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:

How to Avoid Fatty Liver Disease

In the documentary Supersize Me, Morgan Spurlock eats exclusively at McDonald’s for a month and predictably his weight, blood pressure, and cholesterol go up, but so do his liver enzymes, a sign his liver cells are dying and spilling their contents into the bloodstream. His one-man experiment was actually formally replicated. A group of men and women agreed to eat two fast food meals a day for a month. Most of their liver values started out normal, but, within just one week, most were out of whack, a profound pathological elevation in liver damage.

What’s happening is non-alcoholic fatty liver disease (NAFLD), the next global epidemic, as I discuss in my video How to Prevent Non-Alcoholic Fatty Liver Disease. Fatty deposits in the liver result in a disease spectrum from asymptomatic fat buildup to non-alcoholic steatohepatitis (NASH), which can lead to liver scarring and cirrhosis, and may result in liver cancer, liver failure, and death.

NAFLD is now the most common cause of chronic liver disease in the United States, affecting 70 million Americans, nearly one in three adults. Fast food consumption is a great way to bring it on, since it’s associated with the intake of soft drinks and meat. Drinking one can of soda a day may raise the odds of NAFLD by 45 percent, and those eating the equivalent of 14 chicken nuggets’ worth of meat a day have nearly triple the rates of fatty liver compared to those eating 7 nuggets or less.

It’s been characterized as a tale of fat and sugar, but evidently not all types of fat are culpable. Those with fatty hepatitis were found to have eaten more animal fat and cholesterol, and less plant fat, fiber, and antioxidants. This may explain why adherence to a Mediterranean-style diet, characterized by high consumption of foods such as fruits, vegetables, whole grains, and beans, is associated with less severe non-alcoholic fatty liver disease. It could also be related to the presence of specific phytonutrients, like the purple, red, and blue anthocyanin pigments found in berries, grapes, plums, red cabbage, red onions, and radicchio. These anthocyanin-rich foods may be promising for the prevention of fatty liver, but that’s mostly based on petri dish experiments. There was one clinical trial that found that drinking a purple sweet potato beverage seemed to successfully dampen liver inflammation.

A more plant-based diet may also improve our microbiome, the good bacteria in our gut. “‘We are what we eat’ is the old adage but the modern version might be ‘we are what our bacteria eat.’” When we eat fat, we may facilitate the growth of bad bacteria, which can release inflammatory molecules that increase the leakiness of our gut and contribute to fatty liver disease.

Fatty liver disease can also be caused by cholesterol overload. The thought is that dietary cholesterol found in eggs, meat, and dairy oxidizes and then upregulates liver X receptor alpha, which can upregulate something else called SREBP, which can increase the level of fat in the liver. Cholesterol crystals alone cause human white blood cells to spill out inflammatory compounds, just like uric acid crystals in gout. That’s what may be triggering the progression of fatty liver into serious hepatitis: “the accumulation of sufficient concentrations of free cholesterol within steatotic hepatocytes [fatty liver cells] to cause crystallization of the cholesterol.” This is one of several recent lines of evidence suggesting that dietary cholesterol plays an important role in the development of fatty hepatitis—that is, fatty liver inflammation.

In a study of 9,000 American adults followed for 13 years, researchers found a strong association between dietary cholesterol intake and hospitalization and death from cirrhosis and liver cancer, as dietary cholesterol can oxidize and cause toxic and carcinogenic effects. To limit the toxicity of excess cholesterol derived from the diet, the liver tries to rid itself of cholesterol by dumping it into the bloodstream. So, by measuring the non-HDL cholesterol in the blood, one can predict the onset of fatty liver disease. If we subtract HDL from total cholesterol, none of the hundreds of subjects followed with a value under 130 developed the disease. Drug companies view non-alcoholic fatty liver disease as a bonanza, “as is the case of any disease of affluence…considering its already high and rising prevalence and…[its] needing continuous pharmacologic treatment,” but maybe avoiding it is as easy as changing our diet, avoiding sugary and cholesterol-laden foods.

“The unpalatable truth is that NAFLD could almost be considered the human equivalent of foie gras (loosely translated from French as ‘fat liver’). As we overeat and ‘force-feed’ ourselves foods that can result in serious health implications, however, having such a buttery texture in human livers is not a delicacy to be enjoyed by hepatologists [liver doctors] in clinical practice!”


Like my video Preventing Gout Attacks with Diet, How to Prevent Non-Alcoholic Fatty Liver Disease covers an important topic worth the extensive coverage the video provides.

For more on how bad added sugars are for us, see:

For more on how bad cholesterol can be, 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:

What About Extra Virgin Olive Oil?

The relative paralysis of our arteries for hours after eating fast food and cheesecake may also occur after consuming olive oil. Olive oil was found to have the same impairment to endothelial function as high-fat foods like sausage and egg breakfast sandwiches. (See my Olive Oil and Artery Function video for an illustrative chart with different foods.)

Studies that have suggested endothelial benefits after olive oil consumption have measured something different: ischemia-induced dilation as opposed to flow-mediated dilation. There’s just not good evidence that’s actually an accurate index of endothelial function, which is what predicts heart disease. Hundreds of studies have shown that the ischemia-induced dilation test can give a false negative result.

Other oils have also been shown to have deleterious results on endothelial function. A significant and constant decrease in endothelial function appears within three hours after each meal, independent of the type of oil and whether the oil was fresh or deep fried. Olive oil may be better than omega-6-rich oils or saturated fats, but it still showed adverse effects. This was the case with regular, refined olive oil. But what about extra-virgin olive oil?

Extra-virgin olive oil retains a fraction of the anti-inflammatory phytonutrients found in the olive fruit, and so doesn’t appear to induce the spike in inflammatory markers caused by regular olive oil. What does that mean for our arteries? Extra-virgin olive oil may have more of a neutral effect compared to butter, which exerted a noxious effect that lasted for up to six hours—basically right up until our next meal. In the largest prospective study ever to assess the relationship between olive oil consumption and cardiac events like heart attacks, there was a suggestion that virgin olive oil may be better than regular olive oil, but neither was found to significantly reduce heart attack rates after controlling for healthy dietary behaviors like vegetable intake, which tends to go hand-in-hand with olive oil intake.

There have also been studies showing that even extra-virgin olive oil, contrary to expectations, may significantly impair endothelial function. Why then do some studies suggest endothelial function improves on a Mediterranean diet, which is rich in olive oil? It may be because the Mediterranean diet is also rich in whole grains, fruits, vegetables, beans, and walnuts. Fruits and vegetables appear to provide some protection against the direct impairment of endothelial function produced by high-fat foods, including olive oil; therefore, improvements in health may be in spite of, rather than because of, the oil. In terms of their effects on post-meal endothelial function, the beneficial components of the Mediterranean diet may primarily be the antioxidant-rich foods, the vegetables, fruits, and their derivatives, such as balsamic vinegar. Adding some vegetables to a fatty meal may partially restore arterial functioning and blood flow.


If olive oil can impair our arterial function, Why Was Heart Disease Rare in the Mediterranean? I’ve got a whole series of videos on the Mediterranean diet that I invite you to check out.

Fatty Meals May Impair Artery Function so much that a single high-fat meal can trigger angina chest pain. But, whole-food sources of fat such as nuts appear to be the exception. See Extra Virgin Olive Oil vs. Nuts and Walnuts and Artery Function.

I’ve also examined artery function with several other foods: eggs, dark chocolatecoffee, vinegar, tea, and plant-based diets.

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: