Nutrition expert Olivia Wright talks with men with advanced prostate cancer: 25 Sept 2015: Part 2

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Minutes of the dial-in meeting of 25 September 2015 - Part 2: Dr Olivia Wright

Many thanks to member Janis Kinne for the preparation of these minutes.

 

Chairman Bruce Kynaston: Welcomed Dr Olivia Wright and invited her to begin her talk.

 

Olivia Wright: So I guess that was my way of introducing what I thought I would talk about today which is the Mediterranean diet and what we are using in our studies now. Our general overall dietary approaches to help enhance metabolic health to help prevent prostate cancer progression and also improve quality of life and reduce fatigue levels as well. That's another aspect we are looking into. We are also combining our dietary approaches with some exercise connections as well because we find that a combined approach is the best and there is actually very limited research and good quality studies that have been done into that. 

 

A Mediterranean diet is not a new concept as it's  been around, or the thought of it has been around since the 1940s and Ancel Keys was the researcher who started looking at the dietary patterns of men on the island of Crete and also crossed them in other countries, the US, Japan, Italy and Greece, the Netherlands, Finland and what used to be Yugoslavia so he looked at a very large sample of men only. There were 13,000 of them and he looked at their general diet and chronic health issues and he found that the healthiest men were on what he called a ‘poor’ sort of diet which emphasised fruit, vegetables, grains, beans and fish so what we now know as a less refined diet. So no processed foods at all and all fresh and nutrient dense. So the other really important characteristics that this study was looking at was reduced risk of coronary risk which related to all the medical aspects I was talking about before. 

 

So the guys on the island of Crete back then walked everywhere so there was transport by donkey but lots of walking, lots of gardening and labouring in the land and the main meal was really in the middle of the day so included a lot of olive oil as well which is a really good metabolic mediator so really helps reduce inflammation throughout the body and can really reduce the risk of coronary heart disease and I guess where he’s gone with prostate cancer as well. We know that typically a lot of our guys are now living a lot longer and now need to sort of, stave off a lot of other conditions that can occur with general ageing and to try to help mediate that as well by looking into these metabolic aspects. 

 

So there is a medical diet pyramid and what it basically looks like is there is a lot of wholegrain breads and cereals so they are the biggest emphasis. The other thing that's really good to eat is legumes, so in Australia we eat hardly any legumes, broadbeans and chickpeas and things like that. Chick peas are actually really lovely, delicious, nutty flavour; really add well for salads. So with summer coming up it's  really good to throw some baby spinach together with maybe some pumpkin - I can give you these recipes too if you are interested - and then throw some legumes in with that as well. Really generally healthy and including all of the nutrients we are trying to include now. There is open cereals, fruit and veg and then the next group is fish and seafood. There is a little bit of controversy in the literature about fish oil supplements in prostate cancer. So...

... 1 minute missing ...

... dairy is still there. Dairy really important for maintaining good bone health as well. And then up the top is red meat and sweets and things. And the other important one is wine in moderation in this diet as well....

... dietary approach that we are looking to promote at the moment in our studies. We are going to be looking at very scientific measures and biomarkers and gene expression markers but they will be for a whole diet not just one particular nutrient. OK. Is that making sense so far?

 

Jim Marshall: Yes indeed. Yes thanks.

 

Olivia Wright: OK so I'll keep going. So there have been some studies of the Mediterranean diet for use in prostate cancer. The other really important factor of it is relaxation and eating with other people or eating with the family and not alone so the company and the quality of interactions can influence as well. And then they like to get a lot of sleep in the Mediterranean and that may influence their positive outcomes due to plenty of rest and relaxation. So there is a bit of mixed research. So some of the studies in the European Journal of Urology 2014 looked at a large cohort with a very long followup period and they used a questionnaire to measure your Mediterranean diet score so you can actually see how well you are adhering to that style of approach and I can send you out that if you are interested. 

 

... There are other studies where it actually has shown specific reductions in prostate cancer mortality risk particularly looking at fat intake aspect overall as being extremely important and replacing as little as 10% of carbohydrate and animal fats with healthy vegetable fats such as olive oil, nuts, beans ... can cut your prostate cancer mortality risk. They achieved that by largely olive oil and improved nut intake. Just any sort of nuts are really good. A mixture is really good. A variety is always the way to go. 

 

So in order to improve your Mediterranean diet or if you want to start a Mediterranean diet you can add a bit of olive oil to your meals, to your cooking or even better extra virgin olive oil drizzled over salads. For the extra virgin types it is important to keep those cool. You don’t want to heat those because they can decompose very quickly. With the vegetables it is important to choose good quality ones. So we want a range of colours, particularly the dark greens, oranges, the reds, the purples. Nothing to change there - always say that. So it's  really important to have those as much as possible. 

 

For fruit actually choose colours like the dark blues, reds, purples. They are the colours to ask after. Legumes which I have mentioned, so chick peas in particular are very nice and taste a bit nutty and also broad beans and other sorts of beans can add a lot of fibre and nutrition to dishes. Fish especially the oily ones you can add at least twice a week. Salmon, sardines and those type. Mix them up with walnut and almonds, are two of my favourites, as well as Brazil nuts which I'm sure you've heard me talk about before for they're good throwing in content as well as Hazel nuts or any other nuts you can have in there.

 

The other main component of the diet is rich tomato sauces and garlic and onion based type condiments to go with meals. So you could make really nice pasta dishes. Make sure you have a lot of that in there. Tomato soup. Really good rich tomato soup. Just eating tomatoes is really helpful. So that is our lycopene. The lycopene I think is one of the really powerful nutrients to include in the diet. Watermelons as well but the biggest source is tomatoes and tomato paste. 

 

And then wine. It just depends on how much you... if you have cut back I certainly wouldn’t increase, but just the usual healthy intake of one to two standard drinks a day and one alcohol free day per week would be good. Well that is what it looks like and also reducing processed foods and packaged foods. So that was the summary of the Mediterranean diet and Ive got some recipes here that I can pass on to try and help you a little bit with that. Some really good salads you could make. You may see a little bit of weight loss when people change from a more to a less refined style of eating which can be beneficial and really help with metabolic health. And so where in our studies we are aiming for just some small amount of weight loss in our guys of 5 to 10% and just to keep things at bay and help with quality of life.

 

So yeah we changed our approach substantially where we have still have the science in there but it's  probably not quite as “sciencey” sounding on presentation, but that would certainly be part of the analysis looking at a lot of inflammatory markers, obviously all of the metabolic markers, cholesterol levels etc and potentially genes. But we are waiting on the gene analysis to see which genes are the most promising nearer the time when we are actually doing the analysis so we are constantly looking at the literature and seeing the new things that come out and we store our blood that we take and then we make sure we do the most up to date, looking at the mechanism part of it nearer the time. That was what I was planning to say specifically but I'm looking forward to hearing what you think.

 

Bruce Kynaston: Yes well thank you very much Olivia. To use a mixed metaphor you have said a mouthful in a nutshell. 

 

Laughter

 

Bruce Kynaston: Any questions please?

 

Person #13: There is no mention there of sugars and carbs converting to sugars. Do you have a comment?

 

Olivia Wright: Yes. I guess that comes with the less refined diet as well. We recommend that you minimise the added sugars and the consumption of the added sugars because that is very important to metabolic health I guess and also for weight management. So we certainly do... Yeah I actually have a slide here now that I'm looking at it. So that comes into it and we certainly recommend that people be aware of that and added sugars and things. But once they adopt this less refined dietary approach, that sort of follows suit with that. But obviously you want to have your treats every now and then, and we recommend that too. it's  not meant to be... it's  meant to improve quality of life and not meant to make you feel like you are on a diet as such. it's  meant to be a lifestyle package that you can adhere to. And that's one of the studies we are looking to as well. Like can people adhere to this diet. How easy is it to follow? What are the difficulties associated with that? So that the real, what we like to call the translational aspects of our research, getting it out there and talking to people to actually do it rather than spending all of the time in the lab. Does that answer your question?

 

Person #13: Yes, but should you also cut down on the carbs? Bread rolls and sliced bread from the bakery and all that sort of stuff?

 

Olivia Wright: Oh yeah. So instead of the bread from the bakery, although whole grain is a very important factor so instead of the white highly processed breads and often the bread from the bakery has added fat in it to give it that really lovely bakery smell and taste. That's why it actually goes off quite quickly because they have added a bit of extra fat in there. I know that from a baker when I was doing a lifestyle programme once and thought aaaah, that's what happens. So certainly the really good whole grain bread you can buy in the supermarket is beneficial for you. it's  good for fibre but you don’t want to be piling it in, so balancing that with the carbohydrate from really healthy vegetables and legumes would give you a better variety of nutrition.

 

Person #13: Also what about coconut oil as a substitute for olive oil as an alternative?

 

Olivia Wright: Very good question. It is a saturated fat. We have very little evidence in our population that is OK. They have studied it in some Asian populations and they found no adverse effects of it on cardiovascular health, however those populations have adapted to it and have been consuming it for the majority of their life. So I think the issue comes when we introduce something like that later on and we are not used to it. It does behave like a saturated fat as far as I am concerned so I would still prioritise olive oil over that. Definitely. 

 

Person #13: Thank you.

 

Bruce Kynaston: I think an answer to one of the questions about bread rolls and so forth... I don’t think the Cretan gentlemen eat too many of those...

 

Olivia Wright: No that's exactly right!

 

Bruce Kynaston: They didn’t have money to splash around on fast foods. What we call luxuries they don’t have so if we stick to their lifestyle a little bit, exercise and not too much food. Just enough to allow you to work and you live longer.

 

Olivia Wright: That's right. And I think their involvement in a lot of activities and around a lot of people contribute to that as well. So yeah. They were extremely active.

 

Bruce Kynaston: Any more questions?

 

Person #14: Dr Olivia I understood that you said earlier that you can use diet as a means of managing the side effects of ADT. Could you expand on that?

 

Olivia Wright: That's right. The side effects of ADT that we are looking at include changes in cholesterol, a bit of weight gain, changes in body composition so we lose a bit of lean body mass and gain a bit of fat mass and also potentially insulin resistance, not diabetes but insulin resistance so the body isn’t quite as good at managing carbohydrates. So we really encourage this dietary approach to alleviate those side effects. it's  been shown that it can alleviate those metabolic side effects so blood glucose levels go back to normal, cholesterol levels fall and start becoming more stable and appropriate. 

 

There's other things we can suggest as well to fix things. We might suggest plant sterol margarine and things like that to absorb the cholesterol and excrete it. But, yeah, those side effects of ADT, the hormonal related ones, can be quite substantial. Also the fatigue levels. So this diet - we are not sure we are testing - can help with that combined with an exercise regime as well so we can maintain lean body mass whilst on ADT to reduce the loss of it. it's  really good to keep in with some regular exercise patterns. They trialled resistance training here at UQ and found that to be very successful in maintaining lean body mass. And we are looking at quite a high intensity exercise extension for a few weeks on top of a diet intervention to see what we can do. So as far as the exact results we get from our particular diet patterns from ADT we are yet to find out but certainly the theory and the science behind it should help with those cardiovascular and diabetes insulin type resistance effects you can get.

 

Person #10: This trial you are doing with men on ADT on a diet. How long have these men been on ADT for?

 

Olivia Wright: At least 3 months. We like them to have been on it for at least 3 months at any time. So it doesn’t have to be a criterion for inclusion for that. So it's  one of my PhD students conducting that trial so we are... yeah, you don’t have to be still on it now it's  just that if you've ever been on it for 3 months at any stage we are interested in seeing if we can help.

 

Person #10: Ive been on it for years intermittently and I don’t have any special diet but I just exercise regularly with resistance training and hydrotherapy and I seem to be managing OK. Ive also been told though that with most nutrition and diets you get better results if you start them before the cancer comes. Would you like to comment on that?

 

Olivia Wright: Yeah, obviously prevention is advantageous but that's not always possible and for certain reasons unknown to us and in our genetics and other factors we could have a wonderful diet and still develop cancer. So there is a lot of things we don’t understand about it but certainly following a diet like the Cretan men for the entire of our lives should prevent a lot of conditions as well as cancer. But it doesn’t always so... yes. From that point of view that is true but I guess the evidence today from the Cretan diet is that with prostate cancer it can reduce the overall mortality so even at that point in time you can still have a really positive effect from following that diet as well. But if you are interested in our studies drop me a line and we can have a chat later on.

 

Person #10: Yep, OK thanks.

 

Olivia Wright: You would certainly be eligible for it if you wanted to.

 

Person #10: Yep, OK thankyou.

 

Olivia Wright: Thanks.

 

Person #8: A couple of technical ones for you Olivia. One is a while back some of the prostate cancer gurus were strongly supporting the concept behind reducing cellular inflammation a la Barry Sears anti inflammation zone for example. I'm just wondering how much evidence there is for that and if there is what are the useful markers that might be used to track it?

 

Olivia Wright: OK, very good question. Inflammation is really important and we know that from the science that it is linked to a progression of a range of chronic diseases through the inflammatory markers so it can cause the cells to do silly things, to continue to progress. Certainly there is a range of anti inflammatory markers that we look at so we've got quite a few prostate cancer, well not prostate cancer specific ones. We are looking at the interleukins now. I need to double check exactly what we are looking at. I'll try to get a file up. Certainly IL 2, IL 6, IL 10 that we are looking at. We look at insulin related binding proteins 3, certainly IGF1, insulin-like growth factor 1 we do a lot of work with in colorectal cancer as well as prostate cancer because their markers are related to insulin could also be related to inflammation as well.

 

So there is a number of ones. I think PSA is related to it as well. It can be indicated but there are some quite technical ones. Once I find my list of exactly what we are looking at I can show it to you. There is another one, C-reactive protein. The C-reactive protein is probably one you would be able to get more standardly from your standard blood type analysis. So some of the other ones I mentioned you may not be able to get. I'm not sure.

 

Person #8: What was that last one?

 

Olivia Wright: C-reactive protein

 

Person #8: Oh the CRP blood test - yep.

 

Olivia Wright: CRP, yeah. So we in our research we look at a high sensitivity version of that but the standard test is just CRP and that just shows a broad scale systemic inflammation. So it's  not going to tell you there is inflammation in this particular tissue or that particular tissue. it's  often associated with if there is a cardiac event as well it tends to go up. Or any kind of Illness or anything... it's  positivity phase proteins that means it goes up when there is Illness or infection or whatever as well. So it's  not definitive but that's generally used as the inflammatory marker in general day to day life, but we are looking at a lot of other ones. So many that I cant remember them all. But interleukins are a big part of it. But yeah the anti-inflammatory nutrients are indeed being touted as being important over time and certainly if you take a vitamin D supplement then I encourage that for maintaining bone health and we study more vitamin D supplementation for inflammatory reductions happening are quite mixed but we cant seem to get a vitamin D clinical trial to give us any sort of more consistent information in the literature because there are so many genetic issues in vitamin D and the way it operates in the body so until we sort that out we will continue to get all this mixed data.

 

Person #8: From what Ive read DHA, one of the important components of fish oil...

... used to be fairly closely linked...

 

Olivia Wright: Yeah that's right

 

Person #8: I did a test on myself where I was measuring serum DHA, I cant remember the other component, but certainly I was able to track the... by changing diet I was able to track the change in the serum response but whether that was confirmed causing an improvement in my prostate cancer I have no idea.

 

Olivia Wright: Yeah well certainly omega 3’s are very anti inflammatory, and omega 6's are pro inflammatory...

 

Person #8: Yeah I think it was a DHA total Omega...

 

Olivia Wright: Yeah, that's Omega 3...

 

Person #8: Omega 6 I think was the ratio I was looking at...

 

Olivia Wright: Yeah, so we want to get more Omega 3 in the diet we just need the ratio to be at least 3 to 1, Omega3 to Omega 6 to get that on the right side of things, so that's the other main anti inflammatory and we recommend that as an anti inflammatory for any condition that is associated with inflammation so Omega3’s and the DHA.

 

Person #8: OK. Thankyou.

 

Olivia Wright: No worries.

 

Bruce Kynaston: Any more questions or are we done? Gentlemen...?

 

Person #8: I'll ask another one if none else is speaking up. The LDL cholesterol and cholesterol generally is a precursor to testosterone and how it is synthesised in the body so low cholesterol and LDL in particular seems to be logically connected to better PSA that comes if you try and minimise testosterone in the body. Is that a proposition you would agree with or not?

 

Olivia Wright: Yeah, absolutely. Yeah, so definitely cholesterol is a precursor to our fatty hormones and our sex hormones so yeah, absolutely we want to keep that down but yeah also just for general cardiac and metabolic health as well we are really interested in keeping it down. Also which would then feed back on testosterone which also increases risk on cardio vascular issues as well. So it's  all related in a big flow chart circle. We just want to catalyse change across as many systems as we can and have a very broad approach now instead of just giving supplements for various things and seeing what they do, because we cant adequately see what they do basically, with the tests we have available at the moment. So it's  better to take a broader, what we call translation approach.

 

Person #8: Mmm. And finally a comment on red meat?

 

Olivia Wright: Oh, you want me to expand on that?

 

Person #8: Yes, just a little if you can.

 

Olivia Wright: Yes, so... Certainly the Cretan guys didn’t have much of that so probably around once or twice a week they maybe had some red meat, that's how they fitted all of the other good things into their diet and certainly the Australian Dietary Guidelines cut down the amount of red meat they recommend. Now that's because of environmental sustainability purposes, not necessarily nutritional. There is no real strong evidence to suggest that nicely cooked, trimmed fat nice piece of steak, not burnt obviously, on a BBQ is going to do you any harm. The real concern we have with meat is the highly processed, canned, yeah... any highly processed meat that has gone through that procedure with the cancerous chemicals, and strange sausages where your not quite sure what's in there. So when you are going to have meat I would buy the most high quality, whatever your most favourite cut of meat is. Cook it, make sure you don’t burn it and enjoy it and not worry about having it but certainly try and fit all of these other things into your diet as well and keep off the ham and other really highly processed...

 

Person #8: I'll bet that most of the people listening don’t have any red meat at all.

 

Olivia Wright: No...

 

Person #8: That's been the folklore around prostate cancer.

 

Olivia Wright: Yeah... And that's because I think of why the fatty acids in there that they are thinking they have an effect, but I haven’t seen any particular evidence for that and I guess from our point of view we want you to keep your iron levels good as well and... But if you want to avoid it and you're getting a lot of iron from vegetables and other means and fish etc then that's totally ok. You don’t have to eat red meat by any means and they certainly only had it once or twice a week.

 

Person #8: Is the availability of iron from vegetable sources sufficient?

 

Olivia Wright: it's  not as good as from animal sources but seafood is quite rich in it as well and so long as you have the vegetable source with some vitamin C. So have an orange when you have your... or some orange juice or something like that when you have your green veggie source as it helps absorb it a lot better because it makes things a lot more acidic and it activates more absorption processes so that's what we recommend.

 

Person #8: Thankyou.

 

Bruce Kynaston: Olivia, Bruce. On the matter of not eating meat, consider the brumbies and how they eat vegetarian and how they maintain excellent health I'm not too sure but all the animals who eat grass and so forth is a wonder nutritionally.

 

Olivia Wright: That's right

 

Bruce Kynaston: It just goes to show that you don’t need it. But my red meat source is turkey meat because it's  inexpensive and it seems to be the unwanted part when they prepare turkey breasts for a market and I make use of that in small quantities.

 

Olivia Wright: Yes and turkey meat is great as it's  got one of the precursors of seratonin in it which can help with mood as well but quite high in the amino acids.

 

Bruce Kynaston: Low fat and...

 

Olivia Wright: Yeah... very good. That's a very good recommendation for the meat sources.

 

Bruce Kynaston: Another question?

 

Person #14: Just going back to the subject of diet to manage the side effects of ADT. Dr Olivia would you have any do’s or dont’s in regard to that?

 

Olivia Wright: Er, don’t eat too much and do eat like a Cretan. So certainly cut back on all of the processed foods. So cakes, chips, takeaways... If you want to get a takeaway get something you really like so that once a week. Cut back on the alcohol if that's important... But yeah a general overall healthy diet and as far as the dont’s I guess it's  all to do with helping to maintain weight or lose a bit of weight if needed and not to eat too much I guess is the simple part of it. I think as a country as a whole we eat far too much food and our portion sizes are ridiculously large and much bigger than they need to be and of course we have adapted to that over time and that's our biggest problem and I don’t know how that is going to change. it's  quite simple advice but there is nothing that is really specific that I could give that is a scientific way at the moment. Obviously getting the functional nutrients in so a really good variety of fruit and vegetables emphasising the rainbow of colours particularly the blues and the reds and the dark greens and a good intake of fish for the anti inflammatory properties or fish oil if you choose fish oil if you don’t like fish. But yeah that would be... I don’t really have anything else that would be more definitive than that at the moment. We were doing a study in Brazil nuts. We were going to give guys Brazil nuts and a selenium content. Just a small amount in different doses etc, but that project hasn’t continued because the students stopped doing that. we've got a little bit of data to show that the selenium levels increased a little bit, probably because we were only looking at healthy diets to start with, so young guys to see what effect it would have.

 Does that answer your question or does that...?

 

Person #14: Thanks for your comment.

 

 

Person #13: I was recommended I should have apple cider vinegar before each meal. What are your thoughts on apple cider vinegar? Like taking a glass.

 

Olivia Wright: So what was that for? Was there any particular reason for that?

 

Person #13: It was the doctor, the nutritionist who recommended I do that. She put me on the Mediterranean diet and said take that 10 minutes before each meal because I do suffer gastric reflux.

 

Olivia Wright: OK. Well that's quite acidic as well so...

 

Person #13: I know it's  counter intuitive as well but...

 

Olivia Wright: Yeah... Do you find it helps you?

 

Person #13: Well I don’t know because I'm also on tablets for my gastric reflux anyway.

 

Bruce Kynaston: Vinegar with its  acetic acid is nutrition to the good bacteria in our gut.

 

Olivia Wright: Yeah... That's the only thing I can think of, that it can be certainly beneficial to reducing harmful bacteria that may be in the stomach as well. Certainly is something that we are becoming more interested in as well and the bacteria in the micro bio and things. I haven’t seen any particular science or evidence about apple cider vinegar nut it certainly wouldn’t do any harm or have any problem causing properties I would think. But I am sure it would become acetic acid as well and that may help the beneficial bacteria. I'm just looking up some evidence here. I cant find any scientific studies but they are certainly mentioning in some of the natural health web sites promotion of good bacteria throughout the body so stomach as well as intestines.

 

Jim Marshall: Hi again. Vinegar has been used to stop the glucose high from becoming too high, so if you eat a bread roll you can counter that by adding some nuts or almonds. Vinegar will also lower the high so that is perhaps what the doctor was thinking about.

 

Olivia Wright: Maybe. And certainly there we know that it can slow the absorption of things so that could be right. Acid added to anything can be used to reduce digestive times. I'm reading something here that says vinegar might activate some of the digestive enzymes to break down carbohydrates so it will stop them being absorbed as much. I'll have to look into that. it's  given me something to do. 

 

Laughter

 

Olivia Wright: Hey it's  good.

 

Person #13: Mind you that advice came from a beautiful young Russian doctor.

 

Olivia Wright: Right. Just because there is no evidence doesn’t mean it doesn’t work. That's the other fallacy not to fall into, but I'll look into it. But certainly adding fat or adding acid, yeah, they're the main two does slow the gastric dose. So lemon juice might work just as well I'm sure.

 

Person #8:  Just one final question. On glucose, because cancer cells require a fair bit of glucose for their own metabolism, the less of it that is floating around in the blood the better. So that and a lean body mass are supposed to be helpful. Do you have any comment there?

 

Olivia Wright: Yes I certainly agree with that and that is why we are focussed on helping with the metabolic side effects as well because with ADT people can become a bit insulin resistant so they are going to have a higher blood glucose levels. So we can really improve that and impact that by changing diet and increasing exercise. Yeah so definitely we want to cut the metabolism of those cancer cells. Definitely

.

Person #8: So presumably low GI glucose, or low GI carbs I should say would be better than otherwise. For that reason yeah?

 

Olivia Wright: Absolutely, yeah. And they're the less highly refined ones, the ones rich in grains and fibre. All the brown ones. Yep.

 

Unknown: What about rye bread?

 

Olivia Wright: Rye bread? Yeah it's  a good one. it's  quite... as long as it's  not quite highly refined rye bread. Yeah if you really like that. That's good. it's  a whole grain as well. You can look for whole grain labelling these days. So make sure that it's  whole grain and it should be fine. it's  a heavier bread so you probably don’t need as much of that. You would probably have less of that than if you had other breads just for the carbohydrate content. it's  a lot denser. Other than that it's  low GI and a good one as well.

 

Unknown: Could I ask one more question?

 

Olivia Wright: Sure.

 

Unknown: And that relates to unpasteurised milk. Is that better for your bone density or not?

 

Olivia Wright: No. I would say not. I wouldn’t suggest anyone drink unpasteurised milk at all. There are other dreadful risks like food poisoning and yeah...

 

Unknown: I grew up on that as children.

 

Olivia Wright: Yeah that's true. it's  one of the fads going around at the moment that we hear quite a lot of and there is no reason it should be any better for the bones than the pasteurised milk.

 

Olivia Wright: Even better get one with vitamin C added into it as well as that can be even more beneficial if you want to make the most of the milk if you don’t drink a lot of it, if you want to get the best out of it that's possible.

 

Unknown: I'll get it from my own cow.

 

Olivia Wright: Yeah well that's it. If you're totally in control of the non pasteurisation process then that's, yeah, then obviously less refined is better, maybe if you're confident in the safety of it, but we certainly don’t recommend that across the board. No.

Bruce Kynaston: Do we have other questions? If not it would be an appropriate time...

Well Jim would you like to thank our guest?

 

Jim Marshall: Indeed, indeed. Olivia, by coincidence before you came on we were talking about getting a drug called Enzalutamide made available before chemotherapy in Australia. That drug being available before chemotherapy will reduce the risk of death by 29%

 

Olivia Wright: Wow.

 

Jim Marshall: If you want to have that now before the PBS pays for it, it's  between five and six thousand dollars a month. I notice the paper you quoted, quoted a 30% risk reduction from dying...

 

Olivia Wright: Yes.

 

Jim Marshall: ...of prostate cancer...

 

Olivia Wright: That's right.

 

Jim Marshall: ... a lot more cheaply and also reducing your risk of dying of heart disease, stroke and many other things.

 

Olivia Wright: It was actually 29. I rounded it up...

 

Laughter

 

Olivia Wright: Yeah I like to round things up. My notes actually say 29% for prostate cancer mortality. So there you have it. So that's good.

 

Jim Marshall: So you've given us advice worth roughly five to six thousand dollars a month!

 

Olivia Wright: Oh. I am so pleased.

 

Jim Marshall: So you will probably be speaking to more people who are taking ADT than you will ever speak to at any one time. Almost all of your audience here is currently on ADT and anyone who is not on ADT is probably on a break from it.

 

Olivia Wright: Sure.

 

Jim Marshall: So we all have prostate cancer and we all eat so it's  been very valuable to everybody. And I'm sure most of us will live at least a bit longer and more healthily because of your wonderful advice. Thank you very much.

 

Olivia Wright: Oh thanks Jim. I really hope so. We really love helping you out. Call upon us at any time. Myself or any of my students here at EQU and we are really looking to help you all as much as we possibly can with these quite simple strategies, nothing overly complicated because it doesn’t need to be I guess. We do the complicated science stuff at the other end. Yeah, so wonderful to talk as always and I wish you all the very best and good health and happiness.

 

Repeated thanks from the audience.

 

Olivia Wright: Bye Bye

 

Bruce Kynaston: OK Bruce back on the air