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    How cutting carbs may benefit men on hormonal therapy

    Stephen J. Freedland, MDStephen J. Freedland, MDRecent data show that a low-carbohydrate diet may have significant positive effects in men on hormonal therapy for prostate cancer, including metabolic effects. In this interview, study author Stephen J. Freedland, MD, of Cedars-Sinai Medical Center in Los Angeles, discusses his group’s findings, ongoing research on diet and lifestyle changes in men with prostate cancer, and how he counsels patients. Dr. Freedland is professor of surgery (urology), director of the Center for Integrative Research in Cancer and Lifestyle, and the Warschaw Robertson Law Families Chair in Prostate Cancer at Cedars-Sinai Medical Center in Los Angeles. He was interviewed by Urology Times Editorial Council member Stacy Loeb, MD, MSc, assistant professor of urology and population health at New York University School of Medicine, New York.

    At the 2016 AUA annual meeting, you presented results from a prospective, randomized trial of dietary carbohydrate restriction for men initiating androgen deprivation therapy called the Carbohydrate and Prostate Study 1, CAPS1. Please give us a little bit of background on your study.

    We know hormonal therapy, when used in the right patient, is life extending. But the problem with hormonal therapy is it comes with side effects, many of which are familiar to urologists: erectile dysfunction, fatigue, loss of libido, osteoporosis. What’s becoming increasingly clear is that hormonal therapy also has metabolic effects. Some very nice studies show the risk of diabetes increases 40% when you start hormonal therapy.

     

    How did you get the idea that you might be able to reverse some of these changes through diet and exercise?

    I’ve been working with low-carbohydrate diets in the laboratory as an approach to slow cancer. In mice, balanced calorie for calorie, eating a low-carbohydrate diet actually slows their cancer growth. I have also been working with an investigator at Duke University who is performing clinical trials showing that a low-carbohydrate diet in non-cancer patients improves insulin sensitivity. When they’re on a low-carb diet, a lot of diabetic patients completely get off their medication and they lose weight, and it seemed like this diet could prevent the side effects of hormonal therapy.

    Next: How the study was carried out

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