Research

 Research supporting plant based nutrition fascinates and excites me! It also makes me angry that this information is not on the front of News Week and the New York Times. It should be! Since it's not, I'm going to do my part to help get it out to the public. Most of this research comes from the Physicians for Responsibly Medicine and Dr. Joel Fuhrman's newsletters and blog posts. The reference will always be included.

Asthma - Mom’s Yogurt Puts Baby at Risk 

 Breaking medical news from www.pcrm.org

Pregnant women who eat yogurt may put their future children at risk for developing asthma, according to new research in Denmark. Consuming low-fat yogurt while pregnant is directly linked to the development of childhood asthma and hay fever, and full-fat yogurt is associated with adolescent hay fever. Consuming low-fat yogurt was associated with a 60 percent increase in asthma and an 80 percent increase in hay fever, compared with zero consumption of low-fat yogurt. The 61,912 women who completed the food questionnaire were part of the Danish National Birth Cohort.

Maslova E, Halldorsson TI, Stom M, Olsen SF. Low-fat yoghurt intake in pregnancy associated with increased child asthma and allergic rhinitis risk: a prospective cohort study. Poster presented as part of the European Respiratory Society's Annual Congress, Amsterdam, Netherlands, 25 September 2011.
For information about nutrition and health, please visit www.pcrm.org/.

Calcium Intake Associated with Cardiovascular Disease 
Breaking medical news by www.pcrm.org

Calcium supplements may increase the risk of heart attack and stroke, according to a study published this week in the British Medical Journal. Researchers followed 16,718 postmenopausal women in the Women’s Health Initiative. They found that a combination of calcium and vitamin D supplements increased heart health risk by 13 to 22 percent. The analysis showed the risk of calcium intake remained with or without vitamin D.¹
Calcium supplements have been called into question by previous studies showing that calcium intake from both supplements and dairy products increases the risk of prostate cancer.^2-4

1. Bolland MK, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. Published ahead of print April 19, 2011. doi:10.1136/bmj.d2040.
2. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, and the Prevention of Cancer: A Global Perspective. American Institute for Cancer Research. Washington, D.C. 1997; p. 322.
3. Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci E. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. Am J Clin Nutr. 2001;74:549-554.
4. Chan JM, Giovannucci EJ. Dairy products, calcium, and vitamin D and risk of prostate cancer. Epidemiol Rev. 2011;23:87-92.


Cancer Prevention - Lifestyle Changes Vital 
Breaking Medical New by www.pcrm.org 

Lifestyle changes like eating a healthy diet, exercising, and limiting alcohol could prevent about 340,000 cancer cases per year in the United States, according to a new report released by the American Institute for Cancer Research for World Cancer Day. Worldwide, cancer is a leading cause of death accounting for 7.6 million deaths and 12.7 million new diagnoses per year. Lifestyle changes could decrease cancer risk by 38 percent for breast cancer, 45 percent for colon cancer, and 47 percent for stomach cancer.
AICR/WCRF preventability estimates: Update to estimates produced for the 2009 Policy Report. 2011. American Institute for Cancer Research/World Cancer Research Fund. Available at: http://www.aicr.org/site/DocServer/UICCprWCD2011.pdf?docID=4781. Accessed February 7, 2011.

 

Cancer Prevention and Survival - Mushrooms

 Reported by Dr. Joel Fuhrman - www.DrFuhrman.com

For centuries, Eastern medicine has explored the health benefits of mushrooms. Today, researchers are finding that certain properties in mushrooms appear to have anticancerous effects. In 2009, a study from southeast China found that women could reduce their risk of breast cancer by consuming a small amount of mushrooms. When the women in the study included green tea, their breast cancer risk decreased even more. Intake of fresh mushrooms (greater than or equal to 10 grams per day) and dried mushrooms (greater than or equal to 4 grams per day) decreased risk by 64 percent and 47 percent, respectively. The most commonly eaten mushroom in this study was the white button mushroom; one small white button mushroom weighs 10 grams.
So why mushrooms? Apparently mushrooms have multiple beneficial effects on the body that work synergistically to signal certain receptors, which then enhance the immune system. Extracts from certain species of mushrooms are now used pharmaceutically to combat diseases. Some antifungal proteins in mushrooms have been shown to inhibit enzymes that stimulate the human immunodeficiency virus (HIV), and have also shown to inhibit tumor cell proliferation. Beta-Glucans are a type of polysaccharide (long chains of glucose) found in mushrooms. These polysaccharide substances appear to stimulate the immune system.
Unlike pharmaceutical drugs, mushrooms do not have to go though numerous trials in order to be found “safe.” Their ability to modulate the immune system is promising. The research is not perfect, but mushrooms (like many other plant foods) offer for a healthful option for breast cancer patients, survivors, and those looking for ways to prevent cancer.
Reishi mushrooms (rarely found in nature) contain more than 400 different bioactive compounds. Similar to the phytonutrients found in brightly colored plants, mushrooms offer multiple ways to protect the body from foreign invaders. For example, they promote anti-inflammatory responses, protect from chemo and radiation therapy, stimulate antihormonal responses, regulate sleep cycle, and contain potent antioxidants. Because of the various beneficial roles mushrooms exhibit, many nutritionists encourage increased mushroom intake. Shitake, portabella, and chanterelle mushrooms are some of the better known types available.
Wong JH, Ng TB, Cheung RC, et al. Proteins with antifungal properties and other medicinal applications from plants and mushrooms. Appl Microbiol Biotechnol. 2010;87(4):1221-1235.
Ramberg JE, Nelson ED, Sinnott RA. Immunomodulatory dietary polysaccharides: a systematic review of the literature. Nutr J. 2010;9:54
Sanodiya BS, Thakur GS, Baghel RK, Prasad GB, Bisen PS. Ganoderma lucidum: a potent pharmacological macrofungus. Curr Pharm Biotechnol. 2009;10(8):717-742.
Zhang M, Huang J, Xie X, Holman CD. Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. Int J Cancer. 2009;124:1404-1408.
Lull C, Wichers HJ, Savelkoul HF. Antiinflammatory and immunomodulating properties of fungal metabolites. Mediators Inflamm. 2005(2):63-80.


Cataracts - Animal Products in Diet Leads to Increased Risk
 Breaking Medical News by www.pcrm.org

Eating animal products increases the risk of cataracts, according to a new study published in the American Journal of Clinical Nutrition. Based on findings from 27,670 participants in the European Prospective Investigation in Cancer and Nutrition (EPIC-Oxford) study, meat intake was positively associated with risk of cataracts. The participants were divided into six diet groups: highest meat consumption, mid-range meat consumption, least meat consumption, fish-eaters, vegetarians, and vegans. Compared with those who ate the most meat, the risks for developing cataracts after adjusting for multiple confounders including age and smoking were as follows: mid-range meat consumption participants decreased their cataract risk by 4 percent, least meat consumption group by 15 percent, fish-eaters by 21 percent, vegetarians by 30 percent, and those who followed a vegan diet by 40 percent.
Appleby PN, Allen NK, Key TJ. Diet, vegetarianism, and cataract risk. Am J Clin Nutr. Published ahead of print March 23, 2011. doi: 10.3945/ajcn.110.004028.

 

 Colorectal Cancer -  Fiber from Whole Grains Decreases Risk
Reported by The Cancer Project - www.cancerproject.org

It is the position of the World Cancer Research Fund/American Institute for Cancer Research that there is convincing evidence that fiber decreases colorectal cancer risk.
Researchers found that for every 10 grams of fiber consumed from whole grains, there was a decrease in colorectal cancer risk by 10 percent. Those consuming three servings of whole grains per day could decrease their risk by 17 percent, compared with those who ate the least. One serving of whole grains counts as one slice of whole grain bread, a half cup of oatmeal, or a half cup of brown rice. Several mechanisms may be responsible for the decrease in risk from whole grains, including the fiber's ability to produce more frequent bowel movements, dilute carcinogens, boost antioxidants, and produce good bacteria that help balance the digestive tract. Although researchers cannot pinpoint the exact mechanism for a decreased risk, they agree that fiber from whole grains can be a great way to help prevent colorectal cancer. Whole grains contain many vitamins, minerals, and plant-chemicals known to not only decrease the risk of colorectal cancer but heart disease and diabetes, as well.

Aune D, Chan D, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ. 2011; 343:d6617.

Higher Fiber Intake for a Longer Life

Breaking Medical News by www.pcrm.org
 
Higher fiber intake is associated with significantly lower risk of dying, according to a study published online this week. Researchers looked at diet records from 219,213 people who were part of the NIH (National Institutes of Health)-AARP Diet and Health Study. Those who ate the most fiber had lower risks of death from cardiovascular disease and infectious and respiratory diseases, compared with participants who ate the least. Men who ate the most fiber also had a lower risk of cancer death, compared with men who consumed the least. Women with the highest fiber intake showed a non-statistically significant lower risk of death from cancer.
Fiber is only found in foods from plants, such as beans, grains, vegetables, and fruits.
Park Y, Subar AF, Hollenbeck A, Schatzkin A. Dietary fiber intake and mortality in the NIH-AARP Diet and Health Study. Arch Intern Med. Published ahead of print February 14, 2011. doi:10.1001/archinternmed.2011.18.

Osteoporosis Prevention
Reported by Dr. Joel Fuhrman - www.DrFuhrman.com

The worst foods for bone health:

• Animal protein and other high protein foods leave acidic residues in the blood, and the body responds by dissolving bone to release basic calcium salts to neutralize the acid, which results in loss of calcium in the urine. Many studies have found animal protein intake to be associated with low bone mass.^1,2 In contrast, plant protein intake is associated with decreased hip fractures in the elderly.ⁱ Natural plant foods do not leave an acidic residue in the blood or promote urinary calcium excretion.^3,4
• Salt promotes the excretion of calcium in the urine.⁵
• Caffeine also contributes to urinary calcium loss. High caffeine intake is associated with increased bone loss and osteoporotic fractures.^6,7
• Soda, including diet and decaffeinated soda, is associated with bone loss.^8,9 Soda consumption increases parathyroid hormone (PTH) in the blood, which increases blood calcium concentrations by stimulating bone breakdown. This increased blood calcium is then excreted in the urine.¹⁰

The best foods:

Whole plant foods are the best foods for bones. Studies show that individuals with the highest consumption of fruit and vegetables have the strongest bones.^11,12

• Beans, seeds, and greens. A diet full of natural plant foods provides the calcium required to build strong bones. Green vegetables in particular are rich calcium sources. For example, one four-ounce serving of steamed kale has just as much calcium as one cup of milk. Broccoli, bok choy, spinach, sesame seeds, and garbanzo beans are also excellent calcium sources. Furthermore, the body absorbs over 50% of the calcium in green vegetables, compared to only 32% of the calcium in milk.¹³
• Green vegetables are high in vitamin K, which is a crucial component for maintaining healthy bones.¹⁴
• Nuts and seeds are rich in magnesium, an essential mineral for the formation of bone tissue.¹⁵ They also help maintain adequate calorie and protein intake, to maintain muscle and bone mass without having to rely on high acid-forming animal products.

Of course, the right type of exercise, performed regularly is also critical.

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¹Sellmeyer DE, Stone KL, Sebastian A, Cummings SR. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group. Am J Clin Nutr. 2001;73(1):118-122.
²Devine A, Dick IM, Islam AF, et al. Protein consumption is an important predictor of lower limb bone mass in elderly women. Am J Clin Nutr. 2005;81(6):1423-1428.
³Welch AA, Mulligan A, Bingham SA, Khaw KT. Urine pH is an indicator of dietary acid-base load, fruit and vegetables and meat intakes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population study. Br J Nutr. 2008 Jun;99(6):1335-43.
⁴Massey LK.. Dietary animal and plant protein and human bone health: a whole foods approach. J Nutr 2003 Mar;133(3):862S-865S.
⁵Teucher B, Fairweather-Tait S. Dietary sodium as a risk factor for osteoporosis: where is the evidence? Proc Nutr Soc. 2003;62(4):859-866.
⁶Rapuri PB, Gallagher JC, Kinyamu HK, Ryschon KL. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr. 2001;74(5):694-700.
⁷Hallström H, Wolk A, Glynn A, Michaëlsson K. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporos Int. 2006;17(7):1055-1064.
⁸McGartland C, Robson PJ, Murray L, et al. Carbonated soft drink consumption and bone mineral density in adolescence: the Northern Ireland Young Hearts project. J Bone Miner Res. 2003 Sep;18(9):1563-9.
⁹Mahmood M, Saleh A, Al-Alawi F, Ahmed F. Health effects of soda drinking in adolescent girls in the United Arab Emirates. J Crit Care. 2008 Sep;23(3):434-40
¹⁰Larson NS, Amin R, Olsen C, Poth MA. "Effect of Diet Cola on urine calcium excretion" ENDO 2010; Abstract P2-198. http://www.endojournals.org/abstracts/P2-1_to_P2-500.pdf
¹¹Tucker KL, Hannan MT, Chen H, et al. Potassium, magnesium, and fruit and vegetable intakes are associated with greater mineral density in elderly men and women. Am J Clin Nutr 1999;69(4):727-736.
¹²New SA, Robins SP, Campbell MK, et al. Dietary influences on bone mass and bone metabolism: further evidence of a positive link between fruit and vegetable consumption and bone health? Am J Clin Nutr 2000;71(1):142-151.
¹³Weaver CM, Plawecki KL. Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr 1994;59(suppl):1238S-1241S.
¹⁴Feskanich D, Weber P, Willett WC, et al. Vitamin K intake and hip fractures in women: a prospective study. Am J Clin Nutr 1999;69(1):74-79.
¹⁵Rude RK, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr. 2009 Apr;28(2):131-41. 


Osteoporosis/Bone Fractures - 
Increased Calcium Intake Does Not Reduce Risk
http://pcrm.org/news/blog/archive/calcium_osteoporosis_drbarnardsblog_110527.html

A new study published in the British Medical Journal¹ found that people who consumed the highest amounts of calcium did not have a reduction in bone fractures or osteoporosis. In fact, those who consumed the most calcium (more than 1137 milligrams per day) had higher rates of hip fractures and similar rates of osteoporosis, compared with those who consumed less. Researchers looked at 61,433 Swedish women over 19 years and concluded no significant benefit to consuming more than 700 milligrams of calcium per day for bone health.
Previous studies have shown similar results. The Nurses’ Health Study,² which followed more than 75,000 women for 18 years, showed no protective effect of increased milk consumption on fracture risk. Similarly, a 1994 study of elderly men and women in Sydney, Australia, showed that higher dairy product consumption was associated with increased fracture risk. Those with the highest dairy product consumption had approximately double the risk of hip fracture compared with those with the lowest consumption.³
People may want to consider the risks to over consuming calcium. An elevated risk of prostate cancer incidence and mortality has been associated with dairy consumption,^4,5 and the same may be true for ovarian cancer.⁶

1. Warensjo E, Byberg L, Melhus H, et al. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ. 2001;342:d1473.

2. Feskanich D, Willett WC, Colditz GA. Calcium, vitamin D, milk consumption, and hip fractures: A prospective study among postmenopausal women. Am J Clin Nutr. 2003;77:504-511.

3. Cumming RG, Klineberg RJ. Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol. 1994;139:493-503.

4. Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci E. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. Am J Clin Nutr. 2001;74:549-554.

5. Chan JM, Gann PH, Giovannucci EL. Role of diet in prostate cancer development and progression.J Clin Oncol. 2005;23:8152-8160.

6. Cramer DW, Harlow BL, Willet WC. Galactose consumption and metabolism in relation to the risk of ovarian cancer. Lancet. 1989;2:66-71.

Pancreatic Cancer Detection and Prevention 
Breaking medical news by www.pcrm.org 

It takes an average of 6.8 years for a pancreatic cancer cell to spread to other organs, and an average of 2.7 years from then until the patient’s death, according to a new study published in the journal Nature. Researchers used genetic testing methods to detect cancer progression by identifying specific genes thought to influence cancer growth. These timelines for disease progression may be useful for new screening methods in hopes of detecting cancer earlier.
Meanwhile, an Italian study in Cancer Causes and Control shows that diets rich in fruits and vegetables can reduce pancreatic cancer risk. Those who consumed the most fruits and vegetables had an estimated 40 percent decreased risk, compared with those who ate the least. The study found that frequent meat consumption can double risk and that table sugar and white potatoes also increase risk. The researchers suspect insulin resistance may play a role in pancreatic cancer.
Yachida S, Jones S, Bozic I, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010;467:1114-1117. 

Prostate Cancer Prevention

Reported by Joel Fuhrman - www.DrFuhrman.com
 

1) Eat lots of cruciferous vegetables.
Cruciferous vegetables (broccoli, kale, bok choy, arugula, cauliflower, brussels sprouts, cabbage, radish to name a few) contain phytochemicals that stimulates the body to detoxify carcinogens. Men who consumed three or more half-cup servings of cruciferous vegetables per week were 41 percent less likely to develop prostate cancer.¹

2) Reduce consumption of animal protein.
It is widely recognized that a high consumption of animal protein has been linked to a greater risk of prostate cancer.² Greater consumption of meat, poultry and fish is associated with higher blood level of IGF-1 (insulin-like growth factor-1), which is positively correlated with an increased risk of prostate cancer.³ For prostate health, limit or avoid animal products to less than two servings per week. Plant protein, however is protective – legumes, and specifically minimally processed soy products, are associated with decreased risk of prostate cancer.⁴

3) Eat lots of tomatoes.
A study of over 40,000 men revealed that those who consumed the most tomato-based foods (including cooked tomatoes and tomato sauce) reduced their total risk of prostate cancer by 35 percent and their risk of advanced prostate cancer by 50 percent.⁵ Lycopene, which is abundant especially in cooked tomato products is believed to be primarily responsible for this benefit. Tomatoes are extremely nutrient dense, containing lycopene as well as a variety of other protective phytochemicals.

4) Eat plenty of Allium and yellow/orange vegetables.
Allium vegetables - onions, garlic, leeks, shallots, scallions, and chives – have organosulfur compounds with anti-cancer effects, and are associated with reduced prostate cancer risk.⁶ Consumption of orange vegetables including carrots, pumpkin, sweet potatoes, winter squash and corn was also found to be inversely related to prostate cancer.⁷

5) Confirm adequate vitamin D levels with a blood test.
Accumulating research shows that insufficient vitamin D levels are associated with an increased risk of several cancers, including prostate cancer.⁸ While sun exposure is one of the best sources of vitamin D, it is unlikely to get adequate vitamin D from a sun exposure, throughout life, without increasing risk of skin cancer. The safest way to obtain vitamin D is through supplements.

6) Do not rely on PSA screening as a method of “early detection” to prevent prostate cancer.
About 70% of men with elevated PSA do not actually have cancer, and many scientists believe that PSA screening does not reduce prostate cancer-related deaths.⁹ In fact, the U.S. Preventive Services Task Force, the American College of Preventive Medicine and the American Cancer Society do not recommend routine PSA screening.¹⁰ 

7) Avoid supplemental folic acid
Folic acid is the synthetic form of folate, one of the B vitamins. Similar to breast cancer, folic acid supplementation has been associated with increased risk of prostate cancer, whereas food folate is associated with decreased risk.¹² Get natural folate from green vegetables and beans instead of synthetic folic acid from supplements.

8) Avoid dairy consumption.
There is substantial evidence indicating that men who avoid dairy products are at a lower risk for prostate cancer. One study that spanned 41 countries reported a strong correlation between per capita milk consumption and prostate cancer deaths.¹³

9) Exercise at least 3 hours a week.
Exercise, particularly endurance-type exercise such as walking, running, cycling and swimming, are effective forms of disease protection. In one study, men who reported vigorous activity for at least three hours per week had a 61% lower risk of prostate cancer-specific death. Not only does exercise prevent prostate cancer, but it can also slow the progression of cancer.¹⁴

10) Supplement with zinc.
In one study of 525 men with prostate cancer, those who consumed the most zinc (15.7 mg daily) were shown to have 74% reduction in risk of death as compared to men who consumed less than 12.8 mg zinc daily.¹⁶ The power of zinc lies in its ability to cause prostate cancer cell death. It is important to note that zinc from plant foods is not always efficiently absorbed by the body.¹⁵ To ensure adequate zinc levels, (and B12, D and iodine) I recommend supplementation with a multivitamin and mineral supplement that does NOT contain folic acid.


References

¹Kirsh V, Ulrike P, Mayne S, et al. Prospective Study of Fruit and Vegetable Intake and Risk of Prostate Cancer. J Nat Cancer Inst 2007 Aug 1;99(15):1200-9.
²Wolk A. Diet, lifestyle and risk of prostate cancer. Acta Oncol 2004; 44(3):277-81.
³Key TJ. Diet, insulin-like growth factor-1 and cancer risk. Proc Nutr Soc 2011 May 3:1-4.
⁴Kolonel L, Hankin J Whittemore AS, et al: Vegetables, Fruits, Legumes and Prostate Cancer: A Multiethnic Case-Control Study. Cancer Epidemiol Biomarkers Prev 2000; 9:795.
Hwang YW, Kim SY, Jee SH, et al. Soy food consumption and risk of prostate cancer: a meta-analysis of observational studies. Nutr Cancer. 2009;61(5):598-606.
⁵Giovannucci E: A review of epidemiologic studies of tomatoes, lycopene and prostate cancer. Exp Biol Med (Maywood) 2002.227(10):852-9.
⁶Galeone C, Pelucchi C, Levi F, et al. Onion and garlic use and human cancer. Am J Clin Nutr. 2006 Nov;84(5):1027-32.
Hsing AW, Chokkalingam AP, Gao YT, et al. Allium vegetables and risk of prostate cancer: a population-based study. J Natl Cancer Inst. 2002 Nov 6;94(21):1648-51.
⁷Kolonel L, Hankin J et al: Vegetables, Fruits, Legumes and Prostate Cancer: A Multiethnic Case-Control Study. Cancer Epidemiol Biomarkers Prev 2000; 9:795.
⁸Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr;87(4):1080S-6S.
⁹Esserman, L., Y. Shieh, and I. Thompson. Rethinking Screening for Breast Cancer and Prostate Cancer. JAMA: The Journal of the American Medical Association, 2009. 302(15): p. 1685-1692.
Coldman, A.J., N. Phillips, and T.A. Pickles: Trends in prostate cancer incidence and mortality: an analysis of mortality change by screening intensity. CMAJ, 2003. 168(1): p. 31-5.
Andriole, G.L., et al.: Mortality results from a randomized prostate-cancer screening trial. N Engl J Med, 2009. 360(13): p. 1310-9.
¹⁰Ablin, R.J: The Great Prostate Mistake, in New York Times. 2010. p. 27. Available from http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?_r=2
¹²Figueiredo JC, Grau MV, Haile RW, et al. Folic acid and risk of prostate cancer: results from a randomized clinical trial. J Natl Cancer Inst. 2009 Mar 18;101(6):432-5. ¹³Grant WB. An ecologic study of dietary links to prostate cancer. Altern Med Rev. 1999 Jun;4(3):162-9.
¹⁴Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. J Clin Oncol. 2011 Feb 20;29(6):726-32.
Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC. Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer. 2007 Oct 1;121(7):1571-8.
¹⁵de Bortoli MC, Cozzolino SM. Zinc and selenium nutritional status in vegetarians. Biol Trace Elem Res. 2009 Mar;127(3):228-33.