts of the green algae
        Haematococcus pluvialis. They’re also the source of astaxanthin supplements. Astaxanthin also appears in trace amounts in krill oil, shrimp, flamingo feathers etc.




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        1. Just a note on the Nutrex – they have two types of capsules. One is gelatin, and the other is vegan..the vegetarian one is called MD formulas Bio Astin




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  2. Hello Doctor,

    Question if I may for I have searched all the videos “I think!”, spent hours at it anyway, what a fabulous resource by the way. Thank
    you! But I could not piece together a picture concerning my issue. So here I go and will try to keep it short.

    My wife and I had a face to face encounter with pure unassailable logic through Forks over Knives. That led me to your sight which I have been
    following since. We embraced a Vegan lifestyle out of need, and conviction I will add, around the first of July of this year. My weight has dropped over 40 lbs so far, my cholesterol numbers took a nose dive…to the good I will add. :) And my blood pressure has dropped considerably so I know I am on the correct path. I must say also that we are enjoying what we eat! Not easiest thing to turn one’s life upside down, but sure as heck beats six feet in the ground. Sorry I could not resist. =P

    Anyway the reason for this post. I seem to have this incredible dependence on normal testosterone levels. The Doctor worked with me on testosterone therapy, but the injections sent my PSA from 3.78 to 7.98 in just a month or so of therapy. And of course all the other problems men of my age face got worse. He took me off the therapy immediately. Now I know I am approaching a wall of text now, so let me just say life was just ugly after having felt like a person again. Energetic, alive, awake!, and happy about life during therapy, downright depressing after therapy.

    So my question is can you make any suggestions, direct me to any specific articles, books, advice? The doctor has added more medication to
    my current list, and will try me on the therapy in another two months. I am
    very happy we are going to try again because the quality of life was incredibly improved. But it feels wrong to mask things, such as PSA numbers, with another drug. I fear I will be taking the short path, instead of the longer and slower “correct” path of good nutrition. But once again I cannot tell you how good it felt to feel somewhat normal again while on therapy.

    Any input would you could give me would be greatly appreciated. Please understand I have an excellent and caring doctor. But I feel the need to
    branch out a bit on this decision. And if this is not the appropriate place for
    this post please forgive me. You seem to encourage questions at the end of other posts you have created. And this post just hit very close to home.




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  3. Anyone know if Dr. Ornish eliminated all dairy in his cancer/diet study?
    I am writing an article for my local newspaper and don’t want to state that unless I am 100% certain.




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    1. Sounds like the usual industry-funded bullshit to me. I thought we had got over the irrational fear of fat and cholesterol – oh well, while there are still idiots buying statins I suppose the lies will continue.




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  4. Sorry that I’m not the doctor replying, but thought had something relevant to say: My testosterone level nearly doubled when I adopted a WFPB diet, going from low four hundreds to mid seven hundreds in a period of about two years.




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  5. Vegans tend to have higher testosterone naturally and lower risk of prostate cancer. My husband reversed his prostate cancer with a vegan diet and at 60 he has the testosterone level of a 20 year old. Exercise also raised your t level. We are at the gym now.




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  6. I have just been diagnosed with prostate cancer. Some of the cells from the biopsy were graded as having a Gleason score of 8. The urologist who presented me with these results suggested that I needed either surgery or radiation treatments. I asked about a diet-based approach to dealing with this and he pretty much dismissed it out of hand. Any recommendations?




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    1. I was diagnosed with stage zero bladder cancer by a urologist one year ago and have been treated with a series of BCG. Stage 0 is supposedly limited to the bladder surface and my doctor did surgery (entry through the urethra and “scraping” the bladder surface.) The BCG treatment followed and I am now in a maintenance program to prevent recurrence. I strongly recommend that you get a second opinion from an oncologist who specializes in bladder cancer. I changed from a urologist to an oncologist at UCI in California and am very glad that I did. Best to you!




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    2. I had a Gleason 8( The highest severity grade 8-10.) and had surgery where it was noted I was node positive and had local invasion, including nerves which had to be sacrificed with 2 months of total urine incontinence reversed with exercise. My prognosis was poor and I underwent several years of hormone suppression. However, I began what I could do in addition, transitioning to a vegan diet. 15 years later I have no evidence of recurrence and my PSA is normal, undetectable. What you do is your choice, but in my personal experience and experience as a MD, I have found that many answers are not ‘either-or’ but a combination of medical/surgical interventions and lifestyle changes. I had no family history but I think a western diet, BPA and other toxins contributed. Lifestyle interventions are not instantaneous and I do not think with a Gleason 8, lifestyle changes alone may be enough, particularly when some of those prostate cancer men studied in this report had a much less malignant prostate cancer to start i.e.. Gleason 4 compared to Gleason 8. I sought the institutions with the best reputation for surgery(Johns Hopkins) and medical intervention( Dana Farber) I chose surgery over radiation as the complications of surgery are immediate(my incontinence which was unavoidable though resolved with specific exercise) vs the potential of progressive delayed complications of radiation over years. Personally, I just wanted to get that cancer out of my body ASAP. Age is a very important factor as well. I was 50 at the time of my surgery and I am convinced that without all interventions, I would be dead by now. The older the patient and the more medical issues they have, the less likely the Prostate Cancer is to kill them. You are an individual and you need to have your own unique assessment and interventions specific to you. A second surgical opinion and seeing an Oncologist with specific expertise in Prostate cancer is vital. Good luck.




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    3. Consider Focal Laser Ablation and the Dr Ornish and Dr Berger diet mentioned here. Gleason 8 is too high for active surveillance only . FLA is not the only focal surgery available but it is minimally invasive . For more info check Inspire site or contact me. My husband had a 7 and we chose this. He is fine. No ED or urinary dysfunction . He is following this diet also now and taking scorpion venom prescribed by Dr Raymond Chang in NYC.




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  7. I had my prostate removed almost 2 years ago. Alas there is evidence that the cancer probably spread beyond the prostate. My PSA scores are low, but not zero (most recently, 3 months apart, 0.04, 0.04, and 0.05; about 1 year about 0.10). There was a rising pattern to the scores until I made some lifestyle changes. In addition, I am currently taking metformin in a clinical trial of it.

    I am wondering how best to “individualize” the diet changes? For example, would it be smart for me to regularly measure something in the blood (perhaps IGF-1, triglycerides, whatever) to learn whether specific foods raise it/them? I suspect there may be wide variation between individuals about the metabolism of things (e.g., flax seed).




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  8. Hello Tom,
    I am a family physician in private practice and also a volunteer moderator for this website. Thank you for your question. It is a little difficult to answer, because I’m not sure exactly what you’re asking. There are certainly dietary recommendations Dr. Greger has made for preventing, and treating prostate cancer. For example:
    -https://nutritionfacts.org/video/flaxseed-vs-prostate-cancer/ — this looks at flax seeds for treatment and prevention.
    -https://nutritionfacts.org/video/starving-cancer-with-methionine-restriction/ –looks at methionine restriction for cancer in general
    -https://nutritionfacts.org/video/phytates-for-rehabilitating-cancer-cells/ — looks at phytates for cancer treatment in general

    But it sounds like you’re also asking about ANY blood markers which would be helpful to follow, which would help to combat your cancer. I’m afraid that’s a little too broad to get my head around. Anyway, I hope this helps.




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