The Dean Ornish Program is a comprehensive lifestyle modification program that combines a supplemented vegan diet with exercise, stress management, smoking cessation, and group support sessions, primarily aimed at preventing heart disease. However, research suggests it may also be beneficial in managing early-stage prostate cancer.
Dean Ornish and the Preventive Medicine Research Institute
Dean Ornish MD, is the founder and president of the non-profit Preventive Medicine Research Institute in Sausalito, California, and a clinical professor of medicine at the University of California, San Francisco (UCSF). In his book "The Spectrum," he provides examples of individually tailored diet and lifestyle programs, including one to prevent or reverse certain types of prostate and breast cancer.
Rationale for the Ornish Program in Prostate Cancer
Given that cardiovascular disease is a primary or secondary cause of death in men with prostate cancer and that numerous studies suggest diet and lifestyle may play a role in the development of prostate cancer, the Ornish group began exploring the possible effects of such an intervention in the late 1990s.
The program is indicated for early-stage prostate cancer patients (biopsy-documented; Gleason score less than 7; serum prostate-specific antigen (PSA) levels of 4-10 ng/ml; Stages T1 and T2) before surgical intervention or hormone-deprivation, i.e. patients on active surveillance (watchful waiting) closely monitoring disease progress.
Ornish and colleagues suggest the possibility that some or all aspects of the combined lifestyle changes (diet + exercise + stress management) enable patients with early-stage prostate cancer to delay or avoid conventional treatment and/or improve quality of life.
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Mechanisms of Action
The mechanism of action of the Ornish diet and lifestyle modification program was examined in one prospective pilot study that enrolled 31 low-risk prostate cancer patients.
Differences in RNA samples from needle biopsies taken from normal prostate tissue before intervention compared to RNA samples taken after 3 months of intervention indicated that application of the Ornish diet and lifestyle modification program may modulate gene expression in the prostate. Pathway analysis identified significant modulation of biological processes playing critical roles in tumorigenesis, including protein metabolism and modification, intracellular protein traffic, and protein phosphorylation.
In peripheral blood mononuclear cells (PBMCs) of the patients, telomerase activity and hence telomere maintenance capacity was significantly increased. A 5-year follow-up study including 10 men compared with 25 external controls, showed that the relative telomere length had increased in the intervention group and decreased in the control group; the difference between both groups was significant.
Application of the Ornish Program
The Ornish program's cornerstone is a nine-week course designed to give participants the tools they need to lose weight and live longer, healthier lives. Course sessions, held semiweekly in small groups, cover nutrition counseling, meal preparation for the Ornish diet, exercise instruction, and reducing stress through yoga and meditation. To speak with one of Sarasota Memorial’s certified Ornish program specialists, call (941) 917-6139. Click here for a look at the impressive results that cohorts in the SMH Ornish Program achieved.
The Vegan Diet Component
The vegan diet itself is very low in fat: less than 10% of calories comes from fat which occurs naturally in grains, vegetables, fruit, beans, legumes, soy foods and small amounts of nuts and seeds. It is also low in simple carbohydrates but high in fiber, and includes predominantly fruits, vegetables, whole grains, and legumes, all in their natural unrefined forms. Meat, plant foods high in fat (e.g., avocados), fat dairy products, and refined carbohydrates are eliminated. Consumption of minimal amounts of non-fat dairy products such as skimmed milk, non-fat yogurt, and non-fat cheese is allowed.
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The program recommends a low-dose multivitamin and mineral supplement with B-12 (without iron, if not of childbearing age), fish oil and, possibly upon the advice of a physician, calcium supplements. Sugar and alcohol are allowed in small amounts but not encouraged. The diet is in general concordance with the American Cancer Society guidelines.
Exercise and Stress Management
The exercise part consists of regular moderate aerobic exercise. Participants are encouraged to exercise aerobically a minimum of 30 minutes a day or for an hour every other day for a total of 3-5 hours of aerobic exercise per week. If medically appropriate, participants are also encouraged to engage in strength training exercise 2-3 times per week.
Impact on Gene Expression
Epidemiological and prospective studies indicate that comprehensive lifestyle changes may modify the progression of prostate cancer. However, the molecular mechanisms by which improvements in diet and lifestyle might affect the prostate microenvironment are poorly understood.
Intensive nutrition and lifestyle changes may modulate gene expression in the prostate. Understanding the prostate molecular response to comprehensive lifestyle changes may strengthen efforts to develop effective prevention and treatment.
The GEMINAL study was a prospective pilot trial of diet and lifestyle intervention in men with low-risk prostate cancer. Unlike patients with other tumor types, who must undergo immediate resection, radiation therapy, or, rarely, chemotherapy, low-risk prostate cancers may be observed, providing a unique opportunity for molecular study when men undergo serial biopsy during active surveillance. Similar to previous active surveillance clinical studies, the patients reported no adverse events. The observations provide molecular hypotheses that may help explain some of the effects of comprehensive lifestyle changes.
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The Gut Microbiome Connection
Early-life microbial exposures determine sex hormone levels and modify progression to autoimmunity in animal models. In one mouse study, the transfer of gut microbiota from adult males to immature females altered the intestinal microbiome of the recipients, resulting in elevated testosterone and autoantibody production. These effects were found to be mediated through the androgen receptor, which demonstrates that the composition of the intestinal microbiome alters sex hormone levels and serves to potentially regulate autoimmune disease later in life in individuals with high genetic risk.
A study published in Science this year demonstrated that bacteria within the intestinal microbiome can promote resistance to treatments for prostate cancer designed to reduce androgen impact on prostate and potentially make them refractory to anti-androgen therapy, including castration.
The Role of Phytonutrients
The clinical research indicates that a minimally processed, plant-food-based diet that is high in fiber, vitamins, and minerals, and includes diverse sources of phytonutrients is associated with improved prostate health and reduction in prostate cancer risk, as defined by PSA levels.
An interesting 2014 study examined the influence of walnuts on prostate specific antigen levels, and reported that one of its principal phytonutrients, ellagic acid, is metabolized by specific members of the intestinal microbiome into urolithins A and B. Furthermore, these metabolites were found to down-regulate the mRNA and protein levels of both PSA and the androgen receptor in a prostate cell line. The data showed that the urolithins inhibit androgen receptor-mediated PSA expression at the transcriptional level. Additionally, the urolithins induced apoptosis in prostate cancer cells. In summary, the study indicated that the microbial metabolites of walnut ellagic acid, urolithins, attenuate the function of the androgen receptor by repressing its expression, which results in a down-regulation of PSA levels and induces apoptosis.
Plant-Based Diets and Prostate Cancer: A Urologist's Perspective
"Encouraging our patients to adopt a healthy, plant-based diet is a great way to simultaneously promote both prostate and overall health," writes Stacy Loeb, MD, MSc. Loeb is a professor of urology and population health at New York University Grossman School of Medicine in New York, New York.
Although there are many nonmodifiable risk factors for prostate cancer, diet represents one of the most important modifiable factors along the spectrum of disease, from prevention all the way to advanced disease.
By analyzing data from more than 47,000 participants in the Health Professionals Follow-up Study, it was found that those who consumed more plant-based food had a 19% lower risk of fatal prostate cancer; the association was stronger for men younger than 65 years. Other groups have found similar results. For example, data from the National Health and Nutrition Examination Survey showed that men who primarily consumed healthy, plant-based food were 53% less likely to have an elevated prostate-specific antigen (PSA) level.
Consuming more plant-based food is also beneficial after diagnosis to reduce the risk of progression and side effects after treatment. For example, a systematic review of the literature on plant-based diets (eg, vegan or vegetarian) and prostate cancer was conducted. The review identified 5 interventional studies conducted in patients diagnosed with prostate cancer that focused on 2 main clinical scenarios: (1) active surveillance and (2) biochemical recurrence after treatment. One study involving active surveillance was the Prostate Cancer Lifestyle Trial, a randomized clinical trial of patients who participated in a lifestyle intervention comprising a vegan diet, along with physical activity and mindfulness, compared with controls. The lifestyle intervention group was significantly less likely to progress to treatment. In addition, these participants experienced other health benefits from the lifestyle program, such as substantial reductions in cholesterol and weight. Other studies of patients with biochemical recurrence showed more favorable PSA kinetics (eg, longer doubling time) with plant-based diets.
Increasing plant-based food consumption was associated with significantly better scores for sexual, urinary, and other quality-of-life domains (eg, bowel health and vitality) after prostate cancer treatment.
Patients with favorable-risk tumors have a much greater risk of death from cardiovascular disease compared with prostate cancer itself. Even among patients with metastatic prostate cancer, who are more likely to die from it, cardiovascular disease remains an important competing risk of morbidity and mortality. Healthy, plant-based diets have been shown to reduce the progression of major comorbid conditions such as coronary artery disease and diabetes.
Resources for Plant-Based Diets
There are also many helpful books (eg, How Not to Die) and documentaries (eg, The Game Changers, Forks Over Knives). Finally, signing up for a challenge such as Meatless Mondays or Veganuary (going vegan for the month of January) can be a fun way to get started.