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 Plastics Can Affect Your Love Life

Most of the attention on phthalates, a group of hormone-disrupting chemicals found in PVC plastics, has been focused on fetal and child health, particularly regarding genital and behavioral development. Recent data have shown, for example, “incomplete virilization in infant boys” and reduced masculine play as they grow up, and for girls, an earlier onset of puberty. What about affecting hormonal function in adults? I explore this in my video Avoiding Adult Exposure to Phthalates.

Men exposed to high levels of phthalate had lower testosterone levels, but that was for workers in a plastics plant. In the general population, the evidence is mixed. A study in Sweden of men in their 20s found no effect on testosterone, whereas a U.S. study on men in their 30s did find an effect, even at levels of exposure much lower than those of factory workers. When there’s conflicting evidence like this, ideally we’d put it to the test, but you can’t ethically expose people to phthalates so scientists have come up with convoluted methods like implanting the testicles from human fetuses into mice to keep them growing. We want to know about the effects on adult, not fetal, testicles, which had been harder to procure… until recently. “[C]onsent was obtained from all donors.” Now, I’ve heard of blood donors, but this is a whole other level. Researchers obtained donated testicles from prostate cancer patients who underwent castration to control their disease and, indeed, were able to get direct evidence that phthalates can inhibit testosterone production at the kinds of levels one sees in general population studies.

What about breast cancer, the number-one cancer killer of young women? Women working in automotive plastics and food canning are at five times the odds of breast cancer, suggesting a link. In a petri dish, however, phthalates didn’t seem to accelerate breast cancer growth at the levels of exposure expected in the general population. More recently, though, phthalate exposure was found to boost breast cancer cell growth in vitro at the levels found circulating in the bodies of many women. Therefore, the maximum tolerable dose set by governments should be re-evaluated.

How do you avoid the stuff? Well, when you think of plastic chemicals, you may think of water bottles, but they appear to play only a minor role. Most phthalates come from food. How do we know this? If you take people and have them stop eating for a few days, you get a significant drop in the amount of phthalates spilling into their urine. Fasting isn’t exactly sustainable, though. Thankfully, we can see similar drops from simply eating a plant-based diet for a few days, which gives us a clue as to where most phthalates are found. There were a few cases of spikes within the fasting period after showers, however, suggesting contamination in personal care products.

We can counsel patients to reduce phthalate exposures by avoiding the use of scented personal care products, soaps, and cosmetics, since phthalates are used as a fragrance carrier. Phthalates can also be found in children’s toys, as well as adult toys. “On behalf of the Danish [Environmental Protection Agency] EPA, [the Danish Technological Institute] DTI has made inquiries about the consumption pattern in connection with the use of sex toys made of rubber or plastics” to see what kind of exposure one might get “based on worst case scenarios.” Those working behind the counters at sex shops “proved to possess very little knowledge of the materials,” so the researchers had to do their own testing. It turns out that “jelly” is plasticized PVC—up to two-thirds phthalates by weight. Though the use of water-based lubricants may reduce the health risks 100-fold, phthalate exposure through lubricants may still have the opposite of the intended effect. Women with the highest levels of phthalates flowing through their bodies “had over 2.5 times the odds of reporting a lack of interest in sexual activity,” and these weren’t women in a canning factory, rather they were at typical exposure levels in America.


To find out how to lower your exposure to phthalates, see What Diet Best Lowers Phthalate Exposure?

More on hormone-disrupting chemicals in our food supply in:

Interested in learning more about improving sexual health? 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 Health Benefits of Laughter, Tears, and Kisses

In my video, Music as Medicine, I explored a study about how listening to Mozart can reduce allergic reactions. This reminded me of a similar study on humor, which I discuss in Laughter as Medicine. In the study, researchers took a group of people with dust mite allergies and directed half of them to watch a Charlie Chaplin video and the other half to watch the Weather Channel. The researchers then injected all subjects with dust mite poop. In the subjects who watched the humorous video, their allergic response was significantly reduced and this reduction lasted for a matter of hours. This suggests that “the induction of laughter may play some role in alleviating allergic diseases.”

Is there a chance that it might suppress our immune system too much? Apparently not. In fact, if you have people watch a comedian for an hour, their natural killer cell activity goes up, compared to watching nothing. Their white blood cell count, the number of immune cells in their bloodstream, also goes up. The level of immune-boosting interferon and antibody production go up as well and even stay up the next day. So, your body is actually pumping out more antibodies because you saw a funny video the day before. In short, humor seems to offer the best of both worlds at preventing over-reactive allergic responses, while also boosting immune protection.

There is a catch, though. You actually have to laugh. And the more you laugh, the better your natural killer cell activity gets. Exposure to a humorous video without laughing did not significantly affect immune function. Those who didn’t physically laugh did not benefit. This reinforces that it is not the funny video that improved immune function, but our laughter in response. Natural killer cells play a significant role in viral illness and various types of cancer. So, being able to significantly increase the activity of these cells using a brief and non-invasive method could be clinically important the next time you have a cold or cancer.

Laughter, like music or healthy food, offers potential benefits without any risks. Or…almost no risks. You’ve heard of side-splitting laughter? In a rare case, a 67-year-old woman attended laughter therapy sessions where, evidently, rapture led to rupture. Thankfully, you can’t actually laugh your head off, but you can laugh until you wet yourself. “Giggle incontinence,” as it’s called in the medical literature, is actually quite common in women, and is no laughing matter.

Does this mean that the next time you go to the theater, you should choose the comedy over the tear-jerker? Not necessarily. Researchers took people with a latex allergy and had them watch a weather video versus a heart-warming drama. Because viewing the weather information video did not cause emotion with tears, it failed to modulate allergic responses. The tear-jerker, however, successfully reduced the allergic response, but only in those whose tears were actually jerked. So, when it comes to improving allergies, laughing and crying both work, if you actually do them.

Anything else you can do? Kiss! There’s actually a whole science of kissing, which sounds like a pleasant enough college major, until you realize it’s about all the diseases you can get. But if you take people with seasonal pollen or dust mite allergies and have them kiss someone in a room for 30 minutes, they have a significant reduction in their allergic reactions, for both the pollen and the dust mites. If you instead just have them hug for that 30 minutes, there’s no benefit. Bottom line: Kissing significantly reduced allergic responses in patients with both allergic rhinitis (runny nose and itchy eyes) or allergic dermatitis (like a rash). “Collectively these findings indicate that the direct action of love may be beneficial,” though evidently cuddling wasn’t quite direct enough.

With all the side effects of antihistamine drugs, you’d think it would have been easy to get people to sign up for the kissing study. But, it was conducted in Japan where, apparently, they “do not kiss habitually.” The follow-up study, which found a similar benefit for an even more direct action of love, was also performed by researchers who apparently did not speak English as their primary language, evidenced by their speculation about females having more “organisms.”


Did I say “Mozart study”? Yes, there have been a bunch of them, in fact. I had fun with them in my videos Music as Medicine and Music for Anxiety: Mozart vs. Metal. I don’t go seeking out these peripheral topics; I just stumble upon them in the journals. There’s so much wonderful, juicy medical science out there. I wish there were dozens of different NutritionFacts.org-type resources where one could find evidence-based reviews of the latest in the science of wellness. There could be another ten or so websites just on nutrition alone! If anyone out there is interested, I’d be more than happy to share all my know-how to facilitate its creation. I did help the Lifestyle Medicine Foundation develop LifestyleFacts.org. Check it out if you haven’t already.

For less funny and racy ways to combat allergic diseases, see my videos:

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: