Can Loss Of Sleep Make Us Fat?

Posted Posted in Continuing Education, Homestudy, Psychology, Webinars

buddha-85673_640Laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of diabetes and obesity. The relationship among sleep restriction, weight gain, and diabetes risk may involve alterations in glucose metabolism, upregulation  of appetite, and decreased energy expenditure. Shorter periods of sleep are associated with decreased glucose tolerance and increased concentrations of blood cortisol. Research has suggested that long-term sleep restriction (less than 6.5 hours per night) may cause a 40 percent fall in glucose tolerance.

An association between short, habitual sleep time and increased BMI  has been reported in large populations. Short sleep was associated with changes in hormones that control hunger. Specifically, leptin levels were low  while ghrelin levels were high. These effects were seen when sleep duration fell below eight hours. This suggests that sleep deprivation is a risk factor for obesity. One controlled study with healthy males found that a sleep time of around four hours was associated with significantly greater craving for calorie-dense foods with high carbohydrate content (sweets, salty foods, and starchy foods). Reported hunger was also higher.

One could also argue that less time spent sleeping would allow for more time for eating and drinking. This could certainly be a contributor to a general obesogenic environment. On the other side of the energy equation, sleep-deprived people are less likely to be physically active, resulting in lower energy expenditure. Taken together, the increases in appetite and food craving and decreases in activity create a compelling argument for understanding  the role of sleep deprivation in weight management.


Food, Calcium, and Bone Health

Posted Posted in Continuing Education, Elder Care, Homestudy, Nutrition

CalciumFoods_ML1512_ts481492527By Barbara Boughton

Once a woman hits menopause, getting enough calcium for bone health becomes a major concern. Women over age 60 are prone to osteoporosis — and the spinal, hip, and knee fractures that osteoporosis can bring. Yet adequate dietary calcium can help protect people from osteoporosis.  Taking calcium supplements can help as well.

It’s not just menopausal women who should be concerned about getting enough calcium. As consumption of sugary soft drinks has risen among children and teenagers, intake of milk has also declined. But children and teenagers who are able to eat and drink enough calcium-enriched foods—as well as take in sufficient protein during meals—benefit from improved skeletal growth and bone mass. In fact, studies show that children who avoid, for prolonged periods, drinking calcium-containing milk have an almost three-fold higher risk for fracture than age-matched birth cohorts.

Dairy products are considered to be the easiest and cheapest sources of dietary calcium. Most people should have three to four servings of milk products daily in order to improve bone health and prevent osteoporosis. Studies have estimated that increasing dairy intake to three to four servings per day can reduce osteoporosis-related healthcare costs in the U.S. by $3.5 billion per year.

As well as calcium, it’s important to get enough calcium to enhance calcium absorption. What are your calcium and vitamin D requirements? Adults up to age 50 should get 1,000 mg of calcium and 200 International Units (IUs) of Vitamin D. Those over age 50, should intake at least 1,200 mg of calcium and 400 to 600 IUs of vitamin D each day.

Among foods with calcium, some are better than others for bone health. Yogurt is one of the best. It contains a hefty dose of calcium (415 mg per serving of plain, low-fat or non-fat per eight-ounce serving).  Many varieties of yogurt are also fortified with vitamin D. Some brands of fat-free, plain yogurt contain 30 percent of the adult daily requirements for calcium and 20 percent of the adult daily requirements for vitamin D. Although protein-packed Greek yogurts are popular right now—because of their reputed health benefits—they are less useful than other yogurt types for staving off osteoporosis. Greek yogurts contain less calcium than other types of yogurt and very little vitamin D.

Besides dairy products — such as low-fat and non-fat milk, yogurt, and cheese — there are other foods that are good for your bones. Canned sardines and salmon are rich sources of calcium, and fatty fish such as salmon, mackerel, tuna, and sardines are also replete with vitamin D. Some vegetables contain a generous amount of calcium, including collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens, and broccoli. Foods fortified with calcium and vitamin D—such as some juices, breakfast foods, soy milk, rice milk, cereals, and breads—can also add to the health of your bones.

The foods with the highest amounts of calcium are:  plain low-fat yogurt; calcium-fortified orange juice; low-fat fruit yogurt; skim mozzarella cheese and cheddar cheese; canned sardines; reduced and nonfat milk; tofu made with calcium sulfate; fortified breakfast drinks; and calcium-fortified cereals. Vegetables that are the richest sources of calcium include turnip greens, kale, and Chinese cabbage. For those who are lactose-intolerant, eight ounces of calcium-fortified soy milk can have from 80 mg to 500 mg of calcium.  Rice and almond calcium-fortified beverages can be good sources of calcium, too. To find out how much calcium is in these drinks, check the nutrition label on the back of these products at the grocery store.

If you want to eat for bone health, there are also some foods you should avoid. Heavy alcohol drinking (more than two drinks per day) can lead to bone loss, as can drinking more than three cups of coffee per day. Drinks high in caffeine, including coffee, tea, and caffeinated soft drinks, decrease calcium absorption and contributes to bone loss. Sodas also make it harder for the body to absorb calcium. Salty foods cause your body to lose calcium, too. To reduce the sodium in your diet, limit processed foods, canned foods, and salt added to the foods you eat each day. Aim for 2,400 mg or fewer mg of sodium per day.

Although beans contain calcium, they also are high in substances called phytates that interfere with your ability to absorb calcium. To reduce the phytate level in beans, soak them in water for several hours and cook them in fresh water. Wheat bran also contain high levels of phytates, which prevent your body from absorbing calcium. The phytates in wheat bran not only prevent the absorption of calcium in wheat bran but also prevent the absorption of calcium in foods eaten at the same time. For example, if you have milk and 100 percent wheat bran cereal together, your body can absorb some, but not all, of the calcium from the milk. The wheat bran in other foods like breads, however, is much less concentrated and unlikely to have a noticeable impact on calcium absorption.

Some vegetables with calcium can also contain ingredients called oxalates. Oxalates make it more difficult for you to absorb the calcium in vegetables. Foods with both calcium and oxalates include spinach, rhubarb, and beet greens.

As you can see, getting the right kind of calcium and the right amount of calcium from foods are not a simple matter. Yet it’s well worth the effort, since it will improve your bone health and strength—and may reduce your need for supplements.

  1. Food and Your Bones. Fact sheet. National Osteoporosis Foundation.
  2. Dietary Supplement Fact Sheet: Calcium. National Institutes of Health.
  3. Calcium: An Important Nutrient that Builds Bones. Fact Sheet. Osteoporosis Canada.
  4. Calcium, Nutrition and Bone Health. Fact Sheet. American Academy of Orthopedic Surgeons.
  5. Rizzoli, R. Dairy products, yogurts and bone health. Am J Clin. 2014; 99 (suppl): 1256S-62S.



Yoga and Osteoporosis

Posted Posted in Continuing Education, Elder Care, Homestudy

yoga-876744_640By Barbara Boughton

Yoga practitioners have long touted the health advantages of their practice, including increased flexibility, improved balance and posture, and stress reduction.  Some research studies support these claims although the scientific evidence is far from conclusive.  Now, a new study highlights another possible benefit of yoga:  It may improve bone health — even for those with osteoporosis.

Loren M. Fishman, M.D., a physiatrist at Columbia University and a specialist in rehabilitative medicine, has studied the health benefits of yoga for years.  In 2009, Dr. Fishman and colleagues published a pilot study which showed that 11 subjects who practiced yoga regularly over two years showed significant improvements in bone mineral density (BMD) of the spine and hip when compared to seven controls who did no yoga.  To study the bone benefits of yoga in a larger study, Dr. Fishman invested his own money and solicited participants via the Internet to perform, over 10 years, 12 assigned yoga poses each day or every other day.

The results?  Ten years after beginning the yoga program, 227 of the moderately to fully adherent participants showed significant increases in BMD of the spine and femur, but not significant improvements in BMD of the hip, according to the study, published in the journal Topics in Geriatric Rehabilitation in November 2015.  The study’s results are striking because most participants were elderly, with a mean age of 68.  Moreover, 83% had osteoporosis or osteopenia at baseline.

From a DVD, the participants in the study learned the yoga poses.  The participants were instructed to hold each pose for 30 seconds.  Once the participants learned all the poses, the yoga regimen took just 12 minutes to complete.  During the study, the participants used an online program to record how many poses they did and how often.  The researchers collected data on the participants’ BMD.  The researchers also took X-rays of the spine and hips and took blood and urine chemistry at baseline. Ten years later, the moderately or fully adherent participants underwent repeat measurements of BMD and many also had repeat X-rays.

For the yoga regimen, the researchers selected poses that pitted one group of muscles against another and would be most likely to affect BMD of the femur, hip, and spine.  They also chose poses that would be safe for elderly patients with osteoporosis. Thus, the poses required, with a straight back, leg lifts, lunges, and/or twists.  The poses did not require bending the back.  At the conclusion of the study, the researchers wrote, there were no reported X-ray-detected fractures or serious injuries of any type that stemmed from the practice of yoga.

Yoga has distinct benefits over other treatments for osteoporosis because it is low cost and the “side effects of yoga include better posture, improved balance, enhanced coordination, greater range of motion, higher strength, reduced levels of anxiety and better gait,” the researchers wrote in their paper.  By contrast, elderly women treated with osteoporosis medications frequently suffer gastrointestinal side effects, and these side effects are often barriers to treatment compliance.

In fact, a recent study published in Clinical Interventions in Aging (2015) showed that, among 126,188 elderly female Medicare patients, only 28% had initiated and continued treatment one year after being diagnosed with osteoporosis. Gastrointestinal events affected a significant number of patients, including 69% of those patients that were non-adherent.

Still, the authors of the new study on yoga and bone health caution that their research has important limitations.  Many of the study’s participants had weakened bones at the start and were already performing yoga.  The participants’ behavior may have influenced the results.  Also, the study did not assess BMD in the thoracic spine, the forearm, or ribs — places where many osteoporotic fractures occur.  Most importantly, the design of the study — including the use of the Internet as a recruitment tool and the lack of a control group — may have selected participants likely to benefit from yoga and may have limited the conclusions clinicians can draw from the results.

While yoga may have health benefits for patients — and may even improve bone health — clinicians should also consider the potential for injury among elderly participants, especially those with osteoporosis.  Many orthopedic surgeons report that women who do yoga can suffer agonizing pain and serious wear and tear on the hip that can progress to arthritis, according to an article — by writer and book author William Broad — published as an editorial in The New York Times in 2013.

Among orthopedic surgeons, yoga poses are well known for causing hip injuries. The reason for the injuries — especially among women — is that the extreme leg motions of yoga can cause hip bones to strike one another repeatedly, according to the editorial in The Times.

There is much that is still unknown about the true benefits and risks of yoga. Studies on yoga have documented hip damage from the practice, for instance, but research also shows that yoga can help patients cope with the pain of osteoarthritis and fight joint inflammation.

To obtain health benefits from yoga and avoid injury, it is crucial to practice gentler forms of this exercise and to moderate poses if they are painful. “Better to do yoga in moderation and listen carefully to your body.  That temple, after all, is your best teacher,” wrote author William Broad in the Times’ editorial.


  1. Lu YH, Rosner B, Chang G, et al. Twelve-minute daily yoga regimen reverses osteoporotic bone loss. Topics in Geriatric Rehabilitation. November 2015.
  2. Fishman L Yoga for osteoporosis: A pilot study. Topics in Geriatric Rehabilitation. 2009; 25 (3): 244-50.
  3. Siris ES, Yu J, Bognar K, et al. Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clinical Interventions in Aging. November 5,
  4. Brody JE. Twelve minutes of yoga for bone health. The New York Times. December 21, 2015.
  5. Broad WJ. Women’s flexibility is a liability (in yoga). Editorial, The New York Times. November 2, 2013.


Traumatic Stress After Terrorist Attacks

Posted Posted in Continuing Education, Psychology, Seminars, Webinars

ground-zero-81886_640By Barbara Boughton

The recent terrorist attacks in San Bernadino, California, and Paris, France, have highlighted not just safety concerns but also the devastating health effects of such violence. The victims of terrorist attacks can suffer long-term psychological consequences, including post-traumatic stress disorder (PTSD), depression, and anxiety disorders. A terrorist attack can also bring on or exacerbate addictions to alcohol or drugs.

In the wake of a terrorist attack, people who were wounded or those who were relatives or friends of those injured or killed in the attack are at increased risk for short- and long-term psychological symptoms. Even though terrorist attacks are not common, it’s important for clinicians to be prepared to treat the victims of this unexpected violence with effective psychological interventions.

Terrorism evokes fundamental fears of helplessness because the violent actions are intentional, random, and unprovoked and are often aimed at defenseless citizens, according to the American Psychological Association. The people most affected by the trauma of a terrorist attack are the people who were injured or witnessed the attack, and those who learned of relatives, friends, or acquaintances who were injured, killed, or present during the violence. Among these victims, those who had the greatest exposure to the violence, and people who are also survivors of previous traumas—such as domestic violence, child abuse, or war crimes—are most likely to suffer long-lasting and serious psychological effects. Patients with pre-existing psychological diagnoses are also at increased risk for chronic, long-term psychological health effects after being victimized by a terrorist attack. Early and appropriate evidence-based treatment of these vulnerable populations is important, because once it becomes chronic, PTSD is difficult to resolve– and is often comorbid with other psychiatric conditions.

After the Oklahoma City bombing, 45% of direct survivors had post-disaster psychiatric conditions and 34% were diagnosed with PTSD, according to recent studies. Research indicates that up to 2/3 of those who are directly affected by a terrorist attack, either as a victim or relative of a victim, are psychologically impaired, according to a paper on the psychological consequences of terrorism by the Rand Corp. Even two years after a terrorist attack, 30 to 40% of people who were involved with or nearest the site of the attack are likely to develop a psychiatric disorder, according to scientific studies. Two years after the Pentagon attack on September 11, 2001, for instance, over 20% of employees who were present at the attack and responded to a survey were found to have clinical PTSD, according to a 2007 paper published in the British Journal of Psychiatry.

For clinicians who treat the victims of a terrorist attack—whether in brief clinical interventions or longer-term therapy or counseling—an important first step is to express understanding and sympathy for the unique thoughts and feelings of their patients, according to the American Academy of Experts in Traumatic Stress (AAETS). Empathetic listening and when possible, validating the victim’s thoughts and feelings, can help give the individual a sense of control– and prevent him from withdrawing into isolation.

Victims of terrorist attack may experience and express a cascade of emotions or even a lack of emotional reactivity. No matter the response, clinicians should attempt to normalize the victim’s response as much as possible. Discussing the emotional, cognitive, and physiological aftereffects of traumatic events can help the victim or survivor understand that he is experiencing a normal response to an abnormal event, according to the AAETS.

At the start of clinical interventions, the psychologist or social worker should attempt to assess what symptoms or situational challenges are most distressing to the survivor or victim. Often there’s one element that creates the most intolerable distress in the patient. Recognizing and legitimizing, while smoothly challenging the totality of this emotion or aftereffect can be a useful treatment strategy, according to Arieh Y. Shalev, MD, professor of clinical psychiatry at Hadassah University Hospital in Jerusalem, Israel. Once the most distressing aspects of the victim’s situation is known, the clinician can help identify resources and useful solutions to the life problems that the attack may have caused. For instance, the wife or husband of an individual injured or killed in a terrorist in an attack may find it helpful to focus on caring for the emotional and physical needs of their children, according to Dr. Shalev.

Recent studies have found that cognitive behavioral therapy can be effective for reducing the risk for PTSD in the recently traumatized and in treating long-term PTSD after violence. CBT that involves cognitive restructuring and teaching specific coping skills has been shown to be more effective than relaxation training in preventing PTSD after violence, Dr. Shalev notes in his white paper, Treating Survivors in the Acute Aftermath of Traumatic Events, published online by the National Center for PTSD of the U.S. Department of Veterans Affairs. Antidepressants and anxiolytics can also be used for recent victims of violence to reduce depression and anxiety and enhance sleep. However, anxiolytics—especially benzodiazepines—can have side effects that range from somnolence to problems with balance, especially in elderly populations, and may cause drug dependence. So, there should ideally be a short-term treatment and targeted to specific symptoms, such as panic attacks and sleep problems.

The technique known as psychological debriefing has also been used effectively to treat recent trauma survivors, according to Dr. Shalev. Psychological debriefing occurs in several stages, including a phase in which survivors are prompted to describe the events and one in which they are encouraged to express their emotions after the event. The clinician who leads the intervention will also validate the normal nature of survivors’ symptoms and discuss methods of coping with future emotions and consequences of the violence, according to Dr. Shalev. Although it’s not known how effective this type of debriefing is in preventing stress disorders after recent violent events, most participants report that they find these sessions beneficial and satisfying, Dr. Shalev said.


  1. Managing traumatic stress: Coping with terrorism. Fact sheet. The American Psychological Association Web site.
  2. Terrorist attack: How we can prepare for the hidden trauma. Fact sheet. National Center for Crisis Management. American Academy of Experts in Traumatic Stress.
  3. Boscarino JA and Adams RE. Overview of findings from the World Trade Center Disaster outcome study: Recommendations for future research after exposure to psychological trauma. Int J Emerg Men Health 2008; 10 (4): 275-290.
  4. Shalev AY. Treating survivors in the acute aftermath of traumatic events. White paper. National Center for PTSD. U.S. Department of Veterans Affairs.
  5. Ozbay F, der Heyde TA, Reissman D, et al. The enduring mental health impact of the September 11th terrorist attacks: Challenges and lessons learned. Psychiatr Clin N Am. 2013; 36: 417-29.
  6. Tanielian TL and Stein BD and the Rand Corp. Understanding and preparing for the psychological consequences of terrorism in the Mc-Graw Hill Homeland Security Handbook (New York NY: McGraw-Hill Companies, Inc.; 2006).
  7. Whalley MG, Brewin CR. Mental health following terrorist attacks. Br J Psychiatry 2007; 190 (2): 94-96.



Is The Paleo Diet Healty? Arguments Against The Paleo Diet

Posted Posted in Continuing Education, Homestudy, Nutrition

sandwich-498379_640By Barbara Boughton

It’s not surprising that the Paleo diet has health benefits that derive from weight loss, according to its critics. Any diet that restricts calories will lead to weight loss—no matter if it eliminates some food groups as in the Paleo diet, or if it replaces processed foods and sweets with healthy vegetables, lean proteins, and whole grains.

The more important question is whether low-carb weight loss plans, such as the Paleo diet, can result in long-term weight loss and health benefits. It’s difficult to stick with the Paleo eating plan over many months or years because it’s so restrictive, according to the diet’s critics. As a result, its weight loss benefits – and the healthful effects of weight loss—are soon lost.

Good nutrition relies on variety, balance and moderation, according to Marion Nestle, PhD, director of nutrition, food, and public health at New York University, who also wrote an editorial on the Paleo Diet for the Wall Street Journal in March 2015. When one restricts entire food groups, as in the Paleo diet, the risk for nutrient deficiencies greatly increases, according to Dr. Nestle.

A diet that is too restrictive can also take away the joy of eating one’s favorite foods. And while highly processed “junk foods” should be kept to a minimum, a healthy diet can include moderate amounts of your favorite pasta or even an occasional chocolate.

A diet high in saturated fats such as the Paleo diet can lead to obesity as well as health risks such as cardiovascular disease and some cancers, such as colon cancer, according to Paleo diet critics. A diet rich grains and legumes can also be quite healthy and reduce one’s risk morbidity and mortality, according to Dr. Nestle. In fact, many studies show that Asian and Mediterranean diets—rich in carbohydrates and healthy fats such as olive oil, and low in meats and saturated fats—promote health and longevity.

The Paleo diet does get kudos even from its critics for cutting down on processed foods like white bread, artificial cheeses, cold cuts, processed meats, and sugary cereals. These processed foods contain less protein, fiber and iron than their natural counterparts, and are high in sodium and preservatives that increase the risk for heart disease and some cancers.

The Paleo diet is also based on some fallacies, its critics say. Although Paleo diet proponents say Paleolithic hunter-gatherers did not experience cardiovascular disease, signs of atherosclerosis have been found in the Paleolithic era remains. Paleolithic hunter-gatherers were less likely than modern man to succumb to cancer, obesity, and diabetes—but it may not have been because of their diet. Paleolithic people also did not live long enough to acquire these diseases since they were at great risk for morbidity and mortality from infections and parasites.

The Paleolithic diet was not uniform either. It varied greatly based on geography, season, and opportunity. Our Paleolithic ancestors may have evolved and survived, not because of their reliance on a single type of diet, but because they were flexible eaters—a trait that helped them endure in changing times and conditions.

  1. Petrucci K. and Nestle M. Is a Paleo Diet Healthy? The Wall Street Journal. March 23, 2015.
  2. Jabr F. How to Really Eat like a hunger-gatherer: Why the Paleo Diet is Half-Baked. Scientific American. June 3, 2013.
  3. Hamblin J. Science Compared Every Diet, and the Winner Is Real Food. The Atlantic. March 24, 2014.


Is the Paleo Diet Healthy? Arguments For The Paleo Diet

Posted Posted in Continuing Education, Homestudy, Nutrition, Seminars

breakfast-1058726_640More than one-third of U.S. adults are obese—and at high risk for obesity-related diseases such as metabolic syndrome, diabetes, cardiovascular disease, and some cancers. Yet is the Paleo Diet, one of the newest weight-loss trends, the most healthful way to reduce the risk of obesity-related diseases?

The Paleo diet—which relies on eating like our hunter-gatherer ancestors — is one of today’s most controversial diets. It is based on the nutrition of our ancestors living in the Paleolithic period between 2.5 million and 10,000 years ago. The Paleo nutrition plan is a low-carb diet based on meat, non-starchy vegetables, and fats such as coconut oil. It eliminates many of the products of modern agriculture—such as grains, dairy products, beans, and soy products.

Since the 1990s, researchers have known that lifestyle factors, such as diet, can lead to obesity-related health risks, morbidity, and mortality. Yet whether the Paleo diet really plays an important role in avoiding these risks is hotly debated among leading nutritionists.

Arguments for the Paleo Diet: A Good Bet for Reducing Health Risks

The Paleo diet is not only helpful for losing weight—it also has the potential to reduce the incidence of diabetes, high cholesterol, metabolic syndrome, and hypertension, according to some nutritionists. Paleo diet proponents even claim that the Paleo nutrition plan can decrease the risk for cancers and inflammatory diseases.

Some studies do show that a Paleo diet can be beneficial for those with metabolic syndrome, and it can also lead to lower HbA1c levels, lower triglycerides, and lower blood pressure levels, according to Kellyann Petrucci, a naturopathic physician, who wrote an editorial for the Wall Street Journal in March 2015.

Dr. Petrucci argued that some studies suggest that the Paleo diet can be as healthful as the Mediterranean diet for reducing risk for cardiovascular disease and some cancers. She argued that studies have suggested that the Paleo diet in patients with ischemic heart disease may lead to better glucose tolerance and a larger drop in abdominal fat than the Mediterranean diet. She also maintains that diets high in carbohydrates increase risk for colon cancer, while the Paleo diet may reduce this risk.

Some scientific studies have found no evidence that diets high in saturated fats and low in carbohydrates increase risk for heart disease, according to Paleo diet proponents. The criticism that the Paleo diet leads to nutritional deficiencies is also unfounded, according to nutritionists who favor the Paleo diet. Paleo diet foods such as salmon, kale, and broccoli, for instance, are high in calcium. Necessary dietary fiber and nutrients can also be found in the vegetables and fruits, seafood, eggs, and meat found in the Paleo eating plan.

  1. Petrucci K. and Nestle M. Is a Paleo Diet Healthy? The Wall Street Journal. March 23, 2015.
  2. Jabr F. How to Really Eat like a hunger-gatherer: Why the Paleo Diet is Half-Baked. Scientific American. June 3, 2013.
  3. Hamblin J. Science Compared Every Diet, and the Winner Is Real Food. The Atlantic. March 24, 2014.


Primary Care Treatment for Prostate Cancer Survivors

Posted Posted in Continuing Education, Elder Care, Nutrition, Seminars

By Barbara Boughton

cancer-390322_640A new guideline on health care for prostate cancer survivors from the American Society of Clinical Oncology (ASCO) shines a spotlight on the important role of primary care providers.

The new ASCO guideline, published in early February, endorses and adds to a guideline published in June, 2014 by the American Cancer Society. As well as providing guidance on follow up testing for prostate cancer survivors, the ASCO guideline emphasizes counseling about healthy lifestyle behaviors and interventions for the aftereffects of cancer treatment.

Clinicians are an important source for counseling about nutrition, exercise and healthy lifestyle as well as assessments for the late effects of prostate cancer treatment, the guidelines say. Clinicians should play an important part in talking to prostate cancer survivors about their lifestyle habits, and giving them advice about how to make changes. Increasingly, studies show that healthy eating and an active lifestyle can reduce the risk of prostate cancer recurrence. Clinicians should advise prostate cancer survivors to take these healthy lifestyle steps:

  • Achieve and maintain a healthy weight by limiting high calorie foods and drinks. Obesity is associated with worse health outcomes in prostate cancer, including a greater risk for recurrence and decreased survival.
  • Engage in exercise for at least 150 minutes per week, no matter what the survivor’s weight. Research shows that 3 or more hours per week of vigorous exercise is associated with a 61% reduction in prostate cancer-specific death among survivors. As well as discussing these benefits of physical activity with survivors, primary care providers should stress the advantages for quality of life.
  • Eat a diet that emphasizes micronutrient-rich and phytochemical-rich vegetables and fruits, whole grains, and low amounts of saturated fats. Such nutrition improves survival and decreases the risk for second cancers and chronic disease among all kinds of cancer survivors, according to the American Cancer Society.
  • Intake 600 IU of vitamin D per day and consume adequate, but not excessive, amounts of calcium (not to exceed 1200 mg per day). These recommendations are especially important for prostate cancer survivors receiving androgen deprivation therapy (ADT), since these treatments increase the risk of osteoporosis and fractures.

Most adults between ages 19 and 51 and older need 1000 to 1200 mg per day of calcium. Some, but not all studies on nutrition and prostate cancer risk, have indicated an increased risk for prostate cancer among those who had a high intake of calcium, particularly from dairy products. Calcium from supplements has not been associated with increased prostate cancer risk.

All cancer survivors should be given appropriate vaccines, based on age, season (flu), or travel plans. Primary care providers should also counsel prostate cancer survivors to avoid or limit alcohol, since excessive alcohol can affect cancer risk. Clinicians should also assess prostate cancer survivors for tobacco use and provide or refer survivors to cessation counseling.

Bowel dysfunction can occur in prostate cancer survivors as a result of radiation, although bowel symptoms are more common during treatment than after it. Prostate cancer survivors with bowel problems affecting nutrient absorption should be referred to a registered dietitian.

Prostate cancer survivors are also at risk for anemia, cardiovascular disease and diabetes from ADT, and should be regularly assessed for these conditions, and if present, treated. Thirty percent of prostate cancer survivors also experience distress associated with their cancer diagnosis, including increased anxiety and depressive disorders. Ongoing assessment and treatment by primary care providers or referrals to psychologists, psychiatrists and/or social workers are important to minimize cancer-related distress. Treatment for cancer-related anxiety or depression can also minimize the effects of these conditions on survivors’ quality of life.

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