Pomegranates Put to the Test for Prostate Cancer

The pomegranate “has been revered through the ages for its medicinal properties”––so much so that it’s been used as a symbol for some medical organizations. A fruit seems to me a better representation of health than the American Medical Association’s snake on a stick.

The pomegranate is thought to be beneficial for a wide range of diseases, including several types of cancer, cardiovascular disease, and rheumatoid arthritis. Evidently even the cannibals love it as it improves the color of “kid meat.” The researchers were talking about baby goats, but the title of their study did make me do a double-take!

Most of the attention over the last decade has focused on pomegranates and prostate cancer. In vitro studies have shown that pomegranate extract can suppress the growth of prostate cancer cells in a petri dish by up to 95 percent. As you can see in my video Pomegranate vs. Placebo for Prostate Cancer, there is no real difference between what normal prostate cells look like under a microscope with a little or a lot of pomegranate extract; it doesn’t seem to have much of an effect on healthy cells. However, prostate cancer cells are decimated by pomegranate extract—at least in a petri dish, but what about in a person? If these results translated to the clinic, it could be dramatic, but we first need to try it out in people.

“Primary management of prostate cancer…consists of either radical surgery or radiation therapy.” Despite this, “a significant number of patients relapse and ultimately develop metastatic disease.” Even after radical prostatectomy, the cancer comes back in about one-third of the patients, as evidenced by rising prostate-specific antigen (PSA) levels. At that point, the treatment options are limited as the prostate has already been removed. The next step is essentially chemical castration, or hormonal ablation. Just like breast cancer can thrive on estrogen, prostate cancer can thrive on testosterone. We can try to wipe out testosterone, but that can have such negative side effects that anything we can do to delay that would be good. 

So, what about plants? Men in Asia appear to have the lowest prostate cancer rates in the world, up to ten times lower than men in North America. Is this simply because of genetics? No. When Japanese individuals move to the United States and start living and eating like us, their breast and prostate cancer rates shoot right up toward ours. It could be because of what they start eating more of: animal products, which are the strongest risk factor for prostate cancer worldwide on a country-by-country basis. Or, it could be because of what they’re eating less of in the United States, namely their traditional low-fat, high-fiber, generally plant-rich diet with soy products and green tea. So, did the researchers put the cancer patients on a plant-based diet? No, they just had them drink a cup of pomegranate juice every day. Why? Because the study was funded by a pomegranate juice company.

In the three years leading up to the study, participants’ cancer was steadily growing, as measured by the increase in their average PSA levels. Once they started the juice, their tumors continued to grow, but it looked like they were growing slower. In contrast, Dean Ornish and his colleagues got an apparent reversal in early prostate cancer growth with a plant-based diet and other healthy lifestyle changes. Indeed, PSA didn’t just go up slower—it trended down. And, when dripping the blood of the men on prostate cancer cells growing in a lab, the blood serum of those eating healthfully suppressed cancer growth nearly eight times better, whereas the blood of the men on the pomegranate juice suppressed cancer growth by only about 12 percent. Still, to see any effect from drinking a cup of juice a day is pretty impressive.

The problem is that there was no control group in the pomegranate juice study. We could say the patients acted as their own controls, before and after. It’s probably not just a coincidence that their tumors started growing slower right when they started the juice. But, a drug trial tried to do the same thing—treat men with recurring prostate cancer after surgery or radiation. In the drug group, tumor growth slowed in 55 percent of the men. A pretty effective drug, right? Well, the sugar pill worked 73 percent of the time. The placebo effect can be so powerful that it may slow cancer growth. This is why we need placebo-controlled trials. Maybe tricking people into drinking pomegranate-flavored Kool-Aid would have had the same effect. We don’t know until we put it to the test.

Finally, researchers did a randomized, controlled trial of pomegranate juice for prostate cancer, and the daily pomegranate intake had no impact. What do they mean, no impact? Twenty-five percent of the cancer patients appeared to shrink their tumors as soon as they started drinking the pomegranate juice, but 35 percent shrunk their tumors not drinking pomegranate juice. So, any effect appears just to be a placebo. It’s the same story with pomegranate extract pills: They seemed to work until they went head to head with sugar pills and fell flat on their face.

I love pomegranates! Unfortunately, the juice and extracts look no more promising today than when I produced my video Is Pomegranate Juice That Wonderful?.

For some foods that may actually affect prostate cancer progression, 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’s the Secret to Latino Longevity?

Latinos living in the United States tend to have “less education, a higher poverty rate, and worse access to health care” and “represent the ultimate paradigm of healthcare disparities,” with the highest rate of uninsured, lowest rates of health screening and counseling, and poorest levels of blood pressure and blood sugar control, as well as “other measures of deficient quality of care.” So they must have dismal public health statistics, right? According to the latest national data, the life expectancy of white men and women is 76 and 81 years, respectively, and that of black men and women is shorter by a handful of years. And Latinos? Amazingly, they beat out everyone.

Latinos live the longest.

This has been called the Hispanic Paradox (now also known as the Latino Paradox), which I explore in my video, The Hispanic Paradox: Why Do Latinos Live Longer?. Latinos have a 24 percent lower risk of premature death and “lower risks of nine of the leading 15 causes of death,” with notably less cancer and heart disease. This was first noticed 30 years ago but was understandably was met with great criticism. Maybe the data were unreliable? No, that didn’t seem to be it. Maybe only the healthiest people migrate? Turns out the opposite may be true. What about the “salmon bias” theory, which “proposes that Latinos return to their home country…to ‘die in their home’” so they aren’t counted in U.S. death statistics? That theory didn’t pan out either.

Systematic reviews “confirm the existence of a Hispanic Paradox.” Given the strong evidence, it may be time to accept it and move on to figuring out the cause. The very existence of the “Hispanic Paradox” could represent “a major opportunity to identify a protective factor for CVD [cardiovascular disease] applicable to the rest of the population.” After all, whatever is going on “is strong enough to overcome the disadvantageous effect” of poverty, language barriers, and low levels of education, health literacy, quality of healthcare, and insurance coverage. Before we get our hopes up too much, though, could it just be genetic? No. As foreign-born Latinos acculturate to the United States, as they embrace the American way of life, their mortality rates go up. So, what positive health behaviors may account for Latino longevity?

Perhaps they exercise more? No, Latinos appear to be even more sedentary. They do smoke less, however the paradox persists even after taking that into account. Could it be their diet? As they acculturate, they start eating more processed and animal-based foods, and consume fewer plant foods—and perhaps one plant food in particular: beans. Maybe a reason Latinos live longer is because they eat more beans. Although Latinos only represent about 10 percent of the population, they eat a third of the beans in the United States, individually eating four to five times more beans per capita, a few pounds a month as opposed to a few pounds per year. That may help explain the “Hispanic Paradox,” because legumes (beans, split peas, chickpeas, and lentils) cool down systemic inflammation.

In my video, you can see the mechanism researchers propose in terms of lung health. While cigarette smoking and air pollution cause lung inflammation, which increases the risk for emphysema and lung cancer, when we eat beans, the good bacteria in our gut take the fiber and resistant starch, and form small chain fatty acids that are absorbed back into our system and decrease systemic inflammation, which not only may inhibit lung cancer development, but also other cancers throughout the body. Latinos have the lowest rates of chronic obstructive pulmonary disease (COPD) and lung cancer, and also tend to have lower rates of bladder cancer, throat cancer, and colorectal cancer for both men and women.

This “systemic inflammation” concept is also supported by the fact that when Latinos do get cardiovascular disease or lung, colon, or breast cancer, they have improved survival rates. Decreasing whole body inflammation may be important for both prevention and survival.

Asian Americans also appear to have some protection, which may be because they eat more beans, too, particularly in the form of tofu and other soy foods, as soy intake is associated with both preventing lung cancer and surviving it.

Hispanics also eat more corn, tomatoes, and chili peppers. A quarter of the diet in Mexico is made up of corn tortillas, and Mexican-Americans, whether born in Mexico or the United States, continue to eat more than the general population. Looking at cancer rates around the world, not only was bean consumption associated with less colon, breast, and prostate cancer, but consumption of rice and corn appeared protectively correlated, too.

Since NAFTA, though, the North American Free Trade Agreement, the Mexican diet has changed to incorporate more soda and processed and animal foods, and their obesity rates are fast catching up to those in the United States.

In the United States, Latinos eat more fruits and vegetables than other groups, about six or seven servings a day, but still don’t even make the recommended minimum of nine daily servings, so their diet could stand some improvement. Yes, Hispanics may only have half the odds of dying from heart disease, but it’s “still the number one cause of death among Hispanics. Therefore, the current results should not be misinterpreted to mean that CVD is rare among Hispanics.” Ideally they’d be eating even more whole plant foods, but one thing everyone can learn from the Latino experience is that a shift toward a more plant-based diet in general can be a potent tool in the treatment and prevention of chronic disease.

Data like this support my Daily Dozen recommendation for eating legumes ideally at every meal, and we have free apps for both iPhone and Android that can help you meet these dietary goals.

For more on the wonders of beans, split peas, chickpeas, and lentils, see my videos and love your legumes!:

What’s the best way to eat them? See Canned Beans or Cooked Beans? and Cooked Beans or Sprouted Beans?.

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 Effects of the Hops Phytoestrogen in Beer on Breast Cancer Risk

Hops have been used for centuries as a flavoring agent in beer, but “[o]ver the years, a recurring suggestion has been that hops”—and therefore beer—may be estrogenic, thanks to a potent phytoestrogen in hops called 8-PN, also known as hopein. Might beer drinking affect our hormones? I discuss this in my video What Are the Effects of the Hops Phytoestrogen in Beer?.

Even just the alcohol in beer can reduce testosterone levels in men, so when beer was tested as a source of estrogens, the alcohol was first removed. Researchers tested the equivalent of one can of beer every day for a month on the hormone levels of postmenopausal women, so as to not confound the results with her own estrogens, and they found significant alterations of hormonal levels during the beer month and then a return to baseline a week afterwards. But does this have any clinical effects, whether good or bad?

A cross-sectional study of about 1,700 women found that beer drinkers appear to have better bone density, perhaps because of the pro-estrogenic effects. They don’t recommend women start drinking beer for bone health, but suggest it may have beneficial bone effects for women who already drink.

What about helping with hot flashes? About half of postmenopausal and premenopausal women in the United States suffer from hot flashes, whereas the prevalence in Japan may be ten times lower, presumed to be because of their soy consumption. What about hops? There have been a few studies showing potential benefit, leading to a 2013 review suggesting that “hop extract may be somewhat effective in treating menopausal discomforts especially against hot flushes,” but that was before a study reported extraordinary results with about a half teaspoon of dried hop flowers. In the placebo group, the women started out having 23 hot flashes a week and continued to have 23 hot flashes a week throughout the three-month study. In the hops group, the women started out even worse with about 29 hot flashes a week, but then got down to 19 at the end of the first month, then 9, and finally just 1 hot flash a week. And similar findings were reported for all the other menopausal symptoms measured.

Animal estrogens work, too. Millions of women used to be on horse hormones—Premarin, from pregnant mares’ urine. That drug also took care of hot flashes, as well as  curtailed osteoporosis, but caused a pesky little side effect called breast cancer. Thankfully, when this was realized and millions of women stopped taking it, breast cancer rates fell in countries around the world.

The question, then, is: Are the estrogens in hops more like the breast cancer-promoting horse estrogens or the breast cancer-preventing soy estrogens? The key to understanding the health-protective potential of soy phytoestrogens is understanding the difference between the two types of estrogen receptors, alpha receptors and beta receptors. Unlike animal estrogen, the soy phytoestrogens bind preferentially to the beta receptors, and in breast tissue, they’re like yin and yang with the alpha receptors signaling breast cell proliferation. This explains why horse hormones increase breast cancer risk, whereas the beta receptors, where the soy binds, oppose that proliferative impact. So, do the hops phytoestrogens prefer beta, too? No. 8-PN is a selective estrogen receptor alpha promoter. “Surprisingly and in clear contrast to genistein [the soy], 8-PN is a much weaker” binder of beta than of alpha. So, that explains why hops is such a common ingredient in so-called breast enhancing supplements—that is, because it acts more like estrogen estrogen. Given the breast cancer concerns, use of such products should be discouraged, but just drinking beer could provide the exposure to the hops estrogen, which could help explain why beer may be more carcinogenic to the breast than some other forms of alcohol.

A phytoestrogen in beer? For more on the background of this issue, see The Most Potent Phytoestrogen Is in Beer.

Other videos on phytoestrogen include:

To learn more about dietary effects on testosterone, see:

What about “natural” hormones for menopause? See my video Plant-Based Bioidentical Hormones.

For more on the risks of alcohol in terms of breast cancer risk, see Breast Cancer and Alcohol: How Much Is Safe? and Breast Cancer Risk: Red Wine vs. White Wine.

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: