Consequences of Prostate Cancer Treatment

A cancer diagnosis is seen as a teachable moment in medicine where we can try to get people to eat healthier, but “research has suggested that male cancer patients may be reluctant to introduce dietary modification…This has been attributed to dietary modifications often being viewed as mimicking “feminine” eating behaviours, such as emphasizing an increase in fruit and vegetables.” 

As I discuss in my video Changing a Man’s Diet After a Prostate Cancer Diagnosis, “[a]lthough healthy eating might enhance long-term survival, few men with prostate cancer make diet changes to advance their well-being.” Many of the cancer survival trials require adherence to strict plant-based diets, and though researchers tried providing extensive nutrition education and counseling programs, dietary adherence was still a challenge.

Apparently the way Dean Ornish was able to reverse the progression of prostate cancer with a plant-based diet was by home-delivering prepared meals to the subjects’ doors, figuring men are so lazy they’ll just eat whatever’s put in front of them. After all, male culture tends to encourage men to drink beer and eat convenience food and meat.

Take Men’s Health magazine, for example. Included in the list of things men should never apologize for were liking McDonald’s, not offering a vegetarian alternative, and laughing at people who eat trail mix. The magazine features articles with such titles as “Vegetables Are for Girls” and sections like “Men and Meat: There’s Only One Kind of Flesh We Like Better and Even Then She’d Better Know How to Grill.”

To appeal to male sensibilities, doctors are advised to use ‘body as machine’ metaphors, framing “men’s health in terms of mechanical objects, such as cars, requiring tuning.” But if men are so concerned about their masculinity and manhood, maybe we instead should share a bit about what prostate cancer treatment entails. The prostate is situated at the base of the penis, so when you core it out with a radical prostatectomy, you lose about an inch off your penis, if it gets erect at all. Only 16 percent of men undergoing the procedure will regain their pre-surgery level of erectile functioning.

Patients are typically quoted erectile dysfunction rates around 60 to 70 percent, but studies have generally considered erectile function recovery “as the ability to maintain an erection hard enough for penetration about 50% of the time…” So, occasionally being able to get an erection is considered recovery, but when a surgeon tells patients they will recover function, the patients probably assume that means the kind of function they had prior to surgery, which only happens 16 percent of the time and only 4 percent of the time in men over 60. Only 1 in 25 gets his baseline sexual function back.

Erections aren’t the only issue. Patients experience other problems like orgasm-associated pain even years later and urinary incontinence during foreplay, stimulation, or orgasm. The vast majority of couples overestimate how much function they’re going to recover. Couples reported feeling loss and grief. Having cancer is bad enough without the additional losses. You’d think that would be enough to motivate men to improve their diets, but almost a fourth of the men newly diagnosed with prostate cancer state they would prefer to have their lives cut short rather than live with a diet that prohibits beef and pork. More men would rather be impotent than improve their diet. It appears pleasures of the flesh may sometimes even trump pleasures of the flesh.


Did I say reverse the progression of cancer? See Cancer Reversal Through Diet? and my overview video How Not to Die from Cancer.

For more on prostate cancer prevention and survival, check out:

Interested in more information on maintaining male sexual function? See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Best Foods for COPD and Peripheral Artery Disease

It’s great we can improve athletic performance by eating a few beets, but so what if you run 5% faster? It can be a fun experiment to eat a can of beets and maybe shave a minute off your 5k time, but there are people who could really benefit from a more efficient use of oxygen: those suffering from emphysema. Young, healthy adults eating greens and beets can swim, run, and cycle faster and farther, but what about those who get out of breath just walking up the stairs? Do nitrate-rich vegetables work where it counts? Yes–. Time on the treadmill in COPD pateints was significantly extended after two shots of beet juice. I discuss these benefits of nitrate-rich vegetables in my video Oxygenating Blood with Nitrate-Rich Vegetables.

Beet juice can also decrease blood pressure in young, healthy adults, but what about in those who need it––older, overweight subjects? Just one shot a day of beet juice (versus berry juice as a control) led to a significant drop in blood pressure in a few weeks. But within just a few days after stopping three weeks of beeting themselves up, blood pressure went back up. So we have to eat our vegetables and keep eating our vegetables.

Why did it take until 2015 to publish a study on using nitrates to lower blood pressure in people with high blood pressure? You’d think that’d be the first group to try it on. Who’s going to fund it, though—Big Beet? Blood pressure medications rake in more than $10 billion a year. You can’t make billions on beets.

But that’s why we have charities like the British Heart Foundation, which funded a study to give folks with high blood pressure a cup of beet juice a day for four weeks. After all, high blood pressure may be the number-one risk factor for premature death in the world. In ten years, it could affect nearly one in three adults on the planet. But put them on beet juice and blood pressures dropped and kept dropping until they stopped drinking it after a month. With so many people with high blood pressure even despite treatment, the researchers concluded, “an additional strategy, based on the intake of nitrate-rich vegetables, may prove to be both cost-effective, affordable, and favorable for a public health approach to hypertension.”

What about those with peripheral artery disease? There are tens of millions of people with atherosclerotic clogs impairing blood flow to their legs. This can cause a cramping pain in the calves called claudication, due to lack of blood flow through the blocked arteries, severely limiting one’s ability to even just walk around. But when they simply drink some beet juice, they can walk 18% longer. Researchers measured the actual oxygenation of blood within the calf muscle and found that patients were able to maintain more oxygen in their muscles after drinking beet juice.

The nitric oxide from vegetable nitrates not only improves oxygen efficiency but also oxygen delivery by vasodilating blood vessels—opening up arteries—so there’s more blood flow. I’m surprised beet juice companies aren’t trying to position themselves as veggie Viagra! It could certainly explain why those eating more veggies have such improved sexual function, though that study was a snapshot in time so technically you can’t tell whether eating veggies resulted in improved sexual function or improved sexual function led to eating more veggies. However, it seems more reasonable that low fruit and vegetable consumption contributes to erectile dysfunction, rather than the other way around.

What about the most important organ… the brain? Poor cerebral perfusion—lack of blood flow and oxygen in the brain––is associated with cognitive decline and dementia. Researchers showed that the nitrate in vegetables may be beneficial in treating age-related cognitive decline. They showed a direct effect of dietary nitrate on cerebral blood flow within the frontal lobes, the areas particularly compromised by aging. This is a critical brain area for so-called executive function, the basic task and problem solving important for day-to-day functioning. The nitrite from nitrate has been shown to not only increase blood flow to certain areas of the body but also to act preferentially in low oxygen conditions, allowing it to increase blood flow precisely in the areas where it is needed most, and that’s what they found in the brain: increased blood flow to the at-risk areas of the aging brain. The only side effect of beeting your brains out? A little extra color in your life (they noted some of the study subjects started peeing pink).


Nitrates are one of the reasons I recommend eating dark green leafy vegetables every day. See Slowing Our Metabolism with Nitrate-Rich Vegetables and “Veg-Table” Dietary Nitrate Scoring Method. Beets are another good option and not just drinking the juice; take a look at Whole Beets vs. Juice for Improving Athletic Performance.

What else can we do for high blood pressure? See the following videos:

Why is blood flow to the brain so important? I go into depth on the potential consequences in Alzheimer’s and Atherosclerosis of the Brain.

More on diet and pelvic blood flow in men can be found in:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

What to Eat to Cure High Blood Pressure

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That’s the topic of How to Treat High Blood Pressure with Diet

The American Heart Association (AHA), the American College of Cardiology (ACC, and the Centers for Disease Control and Prevention (CDC) recommend lifestyle modification as the first-line treatment. If that doesn’t work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What’s wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don’t treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one’s weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not even more plant-based? We’ve known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I’ve talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. They eat plant-based day-to-day, with meat only eaten on special occasions.

How do we know it’s the plant-based nature of their diets that was so protective, though?

Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low on average were those eating strictly plant-based diets, coming in at about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it “palatable” to the general public.

You can see what they were thinking. Just like drugs never work—unless you actually take them. Diets never work—unless you actually eat them. So what’s the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with some kind of compromise diet, the on a population scale maybe you’d do more. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it’s time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it’s the added plant foods—not the changes in oil, sweets, or dairy—that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we’re already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you’d have to eat around 2 pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don’t seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.


The DASH diet is one of the best studied, and it consistently ranks as US News & World Report’s #1 diet. It’s one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I’ve talked about the patronizing attitude many doctors have that patients can’t handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: