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The Éclair Diet:

July 19, 2010

Jacob Schor with Tina Kaczor

The ‘éclair diet’ has me completely rethinking what to tell men with advanced prostate cancer. It  also has me pondering the way we approach new data that contradicts our ‘standard of care.’  Earlier this year Cipolla et al published the results of a clinical trial in which they put men with hormone refractory prostate cancer on low polyamine diets and had the men take powerful antibiotics every other week to eliminate bowel microflora.

 

Tina Kaczor ND, FABNO wrote up an excellent review of this study in the July issue of the Natural Medicine Journal so there is no need to belabor the study’s details.  Suffice to say that the results were pretty good.  “Most study participants followed the study for about two years. Performance status and pain were significantly improved at both 3 months (p = 0.03) and 6 months (p = 0.02) versus baseline.  Of note, this entire intervention worked best if started within 9 months of diagnosis to a hormone refractory status.  Median cancer specific survival times for patients beginning the diet before the nine month cut-off was 44 months, versus 34 months for those beginning later (p =0.014).  Median cancer specific survival times for the intervention groups as a whole compared to controls are 36 months versus 17 months, respectively (p = 0.004).

Those are statistically significant numbers and more importantly clinically significant improvements; we can be pretty sure that the men who followed this program did noticeably better.  This dietary portion of this treatment program studied focused entirely on lowering polyamines, a group of chemicals that includes putrecine, spermidine and spermine.  These chemicals are well known to increase cell proliferation and are found in higher concentration in cancer cells, especially prostate cancer cells.   Although some polyamines are made in the body, the two primary sources are from food and from gut microflora.

There is a long lead of animal studies to this current human trial.  Cancer growth can definitely be slowed down in test animals by lowering polyamine levels through what the researchers call a ‘triple regime’ that includes a polyamine deprived diet, gut decontamination with lots of antibiotics and administration of a drug that blocks polyamine synthesis in cells. The current human study was conducted by the same researchers who conducted the earlier polyamine lowering rat studies but minus the drug to block polyamine synthesis.

 

 

In this current study, the low polyamine diet was achieved by dividing foods and beverages into three groups.  Group 1 was foodstuffs with less than 100 nmol/g/ml, which could be eaten freely.  Group 2 was foods with between 101-200 nmol/g/ml, which could be ingested only 3-4 times per week.  Group 3 foods had greater than 201 nmol/g/ml of polyamine and were forbidden except for 2 times every seven days. 

Few of us would be able to guess polyamine content of foods and little about these lists of ‘good and bad’ foods correlate with anything that we have ever suggested to our patients that they eat or avoid.  You will notice we refer to this as the, “éclair diet.”

 

Group 3 foods, the foods with the highest polyamine content and that were most important to avoid included:

Calamari, oysters, muscles, crab, scallops, liver mousse, chitterlings, duck-liver pate´, pork liver pate´ garlic, chervil, tarragon, cabbage, broccoli, parsley, mushrooms, green peas, eggplant, tomatoes, bone marrow, oranges, hazelnuts, almonds, pistachios, peanuts, bananas, wheat, mustard, tinned gherkins, tomato paste, instant mashed potatoes, minced spinach, lentils, chickpeas, ratatouille, and sauerkraut.

 

Group 2 foods that contain moderate levels of polyamine:

fresh salmon, beef and ox tongue, chicken, rabbit, veal, lamb, beef, ham, garlic sausage, paella, red beans, radish, chicory, leek, endives, potatoes with skin, spring potatoes, Brussels sprouts, lettuce, cucumber, melon, goat cheese, oat, rye and whole breads, ketchup, grapefruit and orange juices.

Group 1 foods with the lowest polyamine content that could be consumed freely:

scampi, crayfish, hake, cod, whiting, smoked and canned salmon, tinned tuna, bacon, sausages, chipolata, pork, turkey, chorizo, minced pork, salami, onions, celery, carrots, green cabbage, beetroot, skinned potatoes, sorrel, string beans, small tomatoes, peppers, canned vegetable soup, raisins, apples, prunes, pears, avocado, peach, dates, pineapple, grapes, kiwi, lemon, strawberries, fruit salad, butter, cream, milk, yoghurt, soft cheese, Emmental, goat cheese without rind, pasteurized brie, grated cheese, camembert, eggs, rice, semolina, pasta, white bread, sugar, pancakes, chocolate eclair, honey, cookies, pound cake, chocolate, lemon pie, strawberry pie, apricot, strawberry, prune and raspberry jams, salt, pepper, oils, vinegar, coffee, tea, cider, cola, whisky, cognac, port, wine [God Bless the French! TK], apple, grape and apricot juices, beer, tropical fruit cocktail, and tomato juice.

 

Dr. Kaczor in her NMJ review writes,

“… this dietary protocol …. is strikingly different from what we might consider [to be] a good idea. … our starting assumption is that gut microflora are beneficial; we would rarely encourage purposefully taking antibiotics to wipe out gut flora.   Second, is the removal of foods we would otherwise consider highly nutritious.  For example, group 3 [that should be avoided] includes garlic, cabbage, broccoli, tomatoes, almonds, bananas, mushrooms and sauerkraut.  Conversely, Group 1, which was the category that could be freely eaten, includes pork products, canned vegetable soup, dairy products (except aged cheeses), beer, coffee and pound cake.  The authors, being French, list chocolate éclairs in this group of foods that can be freely consumed. This diet clearly diverges from anything we would have until now routinely advocated for our patients.”

What do we do when confronted with information that is in direct opposition with all that we have previously believed to be true?  Do we ignore the information, look the other way and pretend we have not heard or seen it?  Do we quickly jump to the conclusion that this information is false so we can ignore it?  Or do we give it a chance to see if it makes sense?

 

Our profession and many of the therapeutic interventions that we advocate have been the target of such ‘inattention’ from mainstream medical practitioners. It is without doubt more difficult to publish data that argue a view contrary to the generally accepted standard of care.  Will we be guilty of a similar discrimination? Will we ignore data when they don’t fit our worldview?

 

Since reading this study we find that we are seeking some middle ground.  Telling patients with prostate cancer to avoid eating broccoli was beyond our capacity but we have made some changes in our protocols.  One is that stool microbiology labs are run on all prostate cancer patients.

Recall that this study included “gut decontamination” with antibiotics, taken in daily oral doses, every other week, in order to reduce polyamines produced by gut microbes.  This seems too harsh. We know that certain but not all gut microflora produce polyamines, especially Klebsiella pneumonia, Enterobacter spp. and Serratia spp.  Rather than kill off everything, to our naturopathic sensibilities suggest killing the bad bacteria and keeping the good ones. Increasing beneficial microflora should decrease polyamines.  In fact, there are studies that tell us specific probiotics do reduce polyamines.  

Even though this was a small trial (n=42), the results reached statistical significance, suggesting that the benefits might be large.  As peculiar as these dietary rules seem, they will not result in malnutrition, the diet is safe to follow. Given the utterly poor prognosis of hormone resistant prostate cancer, the potential benefit from following these dietary restrictions is compelling.

 

Still, the act of sitting with a cancer patient and going through these food lists is so contrary to so many things that we have read, believed and taught our patients for so long, that it doesn’t come easy.  There is nothing new to this experience.  Throughout the history of medical science, new understandings have come along that have push aside older beliefs and practices. It is only in hindsight that the path appears easy to follow.  Those of us stumbling along it have every right to occasionally feel a bit lost and bewildered. Especially when trying to explain to a patient that he can now eat all the chocolate éclairs he wants. 

 

 

References:

 

 

 Bernard G. Cipolla, Rene´ Havouis, Jacques-Philippe Moulinoux. Polyamine reduced diet (PRD) nutrition therapy in hormone refractory prostate cancer patients. Biomedicine & Pharmacotherapy 64 (2010) 363–368.

 

Verma A. K. Inhibition of tumor promotion by dl-α-difluoromethylornithine, specific irreversible inhibitor of ornithine decarboxylase. Basic Life Sci., 52: 195-204, 1990.

 

Seiler N, Sarhan S, Graffel C, Jones R, Kno¨dgen B, Moulinoux JP. Endogenous and

exogenous polyamines in support of tumor growth. Cancer Res 1990;50:5077–

83

Quemener V, Chamaillard L, Brachet P, Havouis R, Moulinoux JP. [The involvement of polyamines in the malignant proliferative process. The anticancer effect of polyamine deprivation] Ann Gastroenterol Hepatol (Paris). 1995 May-Jun;31(3):181-8; discussion 188-9.

 

Moulinoux JP, Quemener V, Cipolla B, Guillé F, Havouis R, Martin C, Lobel B, Seiler N.

The growth of MAT-LyLu rat prostatic adenocarcinoma can be prevented in vivo by polyamine deprivation. J Urol. 1991 Nov;146(5):1408-12.

 

Chamaillard L, Quemener V, Havouis R, Moulinoux JP.Polyamine deprivation stimulates natural killer cell activity in cancerous mice.Anticancer Res. 1993 Jul-Aug;13(4):1027-33.

 

Brachet P, Quemener V, Havouis R, Tomé D, Moulinoux JP. Alterations in intestinal uptake of putrescine and tissue polyamine concentrations in tumor-bearing rats. Biochim Biophys Act. 1994 Nov 29;1227(3):161-70.

 

Inhibition of the growth of U-251 human glioblastoma in nude mice by polyamine deprivation.

Moulinoux JP, Darcel F, Quemener V, Havouis R, Seiler N. Anticancer Res. 1991 Jan-Feb;11(1):175-9.

Lavizzari, T. Breccia, M. Bover-Cid, S. Vidal-Carou, M.C. Veciana-Nogués, M.T. Histamine, Cadaverine, and Putrescine Produced In Vitro by Enterobacteriaceae and Pseudomonadaceae Isolated from Spinach  Journal of Food Protection, Volume 73, Number 2, February 2010 , pp. 385-389(5)

Linsalata M, Russo F, Berloco P, Valentini AM, Caruso ML, De Simone C, Barone M, Polimeno L, Di Leo A. Effects of probiotic bacteria (VSL#3) on the polyamine biosynthesis and cell proliferation of normal colonic mucosa of rats.  In Vivo. 2005 Nov-Dec;19(6):989-95.

B. Cipolla, F. Guillé and J.-P. Moulinoux Polyamine-reduced diet in metastatic hormone-refractory prostate cancer (HRPC) patients. Biochemical Society Transactions (2003) 31, (384–387).