Best superfoods for men

Most men need to pay more attention to their health. Compared to women, men are more likely to:

• Smoke
• Drink alcohol
• Make unhealthy or risky choices
• Put off regular checkups and medical care

There are also health conditions that only affect men, such as prostate cancer and low testosterone. Many of the major health risks that men face – like colon cancer or heart disease – can be prevented and treated with early diagnosis. Screening tests can find diseases early, when they are easier to treat. It’s important to get the screening tests you need.

The good news is that you can start taking better care of your health today.

Leading Causes of Death in Males United States, 2014

*Percent of total deaths in the race category due to the disease indicated. The white, black, American Indian/Alaska Native, and Asian/Pacific Islander race groups include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race.

The good news is there’s a lot you can do to prevent heart disease.

Healthy Habits

It’s not too late to start healthier habits.

Make eating healthy and being active part of your daily routine. A healthy diet and regular physical activity can help lower your:

• Blood pressure
• Blood sugar
• Cholesterol
• Weight

By keeping these numbers down, you can lower your risk of serious health problems like type 2 diabetes and heart disease.

You can also help prevent health problems by:

• Drinking alcohol only in moderation
• Quitting smoking

How To Keep Your Heart Healthy

What is heart disease ?

When people talk about heart disease, they are usually talking about coronary heart disease. It’s also called coronary artery disease. This is the most common type of heart disease ²⁾.

When someone has coronary heart disease (coronary artery disease), the coronary arteries that take blood to the heart are narrow or blocked. This happens when cholesterol and fatty material, called plaque, build up inside the arteries.

Plaque is caused by:

• Too much fat and cholesterol in the blood
• High blood pressure
• Smoking
• Too much sugar in the blood (usually because of diabetes)

When plaque blocks an artery, it’s hard for blood to flow to the heart. If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina or a heart attack can occur.

• Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
• A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious health problems or death.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart.

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries.

Over time, coronary heart disease (coronary artery disease) can weaken the heart muscle and lead to heart failure and arrhythmias. Heart failure is a condition in which your heart can’t pump enough blood to meet your body’s needs. Arrhythmias are problems with the rate or rhythm of the heartbeat.

Take steps today to lower your risk of heart disease. Heart disease is the leading cause of death for both men and women in the United States.

To help prevent heart disease, you can:

• Eat healthy.
• Get active.
• Stay at a healthy weight.
• Quit smoking and stay away from secondhand smoke.
• Control your cholesterol and blood pressure.
• If you drink alcohol, drink only in moderation.
• Manage stress.

Sodium

You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and “no added salt” foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.

Alcohol

Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain.

Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:

• 12 ounces of beer
• 5 ounces of wine
• 1½ ounces of liquor

Risk factors for heart disease

Everyone is at risk for heart disease. But you are at higher risk for heart disease if you:

• Have high cholesterol or high blood pressure
• Smoke
• Are overweight or obese
• Don’t get enough physical activity
• Don’t eat a healthy diet

Your age and family history also affect your risk for heart disease. Your risk is higher if:

• You are a woman over age 55
• You are a man over age 45
• Your father or brother had heart disease before age 55
• Your mother or sister had heart disease before age 65

Heart-Healthy Eating

Heart-healthy eating usually include:

• Fat-free or low-fat dairy products, such as fat-free milk
• Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
• Fruits, such as apples, bananas, oranges, pears, and prunes
• Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
• Vegetables, such as broccoli, cabbage, and carrots
• Whole grains, such as oatmeal, brown rice, barley and corn tortillas

Not all fats are bad. Monounsaturated (MUFAs) and polyunsaturated fats (PUFAs) actually help lower blood cholesterol levels.

Some sources of monounsaturated and polyunsaturated fats are:

• Avocados
• Corn, sunflower, and soybean oils
• Nuts and seeds, such as walnuts
• Olive, canola, peanut, safflower, and sesame oils
• Peanut butter
• Salmon and trout
• Tofu

When following a heart-healthy diet, you should avoid eating:

• A lot of red meat
• Palm and coconut oils
• Sugary foods and beverages

Two nutrients in your diet make blood cholesterol levels rise:

• Saturated fat—found mostly in foods that come from animals
• Trans fat (trans fatty acids)—found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats.

Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat.

Barley Health Benefits

In scientific studies, barley has been shown to reduce the risk of many diseases and to provide important health benefits. Barley offers many of the same healthy vitamins and minerals as other whole grains, but many think its special health benefits stem from the high levels of soluble beta-glucan fiber found in this grain. According to Health Canada ³⁾ and the US Food and Drug Administration ⁴⁾, consuming at least 3 grams per day of barley beta-glucan or 0.75 grams per serving of soluble fiber can lower levels of blood cholesterol, a risk factor for cardiovascular diseases.

A recent review in the journal Minerva Med ⁵⁾, beta-glucans reduce cholesterol, help control blood sugar, and improve immune system function. New research even indicates that beta-glucans may be radioprotective: they may help your bodies stand up better to chemotherapy, radiation therapy and nuclear emergencies.

• Barley, like all whole grains, reduces blood pressure.
• Eating barley has been shown to lower LDL “bad” cholesterol and may help reduce the risk of heart disease.
• A flood of recent research indicates that barley’s ability to control blood sugar may be exceptional, offering an important tool against rising rates of diabetes.
• Barley has more protein than corn, brown rice, millet, sorghum or rye, and is higher in fiber and lower in soluble (starch) carbohydrates than almost all other whole grains.
• Barley may help you feel full longer, and thereby help you control your weight.
• Barley – even pearl barley – may help reduce visceral fat and waist circumference.

In a 100 gram serving, raw barley provides 354 calories and is a rich source (20% or more of the Daily Value, DV) of essential nutrients, including protein, dietary fiber, the B vitamins, niacin (31% DV) and vitamin B6 (20% DV), and several dietary minerals (see Table 1). Highest nutrient contents are for manganese (63% DV) and phosphorus (32% DV). Raw barley is 78% carbohydrates, 1% fat, 10% protein and 10% water.

Table 1. Barley hulled nutrition facts

Barley Controls Blood Sugar Better

Dutch researchers ⁷⁾ used a crossover study with 10 healthy men to compare the effects of cooked barley kernels and refined wheat bread on blood sugar control. The men ate one or the other of these grains at dinner, then were given a high glycemic index breakfast (50g of glucose) the next morning for breakfast. When they had eaten the barley dinner, the men had 30% better insulin sensitivity the next morning after breakfast.

Barley Lowers Glucose Levels

White rice, the staple food in Japan, is a high glycemic index food. Researchers at the University of Tokushima found that glucose levels were lower after meals when subjects switched from rice to barley ⁸⁾.

Barley Beta-Glucan Lowers Glycemic Index

Scientists at the Functional Food Centre at Oxfod Brookes University in England ⁹⁾ fed 8 healthy human subjects chapatis (unleavened Indian flatbreads) made with either 0g, 2g, 4g, 6g or 8g of barley beta-glucan fiber. They found that all amounts of barley beta-glucan lowered the glycemic index of the breads, with 4g or more making a significant difference.

Insulin Response better with Barley Beta-Glucan

In a crossover study ¹⁰⁾ involving 17 obese women at increased risk for insulin resistance, USDA scientists studied the effects of 5 different breakfast cereal test meals on subjects’ insulin response. They found that consumption of 10g of barley beta-glucan significantly reduced insulin response.

Barley Beats Oats in Glucose Response Study

USDA researchers fed barley flakes, barley flour, rolled oats, oat flour, and glucose to 10 overweight middle-aged women, then studied their bodies’ responses ¹¹⁾. They found that peak glucose and insulin levels after barley were significantly lower than those after glucose or oats. Particle size did not appear to be a factor, as both flour and flakes had similar effects.

Barley Reduces Blood Pressure

For five weeks, adults with mildly high cholesterol were fed diets supplemented with one of three whole grain choices: whole wheat/brown rice, barley, or whole wheat/brown rice/barley ¹²⁾. All three whole grain combinations reduced blood pressure, leading USDA researchers to conclude that “in a healthful diet, increasing whole grain foods, whether high in soluble or insoluble fiber, can reduce blood pressure and may help to control weight” ¹³⁾.

Barley Lowers Serum Lipids

University of Connecticut researchers ¹⁴⁾ reviewed 8 studies evaluating the lipid-reducing effects of barley. They found that eating barley significantly lowered total cholesterol, LDL (“bad”) cholesterol, and triglycerides, but did not appear to significantly alter HDL (“good”) cholesterol.

Cholesterol and Visceral Fat Decrease with Barley

A randomized double-blind study ¹⁵⁾ in Japan followed 44 men with high cholesterol for twelve weeks, as the men ate either a standard white-rice diet or one with a mixture of rice and high-beta-glucan pearl barley. Barley intake significantly reduced serum cholesterol and visceral fat, both accepted markers of cardiovascular risk.

Barley significantly Improves Lipids

25 adults with mildly high cholesterol were fed whole grain foods containing 0g, 3g or 6g of barley beta-glucan per day for five weeks, with blood samples taken twice weekly ¹⁶⁾. Total cholesterol and LDL (“bad”) cholesterol significantly decreased with the addition of barley to the diet.

Barley Pasta Lowers Cholesterol

University of California researchers ¹⁷⁾ fed two test meals to 11 healthy men, both containing beta-glucan. One meal was a high-fiber (15.7g) barley pasta and the other was lower-fiber (5.0g) wheat pasta. The barley pasta blunted insulin response, and four hours after the meal, barley-eaters had significantly lower cholesterol concentration than wheat-eaters.

Barley’s Slow Digestion may help Weight Control

Barley varieties such as Prowashonupana that are especially high in beta-glucan fiber may digest more slowly than standard barley varieties. Researchers at USDA and the Texas Children’s Hospital ¹⁸⁾ compared the two and concluded that Prowashonupana may indeed be especially appropriate for obese and diabetic patients.

Greater Satiety, Fewer Calories Eaten with Barley

In a pilot study not yet published, six healthy subjects ate a 420-calorie breakfast bar after an overnight fast, then at lunch were offered an all-you-can-eat buffet. When subjects ate a Prowashonupana barley bar at breakfast they subsequently ate 100 calories less at lunch than when they ate a traditional granola bar for breakfast.

Oats Health Benefits

Scientific studies have concluded that like barley, oats contain a special kind of fiber called beta-glucan found to be especially effective in lowering cholesterol. The water-soluble, mixed-linkage β-glucan, a form of soluble dietary fibre, is considered the main biologically active component responsible for the capacity of many oat products to lower postprandial glycaemia and fasting plasma cholesterol in human subjects ¹⁹⁾. Many in vitro animal and human studies have shown that water-soluble β-glucan is one of the main bioactive components responsible for a number of the putative health benefits attributed to oat products ²⁰⁾. In breakfast cereals containing 3 g of β-glucan/serving, high-MW (2,210,000 g/mol) or a medium-MW (530,000 g/mol) lowered LDL cholesterol by ≈0.2 mmol/L (5%). However, when the molecular weight of β-glucan was < 210 000 g/mol, the ability of the breakfast cereal to reduce LDL-cholesterol was decreased by 50 % ²¹⁾.

Most β-glucan in the oat groat is located in the inner layer of the cell wall that is enclosed by an insoluble cellulosic and hemicellulosic outer layer ²²⁾. It is generally less water soluble than extracted β-glucan material. Because the cell walls in the inner endosperm are thinner than in the aleurone and subaleurone layers, it appears that β-glucan in the milled whole groat is more easily extracted than that in oat bran ²³⁾, ²⁴⁾. For example, Beer et al. ²⁵⁾ has found that the proportion of soluble β-glucan extracted from oat brans and rolled oats, by hot-water extraction in conjunction with a heat-stable α-amylase treatment, was 30–65 and 70 %, respectively. Under physiological conditions, the percentage of extractable β-glucan was also noticeably higher in rolled oats than in bran samples. Based on the results of physiological and human studies to date, there is strong evidence to show that oat β-glucan lowers total and LDL-cholesterol and reduces after meal effect glycaemia and insulinaemia when it is ingested in sufficiently high doses and at a suitably high molecular weight ²⁶⁾.

• Eating oats helps lower LDL “bad” cholesterol and may help reduce the risk of heart disease.
• Oats help you feel fuller longer, which helps control your weight.
• Oatmeal and oats may help lower blood pressure.
• Oats may help reduce your risk of type 2 diabetes, since their soluble fiber helps control blood sugar.
• Oats help cut the use of laxatives, without the side effects associated with medications.
• Oats are high in beta-glucans, a kind of starch that stimulates the immune system and inhibits tumors. This may help reduce your risk of some cancers.
• Early introduction of oats in children’s diets may help reduce their risk of asthma.
• Oats are higher in protein and healthy fats, and lower in carbohydrates than most other whole grains.
• Oats contain more than 20 unique polyphenols called avenanthramides, which have strong anti-oxidant, anti-inflammatory, and anti-itching activity.

Oats Lower Bad Cholesterol

Researchers at Colorado State University ²⁷⁾ randomly assigned thirty-six overweight middle-aged men to eat either an oat or wheat cereal daily for twelve weeks. At the end of the three-month period, the men eating the oat cereal had lower concentrations of small, dense LDL cholesterol (thought to be particularly dangerous) and lower LDL (“bad”) cholesterol overall, compared to those in the wheat group, while their HDL (“good”) cholesterol was unchanged.

Oats Help Control Blood Pressure

Using a randomized, controlled parallel-group pilot study ²⁸⁾, researchers followed 18 hypertensive and hyperinsulemic men and women for six weeks, while half of them ate oat cereal (5.52g/day of beta-glucan) and the others ate a lower-fiber cereal (less than 1g total fiber). The oat group enjoyed a 7.5mm Hg reduction in systolic blood pressure and a 5.5 mm Hg reduction in diastolic blood pressure, while the wheat group was unchanged.

Oats and Cardiovascular Disease Risk Markers

High consumption of whole-grain food such as oats is associated with a reduced risk of cardiovascular disease and type 2 diabetes. The present systematic literature review ²⁹⁾ concluded that regular consumption of oats or oat bran has a beneficial effect on total cholesterol and LDL-cholesterol, particularly in hypercholesterolaemic (high blood cholesterol) subjects. The intervention trials described in the present review can generally be divided into three groups depending on the product used in the intervention: oat bran; whole-grain oat cereals; oatmeal. For the studies that showed a significant reduction in total cholesterol and/or LDL-cholesterol, the range of doses used was 25–135 g/d for oat bran, 45–90 g/d for whole-grain oat cereals and 60–150 g/d for oatmeal. So it appears that the form of oats does not really affect the outcome. The doses required to reach a significant effect were also similar. However, studies using amounts below 50 g/d are scarce, and more well-designed dose–response studies are needed to confirm the minimum amount required to have a clinical beneficial effect. The 3–6 % cholesterol reduction described in the larger studies would translate to a 6–18 % decrease in coronary heart disease risk. Some studies reported significant effects on blood cholesterol only 2 weeks after beginning the intervention, so it is likely that the benefits of increasing oats intake start very shortly after changing the diet. How long these effects on blood cholesterol remain if subjects revert to their original diet remains to be determined. However, there is no indication that it would significantly modulate insulin sensitivity. It is still unclear whether increased oat consumption would significantly affect other risk markers for cardiovascular disease risk. More comprehensive, properly controlled intervention trials with adequate sample sizes are required to answer this question ³⁰⁾.

To investigate the effect of bread formulated with 6 g of beta-glucan (oat soluble fiber) on serum lipids in overweight normotensive subjects with mild to moderate hypercholesterolemia ³¹⁾. Thirty-eight male subjects [mean age 59.8  yr, mean body mass index (BMI) 28.3 kg/m(2)] who were eligible for the study ate an normal diet for a 1-week period. They were then divided into 2 groups: group A (19 subjects), who were maintained on American Heart Association (AHA) Step II diet, including whole wheat bread, and group B (19 subjects), who were maintained on AHA Step II diet containing high levels of monounsaturated fatty acids plus bread containing 6 g of beta-glucan (Nutrim-OB) for 8 weeks. Plasma lipids and glucose were measured at baseline and after weeks 8 in all subjects. All subjects were advised to walk for 60 minutes every day. Six grams of beta-glucan from oats added to the AHA Step II diet and moderate physical activity improved lipid profile and caused a decrease in weight and, thus, reduced the risk of cardiovascular events in overweight male individuals with mild to moderate hypercholesterolemia. The diet with added beta-glucan was well accepted and tolerated ³²⁾.

This randomized, double-blind, controlled trial ³³⁾ evaluated the influence of low fat, low saturated fat food products that contained free tall oil-based phytosterols (TOP) and oat beta-glucan (from whole oats and bran concentrate) on serum lipid concentrations in adults with mild-to-moderate hypercholesterolemia. The results of this trial suggest that consumption of a group of low fat, TOP and beta-glucan- containing foods is a useful adjunct in the dietary management of hypercholesterolemia ³⁴⁾.

In another randomized controlled trial of comparing oatmeal consumption versus noodle consumption on blood lipids of urban Chinese adults with hypercholesterolemia ³⁵⁾. The oat group (n=85) consumed 100 grams of instant oat cereal versus the control group (n=81) who consumed 100 grams of wheat flour-based noodles daily for 6 weeks. Laboratory and anthropometric measurements were conducted at baseline and at the end of the 6-week intervention. Dietary fiber intake increased significantly in the oat group compared to the control group at the end of the 6-week intervention. Total-, LDL-cholesterol and waist circumference decreased significantly in the oat group compared to the control. HDL-cholesterol decreased significantly in the control group versus the oat group. There were no significant changes in blood pressure, other anthropometric or laboratory measures between the two groups at the end of the intervention ³⁶⁾.

In a 6-week randomised controlled trial was conducted to test whether 1·5 g/d β-glucan provided as ready-to-eat oat flakes was as effective in lowering cholesterol as 3·0 g/d from oats porridge ³⁷⁾. Eighty-seven mildly hypercholesterolaemic ( ≥ 5 mmol/l and < 7·5 mmol/l) men and women assigned to one of three diet arms (25 % energy (E%) protein; 45 E% carbohydrate; 30 E% fat, at energy requirements for weight maintenance): (1) minimal β-glucan (control); (2) low-dose oat β-glucan (1·5 g β-glucan; oats low – OL) or (3) higher dose oat β-glucan (3·0 g β-glucan; oats high – OH). Changes in total cholesterol and LDL-cholesterol (LDL-C) from baseline were assessed. Total cholesterol reduced significantly in all groups ( – 7·8 % in the 3·0 g β-glucan oat group, – 7·2 % in the 1·5 g β-glucan oat group and – 5·5 % in  control groups), as did LDL-C (- 8·4 % in the 3·0 g β-glucan oat group, – 8·5 % in the 1·5 g β-glucan oat group and – 5·5 % in the control group). In responders only, β-glucan groups had higher reductions in LDL-Cholesterol compared with controls. Intakes of oat β-glucan were as effective at doses of 1·5 g/d compared with 3 g/d when provided in different food formats that delivered similar amounts of soluble β-glucan ³⁸⁾.

The United States Food and Drug Administration (FDA) approved a health claim for β-glucan soluble fiber from oats for reducing plasma cholesterol levels and risk of heart disease in 1997. Similarly, in 2004 the United Kingdom Joint Health Claims Initiative (JHCI) allowed a cholesterol-lowering health claim for oat β-glucan ³⁹⁾. In 2007, Health Canada, after careful evaluation, concludes on the basis of new research information that a dose of 3 g/day oat β-glucan consumed as part of a diet “free of saturated fatty acids” or “low in saturated fatty acids” could help to promote cardiovascular health ⁴⁰⁾.

Results of this analysis ⁴¹⁾ show that studies conducted during the past 13 years support the suggestion that intake of oat β-glucan at daily doses of at least 3 g may reduce plasma total and low-density lipoprotein (LDL) cholesterol levels by 5-10% in normocholesterolemic or hypercholesterolemic subjects. Studies described herein have shown that, on average, oat consumption is associated with 5% and 7% reductions in total and LDL cholesterol levels, respectively. Significant scientific agreement continues to support a relationship between oat β-glucan and blood cholesterol levels, with newer data being consistent with earlier conclusions made by the FDA and JHCI ⁴²⁾.

Oats May Help Reduce the Risk of Type 2 Diabetes

Researchers in Mannheim, Germany ⁴³⁾ carried out a dietary intervention with 14 patients who had uncontrolled type 2 diabetes and insulin resistance. The patients were introduced to a diabetes-appropriate diet containing oatmeal during a short hospital stay, then examined again four weeks later. On average, patients achieved a 40% reduction in insulin dosage – and maintained the reduction even after 4 weeks on their own at home.

Oats May Improve Insulin Sensitivity

Researchers in Chicago ⁴⁴⁾ carried out a randomized, double-blind, controlled clinical trial of ninety-seven men and women, in which half of the group consumed foods containing oat beta-glucan, while the other half ate control foods. At the end of the trial period, the oat group showed improvements in insulin sensitivity, while the control group was unchanged.

Oats Increase Appetite-Control Hormones

Australian researchers ⁴⁵⁾ studied fourteen people who ate a control meal and three different cereals with different levels of oat beta glucan. They then collected blood samples for four hours after each meal, and found a significant dose response between higher levels of oat beta glucan and higher levels of Peptide Y-Y, a hormone associated with appetite control.

Oats #3 Overall, #1 for Breakfast, in Satiety Index

Also in Australia, researchers at the University of Sydney ⁴⁶⁾ fed 38 different foods, one by one, to 11-13 different people, then asked them to report their “satiety” or fullness every 15 minutes for the next two hours. From this, they ranked all 38 foods in a “Satiety Index.” Oatmeal rated #3 overall for making people feel satisfied and full, and it rated #1 in the breakfast food group.

Oats consumption and risk of cancer and overall mortality

A review of epidemiological studies on the intake of oats and oat-based products and its effect on the risk of chronic disease and deaths was performed ⁴⁷⁾. Seven studies were identified of cancer risk (two each on prostate and colorectal cancer, and one each on pancreatic, breast and endometrial cancer), and one study on overall mortality.

Oatmeal was one of the components of the healthy Nordic food index, whose association with total mortality was investigated in the Danish Diet, Cancer and Health cohort study (57,053 subjects aged 50–64 at baseline) ⁴⁸⁾. During 12 years of follow-up, 4126 of the cohort participants died. A one-point increase in the index score was associated with a significantly lower mortality for both men and women. Among the individual index components, whole-grain rye bread intake was the factor most consistently associated with lower mortality. An association was suggested for oatmeal intake for >20 g/d vs. ≤20 g/d was 0·91 in men and 0·97 in women.

In an analysis of 1025 cases of colorectal cancer diagnosed among 57,053 participants in the Danish Diet, Cancer and Health cohort study over a 13-year period, no association was found with the healthy Nordic food index, which includes oatmeal intake ⁴⁹⁾. Consumption of oatmeal was similar among those diagnosed with colorectal cancer and those who remained free of the disease. The HELGA cohort comprises 108,000 Danish, Swedish and Norwegian people (including the Danish Diet, Cancer and Health cohort), of whom 1123 developed colorectal cancer during a median of 11 years of follow-up. This cohort was analysed for the intake of whole-grain products, including whole-grain oats ⁵⁰⁾. The intake of whole-grain products was associated with a lower incidence of colorectal cancer; however, no consistent association was observed with the intake of whole-grain oats ⁵¹⁾.

In conclusion, few epidemiological studies have been conducted on oats and oat-based products and disease risk: overall, they provide weak evidence of a protective effect of oats intake on cancer risk and overall mortality. No conclusions can therefore be confidently drawn on the presence or absence of a protective effect of oats consumption on cancer risk in epidemiological studies. The available results, however, are limited and primarily based on a single cohort study from Denmark, and are limited by heterogeneity in study populations and dietary exposure assessment methods between studies ⁵²⁾.

Oat Beta Glucans Improve Immune System Defenses

Italian researchers ⁵³⁾ reviewed existing research about the positive effects of beta glucans on human health. They found that, in addition to reducing cholesterol and blunting glycemic and insulin response, beta glucans boost defenses of the immune system agains bacteria, viruses, fungi, and parasites.

Oats May Boost Nutrition Profile of Gluten-free Diets

Two recent studies ⁵⁴⁾, ⁵⁵⁾ out of Scandinavia show that adding oats to a gluten-free diet may enhance the nutritional values of the diets, particularly for vitamins and minerals, as well as increasing antioxidant levels. Researchers asked 13 men and 18 women with Celiac disease to follow a gluten-free diet with the addition of kilned (stabilized) or unkilned oats. After six months, the addition of stabilized oats resulted in an increased intake of vitamin B1 and magnesium, while the unkilned oats increased intakes of magnesium and zinc. In the second study from Scandinavia, the addition of gluten-free oats allowed people on gluten-free diets to achieve their recommended daily intakes of fiber, as well as increasing levels of a particular antioxidant called bilirubin, which helps the body eliminate free radicals as well as protect the brain from oxidative damage.

Oats Help Cut the Use of Laxatives

Laxative use, especially among the elderly in nursing homes, can lead to malnutrition and unwanted weight loss. Viennese researchers studied 30 frail nursing-home residents in a controlled, blind, intervention trial where 15 patients received 7-8g of oat bran per day. At the end of 6 weeks, 59% of the oat group had discontinued laxative use while maintaining body weight; the control group showed an 8% increase in laxative use and a decrease in body weight ⁵⁶⁾.

Early introduction of oats associated with decreased risk of persistent asthma and early introduction of fish with decreased risk of allergic rhinitis

There are two interesting observations in the present study ⁵⁷⁾. The first is the apparent association between early introduction of oats and protection against persistent asthma. Oats is a commonly used cereal in Finland, as porridge and bread. It is often grouped together with wheat, rye and barley, but it is not closely related to these; e.g. patients with coeliac disease cannot eat wheat, rye or barley, but can use oats ⁵⁸⁾. Animal and cell experiments suggest that oats may have immunomodulatory and anti-inflammatory properties ⁵⁹⁾, ⁶⁰⁾. The same is true for fish – the second interesting finding was that early introduction of fish associates with a reduced frequency of allergic rhinitis. Fish oils may modulate inflammatory responses and have inconsistently modified the risk of allergic diseases and asthma ⁶¹⁾.

The present findings imply that delaying introduction of oats in infancy may increase the risk of asthma by the age of 5 years at least in children with genetic susceptibility for type 1 diabetes. These observations need to be confirmed in other populations ⁶²⁾.

Beneficial effects of oats in the gluten-free diet

The present study was to investigate the nutritional and symptomatic effects of including oats in the gluten-free diet, as well as the patients’ subjective experiences. Twenty two adult coeliac patients included large amounts of oats in their diet. Food intake, gastrointestinal symptoms, blood samples and body weight were examined and compared with examination at baseline. Diet compliance was checked monthly. The results are based on fifteen patients eating oats for 2 years plus three with only 6-months consumption.  Temporary increased flatulence was experienced the first few weeks, as well as improved bowel function with oats in the diet. All patients who carried out the whole study period wanted to continue eating oats after the study, as they found that addition of oats in the gluten-free diet gave more variation, better taste and satiety. Oats improved the nutritional value of the gluten-free diet, had no negative effects on nutritional status and were appreciated by the subjects. Including oats can help coeliac patients following a strict gluten-free diet ⁶³⁾.

Recent evidence suggests that oats that are pure and uncontaminated with other gluten-containing grains, if taken in limited quantities, are safe for most individuals with celiac disease. For adults, up to 70 g (1/2 to 3/4 cup) of oats per day and for children, up to 25 g (1/4 cup) per day are safe to consume ⁶⁴⁾.

Table 2. Oats nutritional facts

Dietary Approaches to Stop Hypertension (DASH)

Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure.

Dietary Approaches to Stop Hypertension (DASH) is a flexible and balanced eating plan that helps create a heart-healthy eating style for life ⁶⁶⁾.

The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt.
The DASH eating plan is a good heart-healthy eating plan, even for those who don’t have high blood pressure.

The Dietary Approaches to Stop Hypertension (DASH) eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:

• Eating vegetables, fruits, and whole grains
• Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
• Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
• Limiting sugar-sweetened beverages and sweets.

When following the DASH eating plan, it is important to choose foods that are:

• Low in saturated and trans fats
• Rich in potassium, calcium, magnesium, fiber, and protein
• Lower in sodium

Ways to Control Sodium Levels

The key to lowering your sodium intake is to make healthier food choices when you’re shopping, cooking, and eating out.

• Don’t add salt when cooking rice, pasta, and hot cereals.
• Flavor your foods with salt-free seasoning blends, fresh or dried herbs and spices, or fresh lemon or lime juice.
• Rinse canned foods or foods soaked in brine before using to remove the sodium.
• Use less table salt to flavor food.
• Read food labels, and choose items that are lower in sodium and salt, particularly for convenience foods and condiments.*
• Choose fresh poultry, fish, and lean meats instead of cured food such as bacon and ham.
• Choose fresh or frozen versus canned fruits and vegetables.
• Avoid food with added salt, such as pickles, pickled vegetables, olives, and sauerkraut.
• Avoid instant or flavored rice and pasta.

*Examples of convenience foods are frozen dinners, prepackaged foods, and soups; examples of condiments are mustard, ketchup, soy sauce, barbecue sauce, and salad dressings.

Most of the sodium Americans eat comes from processed and prepared foods, such as breads, cold cuts, pizza, poultry, soups, sandwiches and burgers, cheese, pasta and meat dishes, and salty snacks. Therefore, healthier choices when shopping and eating out are particularly important.

Increasing Daily Potassium

The DASH eating plan is designed to be rich in potassium, with a target of 4,700 mg potassium daily, to enhance the effects of reducing sodium on blood pressure. The following are examples of potassium-rich foods.

Table 3. Sample Foods and Potassium Levels

Health Benefits of the DASH Eating Plan

Three trials showed the health benefits of the DASH diet, such as lowering high blood pressure and LDL (bad) cholesterol in the blood

Study Results

Three trials found the following health benefits of the DASH diet.

1. DASH (Dietary Approaches to Stop Hypertension Trial): The DASH diet lowers blood pressure and LDL (bad) cholesterol compared with a typical American diet alone or a typical American diet with more fruits and vegetables.
2. DASH-Sodium (DASH Diet, Sodium Intake, and Blood Pressure Trial): The DASH diet lowers blood pressure better than a typical American diet at three daily sodium levels. Combining the DASH diet with sodium reduction gives greater health benefits than the DASH diet alone.
3. PREMIER clinical trial: People can lose weight and lower their blood pressure by following the DASH eating plan and increasing their physical activity.

1. DASH Trial

This trial included 459 adults, some with and without confirmed high blood pressure, and compared three diets including 3,000 mg daily sodium:

• Typical American diet
• Typical American diet plus more fruits and vegetables
• DASH diet

None of the plans were vegetarian or used specialty foods. After 2 weeks, participants who added fruits and vegetables to a typical American diet or those on the DASH diet had lower blood pressure than those who followed a typical American diet alone. However, the participants on the DASH diet had the greatest effect of lowering their high blood pressure.

Follow-up reports from the DASH trial showed that in addition to improving blood pressure, the DASH diet also lowered LDL cholesterol levels. High blood pressure and elevated LDL cholesterol are two major risk factors for cardiovascular disease.

2. DASH-Sodium Trial

This trial randomly assigned 412 participants to a typical American diet or the DASH diet. While on their assigned diet, participants were followed for a month at a high daily sodium level (3,300 mg) and two lower daily sodium levels (2,300 mg and 1,500 mg). Reducing daily sodium lowered blood pressure for participants on either diet. However, blood pressures were lower for participants on the DASH diet versus a typical American diet. Blood pressure decreased with each reduction of sodium. These results showed that lowering sodium intake and eating the DASH diet is more beneficial for lowering blood pressure than following the DASH diet alone.

3. PREMIER Trial

The PREMIER trial included 810 participants who were placed into three groups to lower blood pressure, lose weight, and improve health. The groups included:

• Advice-only group, did not receive counseling on behavior changes
• Established treatment plan, including counseling for 6 months
• Established treatment plan, plus counseling and use of the DASH diet

After 6 months, blood pressure levels declined in all three groups. The two groups that received counseling and followed a treatment plan had more weight loss than the advice-only group. However, participants in the established treatment plan who followed the DASH diet had the greatest improvement in their blood pressure.

The DASH Eating Plan

The DASH eating plan is easy to follow using common foods available in your grocery store. The plan includes daily servings from different food groups. The number of servings you should have depends on your daily calorie (energy) needs.

To figure out your calorie needs, you need to consider your age and physical activity level. If you want to maintain your current weight, you should eat only as many calories as you burn by being physically active. This is called energy balance.

If you need to lose weight, you should eat fewer calories than you burn or increase your activity level to burn more calories than you eat.

Ways to Control Calories

To benefit from the DASH eating plan, it is important to consume the appropriate amount of calories to maintain a healthy weight. To help, read nutrition labels on food, and plan for success with DASH eating plan sample menus and other heart-healthy recipes.

The DASH eating plan can be used to help you lose weight. To lose weight, follow the DASH eating plan and try to reduce your total daily calories gradually. Find out your daily calorie needs or goals with the Body Weight Planner and calorie chart. Talk with your doctor before beginning any diet or eating plan.

General tips for reducing daily calories include:

• Eat smaller portions more frequently throughout the day.
• Reduce the amount of meat that you eat while increasing the amount of fruits, vegetables, whole grains, or dry beans.
• Substitute low-calorie foods, such as when snacking (choose fruits or vegetables instead of sweets and desserts) or drinking (choose water instead of soda or juice), when possible.

Consider your physical activity level. Are you sedentary, moderately active, or active ?

• Sedentary means that you do only light physical activity as part of your typical daily routine.
• Moderately active means that you do physical activity equal to walking about 1.5 to 3 miles a day at 3 to 4 miles per hour, plus light physical activity.
• Active means that you do physical activity equal to walking more than 3 miles per day at 3 to 4 miles per hour, plus light physical activity.

Table 4 below estimates the number of servings from each food group that you should have. Serving quantities are per day, unless otherwise noted.

Table 4. DASH Eating Plan—Number of Food Servings by Calorie Level

^a Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

^b For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.

^c Fat content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving; 1 Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.

^d The DASH eating plan has a sodium limit of either 2,300 mg or 1,500 mg per day.

Table 5. DASH Eating Plan—Serving Sizes, Examples, and Significance

^a Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

^b Serving sizes vary between ½ cup and 1¼ cups, depending on cereal type. Check the product’s Nutrition Facts label.

^c For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.

^d Fat content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving; 1 Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.

The DASH eating plan is just one key part of a heart-healthy lifestyle, and combining it with other lifestyle changes such as physical activity can help you control your blood pressure and LDL (bad) cholesterol for life.

To help prevent and control high blood pressure:

• Be physically active.
• Maintain a healthy weight.
• Limit alcohol intake.
• Manage and cope with stress.

Other lifestyle changes can improve your overall health, such as:

• If you smoke, quit.
• Get plenty of sleep.

To help make lifelong lifestyle changes, try making one change at a time and add another when you feel that you have successfully adopted the earlier changes. When you practice several healthy lifestyle habits, you are more likely to achieve and maintain healthy blood pressure and cholesterol levels.

Cancer Among Men

Three Most Common Cancers Among Men ⁶⁷⁾

1. Prostate cancer (95.5 per 100,000 men)

• First among white, black, Asian/Pacific Islander, and Hispanic* men.
• Second among American Indian/Alaska Native men.

2. Lung cancer (68.1 per 100,000 men)

First among American Indian/Alaska Native men.
Second among white, black, and Asian/Pacific Islander men.
Third among Hispanic* men.

3. Colorectal cancer (44.0 per 100,000 men)

• Second among Hispanic* men.
• Third among white, black, American Indian/Alaska Native, and Asian/Pacific Islander men.

Leading Causes of Cancer Death Among Men

• Lung cancer (52.0 per 100,000 men)

First among men of all races and Hispanic* origin populations.

• Prostate cancer (19.1 per 100,000 men)

Second among white, black, American Indian/Alaska Native, and Hispanic* men.
Fourth among Asian/Pacific Islander men.

• Colorectal cancer (16.9 per 100,000 men)

Third among men of all races and Hispanic* origin populations.

• Liver cancer (9.5 per 100,000 men)

Second among Asian/Pacific Islander men.

What Is Prostate Cancer ?

Prostate cancer is the most common non-skin cancer among American men. Prostate cancer is second only to lung cancer as the cause of cancer-related deaths in American men and is responsible for over 29,000 deaths per year ⁶⁸⁾. One promising approach to reduce the incidence of prostate cancer is through chemoprevention, which has been recognized as a plausible and cost-effective approach to reduce cancer morbidity and mortality by inhibiting precancerous events before the occurrence of clinical disease.

Prostate cancers usually grow slowly. Most men with prostate cancer are older than 65 years and do not die from the disease. Finding and treating prostate cancer before symptoms occur may not improve your health or help you live longer ⁶⁹⁾.

Risk Factors for Prostate Cancer

Research has found risk factors that increase your chances of getting prostate cancer. These risk factors include:

• Age: The older a man is, the greater his risk for getting prostate cancer.
• Family history: Certain genes (passed from parent to child) that you inherited from your parents may affect your prostate cancer risk. Currently, no single gene is sure to raise or lower your risk of getting prostate cancer. However, a man with a father, brother, or son who has had prostate cancer is two to three times more likely to develop the disease himself.
• Race: Prostate cancer is more common in African-American men. It tends to start at younger ages and grow faster than in other racial or ethnic groups, but medical experts do not know why.

Researchers are trying to determine the causes of prostate cancer and whether it can be prevented. They do not yet agree on the factors that can influence a man’s risk of developing the disease, either positively or negatively.

Dietary Factors and Prostate Cancer

According to the World Health Organization, one-third of all cancer deaths are preventable through an increased consumption of natural compounds able to modulate key molecular signaling cascades that ultimately inhibit cancer cell proliferation and induce apoptosis ⁷⁰⁾. A number of dietary phytochemicals, including:

• Curcumin,
• Ursolic acid,
• Lycopene,
• Epigallocatechin-3-gallate (or EGCG),
• Pomegranate,
• Resveratrol,
• Sulforaphane
• 6-shogaol
• Indole-3-carbinol
• Silymarin

Have shown potential chemopreventive effects in vitro and in vivo in either animal models or in clinical studies on several cancers ⁷¹⁾, including prostate cancer ⁷²⁾.

Curcumin

Curcumin is a polyphenol found in turmeric (Curcuma longa), used as a spice, in food coloring, and as a traditional herbal medicine ⁷³⁾. It has been shown that curcumin has health benefits such as antioxidant, anti-inflammatory, and anticancer properties, improvement of brain function, and control of obesity and diabetes.

Ursolic acid

Ursolic acid is a natural pentacyclic triterpenoid carboxylic acid found in many plants including Holy basil, Japanese basil, tulsi, thyme, lavender, catnip, peppermint leaves, rosemary, apples, elder flowers and many others ⁷⁴⁾, ⁷⁵⁾. Ursolic acid has been shown to have apoptotic, anti-inflammatory and anti-tumorigenic effects in various cancer models including prostate, ovary, stomach, intestine, and skin ⁷⁶⁾. Further studies have revealed that ursolic acid has broad-spectrum anti-carcinogenic effects including prevention of DNA damage, inhibition of EGFR/MAPK signaling, inhibition of angiogenesis, activation of apoptotic pathways, and inhibition of Akt/mTOR, NF-κB, Cox-2, and STAT3 signaling pathways ⁷⁷⁾.

Lycopene

Tomato is the main dietary source of lycopene, a red-orange caretenoid, linked with decreased risk of prostate cancer. Lycopene, an O2· quencher, has been shown to reduce the amount of oxidative DNA damage in cell culture and animal studies ⁷⁸⁾. There is evidence that lycopene effectively inhibits proliferation of various cancer cell lines with down-regulation of cyclin D1 and consequent cell cycle arrest at the G0-G1 phase of the cell cycle. This growth inhibition is extended to the three broadly used prostate cancer cell lines PC-3, DU-145, and LNCaP cells. In addition normal prostate epithelial cells were observed to be even more sensitive to growth inhibition by lycopene than cancer cells. This is important because the pathologic hyperproliferation of prostate cells in men developing benign prostatic hyperplasia may be positively affected by lycopene ⁷⁹⁾. Lycopene supplementation to rats resulted in decreased IGF-I and IL-6 expression; also a reduction in the expression of 5α-reductase in prostate tumors with subsequent down-regulation of several androgen target genes was noted ⁸⁰⁾. Lycopene increased the activity of the phase II enzymes GPx, glutathione-S-transferase, and glutathione reductase, as well as glutathione levels in several animal models, presumably due to antioxidant-response element–mediated induction of genes ⁸¹⁾.

A 3-week tomato intervention study in prostate cancer patients showed an increase in the apoptotic index of hyperplastic and neoplastic cells in the resected prostate tissue along with lower plasma levels of PSA (prostate specific antigen) ⁸²⁾. Similar results were obtained when lycopene was given to patients undergoing orchidectomy with subsequent decrease in serum PSA level and reduction in the size of primary and secondary tumors ⁸³⁾. Supplementation of tomato products, containing lycopene, helped lower biomarkers of oxidative stress and carcinogenesis in healthy and type II diabetic patients and prostate cancer patients, respectively ⁸⁴⁾. In addition, a phase II study showed that whole-tomato lycopene supplementation had significant results and maintained its effect on PSA over 1 year ⁸⁵⁾. However, a more recently concluded phase II trial shows that lycopene-rich tomato supplement was not effective in patients with androgen-independent prostate cancer ⁸⁶⁾. In addition, lycopene supplementation in men with biochemically relapsed prostate cancer did not result in any discernible response in serum PSA ⁸⁷⁾, and a lack of association between prostate cancer risk and lycopene intake was observed in a multicenter study by Kirsh et al. ⁸⁸⁾. In view of these seemingly conflicting results, well-designed studies are necessary to establish the role of tomatoes and tomato products in the prevention and therapy of prostate cancer.

Epigallocatechin-3-gallate (or EGCG)

Green tea, obtained from the plant Camellia sinensis, with its high polypheniolic content has been shown to be an effective chemopreventive agent against various cancers ⁸⁹⁾. The polyphenols present in tea leaves as flavanols, or more commonly known as catechins, are epicatechin, epigallocatechin, epicatechin-3-gallate, and epigallocatechin-3-gallate (EGCG), of which the latter has gained the most attention with respect to its anticarcinogenic activity. Epigallocatechin-3-gallate (EGCG) makes up ∼10% to 50% of the total catechin content and has a higher antioxidant activity than vitamins C and E. Epigallocatechin-3-gallate (EGCG) inhibits cellular proliferation primarily by acting as antioxidants and scavenging the free radicals, by inhibiting the enzymes involved in cell replication and DNA synthesis along with interfering with cell-to-cell contact adhesion, and inhibiting intracellular communication pathways required for cell division.

A case control study, conducted in southeast China during 2001 to 2002, reported a reduced prostate cancer risk with increasing frequency, duration, and quantity of green tea consumption ⁹⁰⁾. In another study, patients with asymptomatic androgen-independent metastatic prostate carcinoma and progressive PSA (prostate specific antigen) elevation were evaluated after ingestion of 6 g of green tea per day ⁹¹⁾. Only one patient manifested a decline in serum PSA, and no patient manifested a tumor response on radiographic assessment or physical examination. Thus, a limited antineoplastic effect with a maximum response rate of 2% was seen with green tea ⁹²⁾. Similar results were seen in another clinical trial involving patients with hormone refractory prostate cancer. Green tea extract capsules, prescribed at a dose level of 250 mg twice daily, showed minimal clinical activity against the disease ⁹³⁾. Both these studies were conducted in end-stage disease, signifying that green tea may be more effective if used in the early stages of the disease or in patient at high risk. In this context, Bettuzzi et al. ⁹⁴⁾ have shown that after a year’s oral administration of green tea catechins, only one man in a group of 32 with high-grade PIN developed prostate cancer compared with 9 of 30 in the control group; a rate of only 3% in men developing the disease versus the expected rate of 30% in men treated with placebo. Hence, large-scale, prospective, randomized trials are necessary to test the efficacy of green tea for the prevention and treatment of prostate cancer.

Pomegranate

Pomegranate, a rich source of polyphenolic compounds, including anthocyanins and hydrolyzable tannins, with a reportedly higher antioxidant activity than green tea and red wine ⁹⁵⁾. Recent studies show that anatomically discrete sections of the pomegranate fruit acting synergistically exert antiproliferative and antimetastatic effect against prostate cancer cells ⁹⁶⁾. Invasion across matrigel by PC-3 cancer cells was found to be inhibited after treatment with combinations of fermented pomegranate juice polyphenols, pomegranate peel polyphenols, and pomegranate seed oil, with a decrease in the expression of phospholipase A2, associated with invasive potential of theses cells ⁹⁷⁾.

One small study from 2006 ⁹⁸⁾ found that drinking a daily 227ml (8oz) glass of pomegranate juice significantly slowed the progress of prostate cancer in men with recurring prostate cancer. This was a well-conducted study, but more are needed to support these findings.

A more recent study from 2013 ⁹⁹⁾ looked at whether giving men pomegranate extract tablets prior to surgery to remove cancerous tissue from the prostate would reduce the amount of tissue that needed to be removed. The results were not statistically significant, meaning they could have been down to chance.

Resveratrol

Resveratrol (3,4′,5-transtrihydroxystilbene), a plant-derived polyphenolic compound with chemopreventive properties, is found in grapes, berries, red wine, peanuts, and other edible products ¹⁰⁰⁾. Resveratrol has been shown to have cardiovascular benefit and anti-diabetic effects in both mice and humans. In addition, Resveratrol was shown to inhibit skin tumor promotion and also inhibit the growth of many cancer cell lines, including breast, prostate, colon and liver ¹⁰¹⁾. Resveratrolexerts its diverse biological effects by interacting with specific targeting proteins, probably via its stilbenoid core and hydrophilic side groups, and has been proved to check carcinogenesis at each discrete stage. Cell culture studies show that resveratrol inhibits tumor growth by stimulating apoptosis and arresting cells at different locations in the cell cycle and is associated with modulation of phosphoglycerate mutase and accumulation of endogenous ceramide in prostate cancer cell lines ¹⁰²⁾. Its antitumor activity is consistent with repression of Src-Stat3 signaling, as well as protein kinase C–mediated Erk1/Erk2 activation ¹⁰³⁾. Gene expression studies have provided additional insights into the mechanisms of action of this compound in prostate cells. Resveratrol treatment resulted in decreased expression of genes involved in cell proliferation, apoptosis, and polyamine biosynthesis ¹⁰⁴⁾. Although considerable in vitro data exist, well-designed preclinical studies in animal models are required to evaluate the future of this compound as an effective agent against prostate cancer.

Sulforaphane

Sulforaphane, an isothiocyanate phytochemical found in cruciferous vegetables (e.g. broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kohlrabi, mustard, rutabaga, kale, garden cress, bok choy and turnips), is a promising anticancer agent with multiple cellular targets ¹⁰⁵⁾. Several studies have also implicated Sulforaphane as a promising agent for metastatic castration-resistant prostate cancer, especially since it shows specific toxicity towards transformed cells without significant adverse effect on primary prostate epithelial cells ¹⁰⁶⁾. At pharmacological doses, Sulforaphane has been shown to slow down the progression of prostate cancer ¹⁰⁷⁾. A recent study has also documented the ability of Sulforaphane to target the cancer stem cell phenotype ¹⁰⁸⁾. Mechanistic studies have reported Sulforaphane-induced cell death to be initiated by reactive oxygen species ¹⁰⁹⁾ and the release of hydrogen sulfide ¹¹⁰⁾. These findings clearly suggest that Sulforaphane may be used as a promising adjunct agent to augment the efficacy of anti-androgens against aggressive prostate cancer cells ¹¹¹⁾.

6-shogaol

Ginger (Zingiber officinale) is a well known herb consumed as a spice and food as well as widely used as herbal medicine for various ailments. A number of biologically active ingredients including gingerols and its various derivatives have been identified and synthesized from ginger in recent years. One important class of derivatives are shogaols that are primarily the dehydrated products of gingerols and are found exclusively in dried ginger. Among the shogaols, 6-shogaol has achieved a great deal of attention due to its potent anticancer activity against various cancer cells ¹¹²⁾.

6-Shogaol is a potent bioactive compound in ginger (Zingiber officinale Roscoe), has been shown to possess anti-inflammatory and anticancer activity. In a test tube study ¹¹³⁾, it was demonstrated that treatment of androgen-dependent and -independent human prostate cancer cells in culture with 6-Shogaol inhibits survival and induces apoptosis. 6-Shogaol also inhibits survival and induces apoptosis in cultured mouse prostate cancer cells derived from HiMyc mice. Importantly, 6-Shogaol was highly effective at inhibiting the growth of HMVP2 cells in an allograft tumor model. These effects of 6-Shogaol were associated with inhibition of both STAT3 and NF-κB signaling and possibly other signaling pathways (e.g., Src). On the basis of these test tube findings, it was suggested that 6-Shogaol has a combination of activity, low toxicity, and biochemical properties that makes it of potential utility as a naturally occurring chemopreventive and/or therapeutic agent in prostate cancer. Overall, the current results suggest that 6-Shogaol may have potential as a chemopreventive and/or therapeutic agent for prostate cancer and that further study of this compound is warranted ¹¹⁴⁾.

Indole-3-carbinol

Indole-3-carbinol is a common phytochemical present in a wide variety of plant food substances, including cruciferous vegetables (cabbage, radishes, cauliflower, broccoli, brussels sprouts, and daikon) ¹¹⁵⁾. The glucosinolates contained in these on ingestion are rapidly converted into a range of polyaromatic indolic compounds ¹¹⁶⁾ responsible for its biological effects in vivo, among which 3,3′-diindolylmethane is a major component ¹¹⁷⁾. Its varied anticancer effects are mediated through the regulation of the cell cycle, cell proliferation, apoptosis, oncogenesis, transcription, and cell signal transduction. The molecular mechanisms by which indole-3-carbinol inhibits cell growth and induces apoptosis in prostate cancer cells involve the inactivation of Akt, mitogen-activated protein kinase, and NF-κB signaling pathways, along with other transcription factors, including SP1, ER, AR, and Nrf2 ¹¹⁸⁾.

Indole-3-carbinol, in conjunction with genistein, is able to induce the expression of both BRCA1 and BRCA2 in breast and prostate cancer cell types, suggesting potential relevance to cancer prevention ¹¹⁹⁾. Indole-3-carbinol injections given to rats, both i.p. and i.v., were equally effective in inhibiting the incidence, growth, and metastases of prostate cancer cells ¹²⁰⁾. Although a number of studies have been conducted in humans to test the efficacy of indole-3-carbinol as a chemotherapeutic agent for breast and cervical cancers, clinical trial have yet to be carried out for the assessment of indole-3-carbinol against human prostate cancer.

Silymarin

Silymarin, a polyphenolic flavonoid isolated from the seeds of milk thistle has recently gained much attention due to its anticancer properties. Silibinin, isosilybinin, silychristin, and silydianin are various isomers present in the compound, of which silibinin is thought to be the most active ¹²¹⁾. The underlying mechanism of silibinin/silymarin efficacy against prostate cancer involves alteration in cell cycle progression with induction of CDKIs, Cip1/p21 and Kip1/p27, and a resultant G1 arrest ¹²²⁾. Silibinin has shown a strong potential to modulate IGF signaling in CaP cells toward cell growth inhibition with an increased IGF-binding protein-3 gene expression and inhibition of insulin receptor substrate-1 tyrosine phosphorylation ¹²³⁾. Silymarin can inhibit nuclear localization and transactivation activity of the AR ¹²⁴⁾ with down-regulation of the AR coactivator, the prostate epithelium-derived Ets transcription factor, and several androgen-regulated genes, including PSA, human glandular kallikrein, and an immunophilin, FKBP51 ¹²⁵⁾. In a randomized, double-blind, placebo-controlled crossover study, a significant delay in PSA progression was seen in patients with a history of prostate cancer and rising PSA levels after radical prostatectomy supplemented with soy, isoflavones, lycopene, silymarin, and antioxidants in their diet ¹²⁶⁾. Recently, phase I clinical trials for silibinin have started in prostate cancer patients due to its nontoxic and mechanism-based strong preventive/therapeutic efficacy observed in preclinical models ¹²⁷⁾.