Health for life

Coffee consumption is associated with a lower risk of prostate cancer recurrence and progression, according to a new study by Fred Hutchinson Cancer Research Center scientists that is online ahead of print in Cancer Causes & Control.

Corresponding author Janet L. Stanford, Ph.D., co-director of the Program in Prostate Cancer Research in the Fred Hutch Public Health Sciences Division, conducted the study to determine whether the bioactive compounds in coffee and tea may prevent prostate cancer recurrence and delay progression of the disease.

Stanford and colleagues found that men who drank four or more cups of coffee per day experienced a 59 percent reduced risk of prostate cancer recurrence and/or progression as compared to those who drank only one or fewer cups per week.

They did not, however, find an association between coffee drinking and reduced mortality from prostate cancer, although the study included too few men who died of prostate cancer to address that issue separately.

First study to assess the link between tea and prostate cancer outcomes

Regarding tea consumption, the researchers did not find an associated reduction of prostate cancer recurrence and/or progression. The study also did not draw any conclusions regarding the impact of tea drinking on prostate-specific death.

“To our knowledge, our study is the first to investigate the potential association between tea consumption and prostate cancer outcomes,” the authors wrote. “It is important to note, however, that few patients in our cohort were regular tea drinkers and the highest category of tea consumption was one or more cups per day. The association should be investigated in future studies that have access to larger populations with higher levels of tea consumption.”

The population-based study involved 1,001 prostate cancer survivors, aged 35-74 years old at the time of diagnosis between 2002-2005, who were residents of King County, Wash. Participants answered questions regarding their diet and beverage consumption two years prior to prostate cancer diagnosis using a validated food frequency questionnaire, and were interviewed about demographic and lifestyle information, family history of cancer, medication use and prostate cancer screening history.

The researchers followed up with patients more than five years after diagnosis to ascertain whether the prostate cancer had recurred and/or progressed. Those who were still living, willing to be contacted and had been diagnosed with non-metastatic cancer were included in the follow-up effort.

Of the original 1,001 patients in the cohort, 630 answered questions regarding coffee intake, fit the follow-up criteria and were included in the final analysis. Of those, 61 percent of the men consumed at least one cup of coffee per day and 12 percent consumed the highest amount: four or more cups per day.

The study also evaluated daily coffee consumption in relation to prostate cancer-specific death in 894 patients using data from the initial food frequency questionnaire. After the median follow-up period of eight-and-a-half years, 125 of the men had died, including 38 specifically from prostate cancer. Daily coffee consumption was not associated with prostate cancer-specific mortality or other-cause mortality, but with few deaths these analyses were limited.

“Our study differs from previous ones because we used a composite definition of prostate cancer recurrence/progression,” said first author Milan Geybels, a doctoral student at Maastricht University in the Netherlands who was a graduate student in Stanford’s Prostate Studies group at Fred Hutch when the study was conducted. “We used detailed information on follow-up prostate-specific antigen levels, use of secondary treatment for prostate cancer and data from scans and biopsies to assess occurrence of metastases and cause-specific mortality during follow up. Using these detailed data, we could determine whether a patient had evidence of prostate cancer recurrence or progression.”

The results are consistent with findings from Harvard’s Health Professionals Follow-up Study, which found that men who drank six or more cups of coffee per day had a 60 percent decreased risk of metastatic/lethal prostate cancer as compared to coffee abstainers.

Phytochemicals in coffee have anti-inflammatory and antioxidant effects

Further research is required to understand the mechanisms underlying the results of the study, but biological activities associated with consumption of phytochemical compounds found in coffee include anti-inflammatory and antioxidant effects and modulation of glucose metabolism. These naturally occurring compounds include:

Caffeine, which has properties that inhibit cell growth and encourage apoptosis, or programmed cell death. Previous studies have found that caffeine consumption may reduce the risk of several cancer types, including basal-cell carcinoma, glioma (a cancer of the brain and central nervous system) and ovarian cancer.
Diterpenes cafestol and kahweol, which may inhibit cancer growth.
Chlorogenic acid, which, along with caffeic acid, can inhibit DNA methylation, a biochemical process involved in the development and progression of many cancer types.
Additional studies needed to confirm whether coffee can prevent cancer recurrence

The researchers emphasize that coffee or specific coffee components cannot be recommended for secondary prevention of prostate cancer before the preventive effect has been demonstrated in a randomized clinical trial. Further, there’s ongoing debate about which components in coffee are anti-carcinogenic, and additional large, prospective studies are needed to confirm whether coffee intake is beneficial for secondary prevention.

Coffee drinking may even be problematic for some men, Geybels said.

“Although coffee is a commonly consumed beverage, we have to point out that increasing one’s coffee intake may be harmful for some men. For instance, men with hypertension may be vulnerable to the adverse effects of caffeine in coffee. Or, specific components in coffee may raise serum cholesterol levels, posing a possible threat to coronary health. Patients who have questions or concerns about their coffee intake should discuss them with their general practitioner,” he said.

The investigators also noted limits to their study, which included a lack of data on how coffee consumption might have changed following diagnosis, whether the coffee that participants consumed was caffeinated or decaffeinated, and how the coffee was prepared (espresso, boiled or filtered), a factor that may affect the bioactive properties of the brew.

As part of its 2010 dietary guidelines released on January 31, the USDA recommended that the average American eat approximately 4.5 cups of produce per day. Broken down a bit more, that’s 2.5 cups of vegetables, and 2 cups of fruit. In a study released days later by the USDA’s Economic Research Service, researchers concluded all 4.5 cups could be purchased for between $2 and $2.50 per day.

Reactions on one major food blog ranged from supportive (“[I] like that they are promoting the fact that eating healthy doesnt have to expensive.”) to skeptical (“Where the hell are they shopping?”) to outright critical (“God, the USDA is full of such bull****”).

While I think the ERS researchers are correct with their $2.50 number (more on that in a minute), some of the skepticism is merited, for three big reasons:

1. They used food prices from 2008. A certain economic meltdown makes those numbers highly suspect today.
2. Among the vegetables counted towards the $2.50 total are white potatoes and corn, starchy foods not exactly known for their vitamins and minerals. Also included is iceberg lettuce, which has the rough nutritional value of licking a rock.
3. Juice is counted as produce, though the USDA itself admits, “Although 100% fruit juice can be part of a healthful diet, it lacks dietary fiber and when consumed in excess can contribute extra calories.”

With that in mind, for the huge majority of us who don’t live in food deserts, is it still feasible to pay $2.50 for 4.5 cups of produce per day? How? And going one step further, is it possible to purchase a variety thereof? Because anyone can buy seven bananas for $2, but cramming in spinach, yams, berries, and pluots gets a little harder.

My answer to each question is a resounding, “Heck yeah, but you have to do some legwork, first.” To that end, here are some suggestions to keep costs down, and nutrition way, way up.

Buy in season and on sale. These two occurrences frequently coincide, since supermarkets have to move surpluses of in-season fruits and vegetables before they rot. So, pay attention to produce calendars, hunt for bargains at farmer’s markets, and look out for circular sales in larger grocery stores. To wit: I recently scored a 5-lb. bag of gigantic navel oranges (13 in all) for $4.97 at my local Foodtown. That’s $0.38 per orange, which comes out to more than 1 cup of fruit.

Buy whole. Not cut up, drenched in cheese, or (sorry) pulped into juice. Whole fruits and vegetables are almost always cheaper and higher in nutrients than those that have been doctored. The perfect example? The humble carrot. A pound of whole carrots at my old supermarket was $0.89. ($0.66 on sale.) A pound of baby carrots, which are actually regular-sized carrots run through a peeling/whacking machine, cost $1.50. Prep them anyway you like once you’re home, but buy ‘em big before then.

Buy generic, or with coupons if you can nail a better price. While this might not apply to fresh fruits and vegetables, generic frozen and canned produce is generally a big bargain. In studies, many shoppers cant tell the difference between house and name brands, and frequently, the foods are cut and packaged in the same buildings. HOWEVER: if you have dynamite coupons, or can pair coupons with sales, name brands could be the bigger bargain. Do the math and see where you end up.

Buy fresh or frozen first, then canned. Then juice, I guess. While the USDA claims there’s no consistent price advantage of one over the other, I find A) (tomatoes excepted) fresh and frozen produce tastes better than canned, B) fresh and frozen produce is often sold/frozen at the height of growing season, giving it a bigger nutritional impact, and C) canned mushrooms are the devil. (Seriously. You can tell a good pizza joint by whether or not their mushrooms are fresh.) As for dried fruits, try purchasing them in a bulk food store or ethnic market, since theyre ludicrously expensive in many big chains. If juice is a necessity (you have children, for example), buying 100% fruit juice is best, and even then, not if you have to sacrifice other means of packing in the produce.

Find a happy medium between big nutrition and big savings. Though tasty and inexpensive, potatoes are somewhat lacking in the nutrient department. On the flip side, berries are powerhouses of vitamins and minerals, but often prohibitively pricey. Don’t forgo either extreme entirely (since a world without blueberries isn’t a world worth living in), but concentrate most of your cash on the guys in the middle. Cruciferae, leafy greens, root vegetables, citrus fruits, stone fruits, and melons are among the many options, and compromise is the name of the game.

Buy from the secret bin. Shoppers will often shy away from lightly bruised fruit, slightly limp broccoli, or salad close to its sell-by date. Their loss becomes your gain, since supermarkets will sell these products at a steep discount. Hidden at the back of many grocery stores is that shelf, which can be summed up thusly: Looks Iffy, Tastes Fine.  Go to it. Learn it. Love it. (Of course, dont buy rotted produce from it. Thats silly.)

Buy from multiple markets if you can swing it. Supermarkets within the same general area will frequently offer competing deals to lure customers in the door. In my old neighborhood ("Back in St. Olaf…"), one store would offer a 3/$5 deal on berries, while the place down the street promoted stone fruit for $0.99/lb. Purchasing from both promised variety, as well as big savings. Even if theres not a second market near you, the occasional trip to Trader Joes or CostCo. (which rarely have sales, but keep their prices consistently reasonable), can mean more produce at a lesser cost.

Before you finish up this article with a, “Harrumph! I knew all this already, and I still can’t afford 4.5 cups of produce on $2.50 per day,” check out the edible cup equivalents in the ERS study. These numbers, averaged across the nation, probably figure more importantly than retail price per pound, since they don’t include inedible parts of produce (corn husks, plum pits, etc.). Here are some examples - mean costs per cup, according to their 2/11 study:


So, 4.5 cups - a cup each of kale, sweet potatoes, navel orange, and pears, plus a half-cup of tomatoes – can be purchased for a grand total of $2.16. As mentioned, these prices have probably gone up since 2008, but A) please note we still saved $0.34, and B) some caul shopping should net you much better deals.

Honestly, everything I just wrote/everything you need to know can be found in two documents, both of which merit further study:

• The USDA’s Dietary Guidelines for Americans, 2010
• How Much Do Fruits and Vegetables Cost?

Readers, did I miss anything? Do you think its possible to get 4.5 cups of produce for $2.50 a day? Any tips? Let er rip.

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If this article interested you, you might also enjoy:

• 10 Cheap Ways to Simplify Food Shopping
• The 10 Cheapest, Healthiest Foods Money Can Buy
• 10 Foods You Should Always Splurge On

A study in this months Journal of the American College of Cardiology found that 3 cups a day, for 30 days, of flavanol-rich cocoa improved blood flow through the brachial artery (the main blood vessel of the upper arm) by 30%.

All 41 participants in the randomized, double-blind study had diabetes and took medications. Three times daily, participants blended an 18-gram cocoa mix into 250 ml of water (8 oz). The mix contained either 25 mg (control) or 321 mg (intervention) total flavanols.

Its important to note that the high-flavanol cocoa used in the study was not the same as cocoa you can buy in grocery stores. It was a product called CocoaPro, developed in a proprietary process by Mars, Inc., to retain flavanol content. Mars lent funding to this study.

Flavanols In Foods

Flavanols are a class of flavonoids present in a variety of foods. Besides cocoa and chocolate, which are especially good sources, carob, tea, pinto beans (and other beans), wine, grapes, apples, apricots, bananas, blueberries, cranberries, and other berries contain flavanols (flavanols are not the same as flavonols). The USDA maintains a database of flavanols, and other flavonoids, in foods. You can access it at:

USDA Database for the Flavonoid Content of Selected Foods, Release 2.1 (2007)

Below are some specific foods along with their flavanol content.² (Catechin and epicatechin are both flavanols.) Values are given in milligrams of flavanols per 100 grams of food - that would be about 1/4 pound of grapes, apples, etc.


Click for larger.

Note that none of these foods (per 100 gram serving) contain the amount of flavanols used in one cup of cocoa from the study (321 mg). In fact, they come closer to the amount found in the control. Unless youre consuming Mars patented CocoaPro - 3 times daily - you likely wont consume enough flavanols regularly to achieve the results seen in this study.

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¹ Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients, Journal of the American College of Cardiology, 2008

² Cocoa Flavanols And Cardiovascular Health, 2004