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:

The Best Diet for Rheumatoid Arthritis

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting millions. It is characterized by persistent pain, stiffness, and progressive joint destruction leading to crippling deformities, particularly in the hands and feet. What can we do to prevent and treat it?

In my video Why Do Plant-Based Diets Help Rheumatoid Arthritis?, I show a famous 13-month randomized controlled trial of plant-based diets for rheumatoid arthritis where patients were put on a vegan diet for three and a half months and then switched to an egg-free lactovegetarian diet for the remainder of the study. Compared to the control group (who didn’t change their diet at all), the plant-based group experienced significant improvements starting within weeks. Their morning stiffness improved within the first month, cutting the number of hours they suffered from joint stiffness in half. Their pain level dropped from 5 out of 10 down to less than 3 out of 10. Disability levels dropped, and subjects reported feeling better; they had greater grip strength, fewer tender joints, less tenderness per joint, and less swelling. They also had a drop in inflammatory markers in their blood, such as sedimentation rate, C-reactive protein, and white blood cell count. As a bonus, they lost about 13 pounds and kept most of that weight off throughout the year.

What does diet have to do with joint disease?

Rheumatoid arthritis is an autoimmune disease, in which our own body attacks the lining of our joints. There’s also a different autoimmune disease called rheumatic fever, in which our body attacks our heart. Why would it do that? It appears to be a matter of friendly fire.

Rheumatic fever is caused by strep throat, which is itself caused by a bacterium that has a protein that looks an awful lot like a protein in our heart. When our immune system attacks the strep bacteria, it also attacks our heart valves, triggering an autoimmune attack by “molecular mimicry.” The protein on the strep bacteria is mimicking a protein in our heart; so, our body gets confused and attacks both. That’s why it’s critical to treat strep throat early to prevent our heart from getting caught in the crossfire.

Researchers figured that rheumatoid arthritis might be triggered by an infection as well. A clue to where to start looking was the fact that women seem to get it three times more frequently than men. What type of infection do women get more than men? Urinary tract infections (UTIs). So, researchers started testing the urine of rheumatoid arthritis sufferers and, lo and behold, found a bacterium called Proteus mirabilis. Not enough to cause symptoms of a UTI, but enough to trigger an immune response. And indeed, there’s a molecule in the bacterium that looks an awful lot like one of the molecules in our joints.

The theory is that anti-Proteus antibodies against the bacterial molecule may inadvertently damage our own joint tissues, leading eventually to joint destruction. Therefore, interventions to remove this bacterium from the bodies of patients, with consequent reduction of antibodies against the organism, should lead to a decrease in inflammation.

As we saw in my video Avoiding Chicken to Avoid Bladder Infections, urinary tract infections originate from the fecal flora. The bacteria crawl up from the rectum into the bladder. How might we change the bugs in our colons? By changing our diet.

Some of the first studies published more than 20 years ago to fundamentally shift people’s gut flora were done using raw vegan diets, figuring that’s about as fundamental a shift from the standard Western diet as possible. Indeed, within days researchers could significantly change subjects’ gut flora. When researchers put rheumatoid arthritis sufferers on that kind of diet, they experienced relief, and the greatest improvements were linked to greatest changes in gut flora. The diet was considered so intolerable, though, that half the patients couldn’t take it and dropped out, perhaps because they were trying to feed people things like “buckwheat-beetroot cutlets” buttered with a spread made out of almonds and fermented cucumber juice.

Thankfully, regular vegetarian and vegan diets work too, changing the intestinal flora and improving rheumatoid arthritis. However, we didn’t specifically have confirmation that plant-based diets brought down anti-Proteus antibodies until 2014. Subjects that responded to the plant-based diet showed a significant drop in anti-Proteus mirabilis antibodies compared to the control group. Maybe it just dropped immune responses across the board? No, antibody levels against other bugs remained the same; so, the assumption is that the plant-based diet reduced urinary or gut levels of the bacteria.

A shift from an omnivorous to a vegetarian diet has a profound influence on the composition of urine as well. For example, those eating plant-based had higher levels of lignans in their urine. Up until now, it was thought that they only protected people from getting cancer, but we now know lignans can also have antimicrobial properties. Perhaps, they help clear Proteus mirabilis from the system. Either way, these data suggest a new type of therapy for the management of rheumatoid arthritis: anti-Proteus measures including plant-based diets.


I have to admit I had never even heard of Proteus mirabilis. That’s why I love doing work—I learn as much as you do!

I explored another unconventional theory as to why plant-based diets are so successful in treating inflammatory arthritis in Potassium and Autoimmune Disease.

There’s another foodborne bacteria implicated in human disease, the EXPEC in chicken leading to urinary tract infections—another game-changer: Avoiding Chicken To Avoid Bladder Infections.

I have a bunch of videos on gut flora—the microbiome. They include: 

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:

Image Credit: Sally Plank / Flickr. This image has been modified.