Interview With Laura Dunn, Professor of Psychiatry and Behavioral Sciences at Stanford and Prostate 8 Collaborating Scientist

Dr. Laura Dunn, Professor of Psychiatry and Behavioral Sciences at Stanford and Prostate 8 Collaborating Scientist (and former Professor of Psychiatry at UCSF), is an expert in the field of psycho-oncology and routinely evaluates and treats cancer patients for a wide range of symptoms. We sat with Laura to learn more about her research.

Q: Is it common to feel anxious, depressed, or distressed after being diagnosed with prostate cancer?

 A: After being diagnosed with cancer, it is common to feel a number of intense emotions. Many people experience some level of depression, anxiety, or distress when faced with the diagnosis of cancer. In a recent study, 14–20% of men with prostate cancer reported elevated levels of distress. These rates were higher than those seen in similarly aged men without a diagnosis of prostate cancer. While these emotions may feel overwhelming, it is important to know that men can learn ways to cope better with these feelings. Seeking help from a counselor experienced in working with cancer patients is often very helpful for patients and their families.

Q: Is there any difference in anxiety, depression, or distress between men treated with active surveillance and those treated with radical prostatectomy?

 A: From what we know so far, patients with prostate cancer managed with active surveillance and those treated with radical prostatectomy appear to experience similar rates of depression, anxiety, and distress.

Q: Do anxiety, depression and distress affect sex life and urinary function in men treated for prostate cancer?

 A: Studies have reported that higher levels of depression, anxiety, and distress are associated with worse sexual function, sexual bother, and urinary problems. While these complications are certainly due to the disease and its treatment, the emotional symptoms are also important to address. Support and guidance from a counselor may help you cope with these troublesome side effects and return to your normal function sooner.

Q: In the New York Times article, “Anxiety Lingers Long After Cancer,” you comment on how a prostate cancer diagnosis can sometimes lead to worse anxiety in a spouse or significant other than in the patient himself. Can you explain this?

 A: Studies show that men do not want to worry their spouse or family members, so they often avoid mentioning the aches and pains that they experience. However, lack of communication can lead to MORE worry about the spouse/family members because they do not understand what their loved one is going through or feeling. These data underline the importance of communication during cancer. Talking honestly and truthfully can lessen uncertainty, stress, and anxiety — and, importantly, help both partners not feel so alone in the experience.

Q: Do you have any guidance for men who are coping with anxiety, depression and distress after prostate cancer?

 A: Cancer is not easy and it can be very stressful. It is perfectly normal to feel depressed, anxious, and distressed after a cancer diagnosis; however, it is also important to acknowledge those feelings and seek help if the symptoms are interfering with one’s day-to-day functioning. If you are suffering from anxiety, depression, or distress, talk to your doctor. He or she can refer you to a counselor with expertise in evaluating and helping you manage the psychological aspects of cancer. It is also important to be open with your spouse or a close family member, and possibly include him or her in some of your counseling sessions, so that you are all on the same page and can support one another during difficult times.

Q: Finally, what are some tools to help men with prostate cancer deal with depression, anxiety, or distress?

 A: There are many tools that can be used to help cope with depression, anxiety, and distress. Most importantly, do not be afraid to seek help. Consider joining a support group or seeking out counseling. It is also important to stay physically active. Exercise improves mood levels and helps maintain physical function. Take time to enjoy spending time with friends and family, and try to continue to participate in hobbies or activities that you enjoy (e.g., watching sports, going to the park, trying out a new hike, reading books, watching movies). Everyone has their own ways of coping; if your coping strategies that have helped you in the past don’t seem to be working, that is another indication that it might be a good idea to seek additional support.

Chain Restaurants

Following the Prostate 8 recommendations for eating well can be difficult when eating out, especially at chain restaurants. Below we have provided a guide on the dishes you should feel free to enjoy and those you should definitely avoid at a number of popular chain restaurants:

Chipotle

AVOID: Burrito, with carnitas, cilantro-lime rice, sour cream, roasted chili corn salsa, and cheese. This Burrito has almost 910 calories, a days worth of sodium and over 40 grams of cholesterol and fat all wrapped up in one. Try to avoid the tortillas and cheese at chipotle. You can still make a great meal without them!

ENJOY: Burrito bowl with chicken, brown rice, black beans, fajita veggies, guacamole, and green salsa. This burrito bowl boasts a lean protein and the added guacamole will help you fulfill your daily vegetable fat serving. Not to mention, its delicious!

Panera Bread

AVOID: Mac N Cheese and the Italian Combo Sandwich. Both of these dishes possess an abundance of calories, sodium and processed carbohydrates. Much of the food at Panera is deceptive: low in calories but high in sodium. Be careful when ordering.

ENJOY: Power Kale Salad (with vinaigrette instead of Caesar dressing) and Classic Salad with chicken. Both of these salads are dressed with oil-based dressings, an excellent source of vegetable fat. In addition, the Power Kale Caesar Salad, a new menu item, will have you on your way to consuming a serving of cruciferous vegetables for the day.

P.F Chang’s

This Asian-fusion restaurant presents one of the more challenging parts of eating out: family style entrées. While it may be difficult to remain healthy in a group, make sure to order two or three dishes that are both nutritious and enjoyable.

AVOID: Mu Shu Pork and Shrimp with Candied Walnuts. Both of these menu items have your daily serving of sodium in one dish. Make sure to avoid fried dishes and those coated in sugary, dense sauces.

ENJOY: Steamed Salmon with Ginger and Buddha’s Feast (steamed). This steamed salmon makes for a great protein addition to you and your group’s meal. Not only will it have you halfway to 2 servings of fish per week, but also it will provide a lighter and fresher flavor to meal as a whole. Buddha’s Feast, a collection of vegetables, is a great side dish for the table. Loaded with broccoli, this dish could be considered your daily serving of cruciferous vegetables. Make sure to order Buddha’s Feast steamed!

Subway

AVOID: Anything with processed meats! Many of the sandwiches at Subway are loaded with processed meat. Avoid any sandwich that has ham, pepperoni, bacon or any other sliced meat (turkey, roast beef) as an ingredient. This makes up a majority of the sandwiches at Subway. See below for options that are free of processed meat.

ENJOY: Veggie-Delite and Oven-Roasted Chicken Sandwich on whole wheat. Both of these options are packed full of vegetables and rich in fiber. You can also add guacamole to your sandwich to introduce healthy sources of vegetable fat into your meal.

The Cheesecake Factory

AVOID: Miso Salmon and the Factory Nachos. These dishes are both deceptive, but don’t be fooled. The Miso Salmon is a whopping 1,700 calories and holds almost twice the suggested daily serving of sodium all in one dish! The Factory Nachos boast even higher numbers. Instead of nachos suggest the table splits chips and guacamole for an appetizer.

ENJOY: Kale and Quinoa Salad and the Herb-Crusted Salmon Salad. These salads will have you well on your way to meeting the Prostate 8 recommendations for cruciferous vegetables and fish, respectively. Unlike many salads, both dishes are hearty and will leave you more than satisfied. Ask for dressing on the side as restaurants often douse salads in an excessive amount. Check out The Cheesecake Factory’s “SkinnyLicious” menu for more nutritious meals.

Overcoming Barriers to Exercise

It’s a lot easier to think of reasons not to exercise than it is to actually lace up your running shoes and go to the gym. After all, exercise can appear daunting or time-consuming — but it doesn’t have to be that way. Once you find the right exercise regimen, you’ll be able to experience the benefits of physical activity. We looked at lifestyle surveys from Prostate 8 study participants and found some of the most common obstacles to exercising. Here are some suggestions for how to overcome these obstacles and get active.

I’m not interested in exercising.

- You don’t need to run a marathon to get a good workout! It’s just a matter of finding something that you enjoy. From hiking to gardening to swimming, there are many forms of exercise that are accessible and entertaining.

I don’t enjoy physical activity.

- If you feel bored with your exercise routine, maybe it’s time to make a change. Try a new exercise class, or walk, run, or bike on a different route. Just remember to start slowly so you don’t hurt yourself.

- Take your mind off of exercising to make the time go by faster. Listen to your favorite music, tune into an educational podcast, or watch a sports game on TV in the gym.

- Exercise with others. Teaming up with a friend or family member adds a social element to exercise — plus, you can motivate each other.

I don’t have enough time to exercise.

- Incorporate exercise into your daily routine. You can receive the benefits of exercise without going to the gym. Take the stairs instead of the elevator; park in the back of the parking lot and walk; spend time gardening or doing household chores.

- Plan ahead — create an exercise schedule and stick to it. By making exercise a non-negotiable part of your day, you will be able to balance it with family, work, and social commitments.

I don’t have the energy for a workout.

- It may seem counterintuitive, but exercise can actually increase energy. Exercise delivers oxygen to your muscles and helps your cardiovascular system work more efficiently, making you feel less fatigued. So next time you’re feeling drained, simply try going for a brisk walk.

- Focus on getting energy from your diet. Nutritious, well-rounded meals will help you stay active throughout the day. Eat fresh fruit, lean protein, and complex carbohydrates like oatmeal and whole-grain bread.

Book Review: Habits and Happiness: How to Become Happier and Improve Your Wellbeing by Changing Your Habits by Braco Pobric

An old adage states, “Your mind is like fertile soil…It doesn’t matter what you plant there, anything will grow.” But, until statements like these are subject to rigorous research, they can become fodder for new age rhetoric. 

In his 2014 book, Habits and Happiness: How to Become Happier and Improve Your Wellbeing by Changing Your Habits, Braco Pobric has summarized the best of the old and new science of happiness research. The book’s mission is to help us identify ways to break old “bad” habits and replace with new “good” habits. This summary comes with its own warning, however, and that is that it is not enough to just read about habits. “For change to occur,” says Pobric, “you must be committed.”

Rather than explore one large theory of habit building, the book hits hard and quick, offering a new concept in each short chapter. These practical exercises include hints like practicing a “time in” which reinforces what you read; rewarding good habits; mindfulness; breaking down larger goals to small, actionable items; and charting your new course, among others. 

What it might lack in original thinking, it makes up for in presentation. His work draws on pioneers such as William James, the famous psychologist from the late 1800s to the recent writings of Charles Duhigg, who scripted the habit loop. In reiterating findings from others, he offers us a concise meta-analysis of pertinent thinking written in a fresh, accessible, and motivating prose. This gem of a book also has the extra advantage of being compact in size with large type, making it a perfect reading companion for the treadmill (hint-hint).

Your Gym at Home: Use Everyday Objects

Not having access to a gym may feel like a barrier to getting exercise, but in fact items in your house work just as well as pricey gym equipment!

Check out these ideas on how to stay fit without leaving the house:

• If you have a flight of stairs…You have the perfect cardio opportunity! Walk up and down a flight of stairs 3 times, and then rest for 30 seconds. Repeat up to 10 times. Start slow, and increase your pace as you feel comfortable (1 flight = up & down).
• For an added challenge, try walking up every other step (only do this on the way up, not the way down) or do 5 push-ups in between each flight.

If you just have a couple steps…

• You can try the “step-up with weights” exercise from the Prostate 8 Sample Home-Based Resistance Exercise Workout! Go to the Get Active webpage and click on “Toolkit” in the heading at the top. Begin standing in front of the first step with both feet together. Alternate left and right leg stepping up onto the step.
• Try this exercise with one full water bottle in each hand for a more advanced movement.

If you need weights…

There are items all over your house that can be used as weights! Try the dumbbell squat, seated row, and shoulder press in the Prostate 8 Sample Home-Based Resistance Exercise Workout. Use any of the following household items as weights:

•  1 pound weight substitutes: 16 oz. soda bottle, 16 oz. bottle of vinegar
• 5 pound weight substitutes: Standard bag of flour, half gallon of milk or orange juice
• 8 pound weight substitutes: Gallon of water or milk
• 10 pound weight substitute: Large bottle of laundry detergent (4.43 liters or 1.17 gallons)

If you have a chair…

You can use it for a number of strength exercises at home:

• Incline push-ups: Place the chair against a wall, so it will not slide out from under you. Then, place your palms on the seat of the chair and walk your feet back so that your body is in a straight line (“plank position”), forming a triangle between the chair, the floor, and your body. Then, slowly bend your arms to lower your chest toward the chair and push back up to straight arms. Throughout the movement, be careful to keep your abdominal and back muscles engaged, so that you do not arch or hollow your back or bend at the waist — your body should form a straight line the whole time with only your arms moving.
• Seat Taps: Stand facing the front of the chair. Simultaneously lift your right arm up to the sky and bring your left leg up to tap the seat of the chair with your left toes. Immediately bring your left foot and right arm back down, and repeat on the other side so you lift your left arm and tap the seat with your right toes. Continue to alternate taps for 45 to 60 seconds, using your arms for momentum and balance. Start slowly to get used to the movement, and increase your pace as you feel comfortable. You may want to have the chair set against a wall so it will not move out from under you, and you can grab the back of the chair for balance if needed.

If you have a paper towel roll (or any other non-fragile object that is approximately 6” high and wide)…

Place the roll on the floor and jump (or step) back and forth over it for 60 seconds, getting your knees up as high as possible. Repeat 10 times with a minute rest in between.

• To make this movement more advanced, start on one side of the roll and lower your body to the ground (bottom of a push-up position). Stand back up and jump or step over the roll. Then lower your body to the ground on the other side, stand back up, and repeat. This is called a burpee-jump over.

Achieving and Maintaining a Healthy Weight

Prostate 8 presents information on diet and physical activity separately, but achieving and maintaining a healthy weight requires us to think about both together. Your body weight is largely determined by energy balance: balancing your calorie intake (how much energy you consume) with your calorie expenditure (how much energy you burn). Calories are a measure of energy. If the calories you eat are equal to the calories you use up, you have achieved energy balance and your weight will stay the same. But balancing calorie intake and expenditure can be hard to do. Certain foods, namely refined carbohydrates like white bread, juices, and sugared beverages, are processed quickly by the body and can cause a spike, and subsequent drop, in blood sugar levels. This may actually make you feel hungry again a short while after eating, even though you consumed sufficient calories. In contrast, healthy fats, lean proteins, and vegetables are digested slowly and help keep hunger at bay.

Aim to achieve or maintain a healthy weight. Many studies use body mass index (BMI) to study weight. BMI is a measure of body weight adjusted for height. For example, for a healthy BMI of 19–24, a 5’ 8” tall man would weigh between 125–168 pounds, while a 6’ tall man would weigh between 140–177 pounds. Among most adults, higher BMI is an indication of more body fat. A BMI above 25 kg/m2is associated with increased risk of disease and all-cause mortality. Among men with prostate cancer, higher BMI levels at the time of diagnosis have been associated with increased risk of biochemical recurrence and prostate cancer-specific mortality.

Do you know what your BMI is? Use this simple calculator, provided by the National Institutes of Health to find out: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

Here are three useful tips to achieving and maintaining a healthy weight:

1) Avoid sugary drinks. This includes sports drinks, any type of soda, and fruit juice. These are “empty” calories coming mostly from sugar that we tend to add on top of our usual diet, which can lead to excess calorie intake and weight gain.

2) Choose vegetables, lean proteins, and healthy fats over refined carbohydrates. Refined carbohydrates are “empty” calories that are metabolized quickly and result in a spike (and subsequent drop) in blood sugar, leading you to feel hungry again a short time after eating. To identify these foods, think ‘white’ — white bread, pasta, white rice, potatoes, baked goods made with white flour and sugar. We recommend replacing such foods with lots of vegetables, lean proteins (seafood, poultry), whole grains, legumes (beans, lentils), and healthy fats (olive oil, nuts). Vegetables are low in calories and high in fiber, water, and nutrients. If fresh vegetables are not in season or expensive, consider buying frozen vegetables. Frozen vegetables often have as much or more nutrients than fresh because they are quickly frozen after picking. If choosing frozen or canned vegetables, be sure to select ones that do not have any added ingredients — syrups and sauces add unwanted calories fast. You cannot consume too many fresh vegetables! Lean proteins and healthy vegetable fats also provide essential nutrients while helping you to feel satiated and full, which leads to less overeating in the long-term.

3) Revise your plate. Adjust the relative proportions of food groups and total amount of food. Follow this simple rule of thumb: 2/3 (or more) vegetables and whole grains and 1/3 (or less) lean protein (seafood, poultry, tofu). Consider serving two or more types of vegetables at each meal for variety, such as a steamed or roasted vegetable (green beans, broccoli, cauliflower) and a green salad. Use healthy oils (like olive oil) when cooking, as a dressing for vegetables or grains, and at the table; 1 tablespoon = 1 serving of olive oil. If weight loss is your goal, maintain the 2/3 veggies and whole grains to 1/3 lean protein, and slightly reduce the total amount of food on your plate. Using a smaller plate or bowl can be helpful to achieve smaller portions. Reduce portions by small amounts that you can maintain, and your body will get used to eating slightly smaller amounts without feeling deprived. Small changes add up over time, and gradual weight loss that you can maintain is preferable to rapid weight loss that doesn’t last.

See additional tips and delicious recipes on the Prostate 8 website.

Eat mindfully: Tips for a healthy diet

Up until now, we’ve been talking about prostate health — today, we’re taking some time to look at the bigger picture. Guidelines for healthy eating change all the time, and it can seem like there is a new article every day about which foods to eat or avoid. We want to help you decode dietary recommendations by getting to the source: the 2015 Dietary Guidelines Advisory Committee (DGAC) report from the USDA and the Department of Health. Here are the highlights.

Skip the salt

By reducing your dietary sodium, you can prevent and treat high blood pressure, according to the DGAC. It is recommended to consume no more than 2,400 mg of sodium per day — this is the amount of sodium in just one teaspoon of table salt.

Be careful — it’s not always obvious when foods are high in sodium. According to the DGAC, 21 percent of daily sodium comes from burgers and sandwiches. Many prepared soups also have a lot of salt, so make your own soup with low salt or look for low-sodium brands. By cooking at home using raw ingredients and adding flavor with herbs and spices instead of processed/prepared foods or eating out, you can easily keep your sodium intake at a healthy level.

Eat the right kind of fat

The DGAC recommends decreasing consumption of saturated fat. Saturated fats are solid at room temperature, and most commonly found in dairy and red meat. By eating unsaturated fats instead, you can reduce your cholesterol levels and improve your overall health. This means using vegetable oils (like olive oil) instead of animal fats (like butter) as well as choosing lean protein sources, such as skinless poultry or fish, over beef or whole fat dairy. Partially hydrogenated oils also known as trans fats should be avoided.

A key point is that the right kind of fats are good for you! Avoid “low fat” products, as many “low-fat” or “non-fat” processed foods have high levels of added sugars and sodium. Instead of eating non-fat products, focus on eating products containing healthy, unsaturated fats.

Go nuts

By increasing your consumption of healthy fats, such as the ones found in olive oil and nuts, you can improve your prostate health and your cardiovascular health.

Recently, the PREDIMED trial (Prevention with a Mediterranean Diet) conducted in Spain among 7,447 persons at high cardiovascular risk, randomly assigned participants to consume extra-virgin olive oil (intervention group #1), mixed nuts (intervention group #2), or low-fat diet (control group). Participants were followed for major cardiovascular events (heart attack, stroke, or death from cardiovascular causes). Compared to the control group, men and women who consumed more olive oil or nuts had a 30 percent lower risk of incident cardiovascular disease. The benefit was the same whether the participants were given olive oil or nuts.

Be naturally sweet

Added sugars are sugars that are added during the processing of foods. Strong evidence shows that eating too much added sugar is associated with weight gain and type 2 diabetes. So what foods should you avoid? Sweetened beverages, especially sodas and juice drinks, are some of the biggest culprits. In fact, beverages supply 47 percent of added sugar intake!

It’s still unclear what impact low-calorie sweeteners, like Splenda, Sweet ‘n Low, and Equal, have on health. Therefore, it’s best to avoid these sugar substitutes or use them in moderation.

Next time you want something sweet, try to pick foods with natural sugars, such as fresh fruit. Instead of drinking a sugar-packed soda, try adding lemon, mint, or cucumber slices or just a splash of 100% fruit juice to sparkling water.

Get on your best behavior

Good nutrition depends not just on what you eat, but also where and with whom you eat, according to the DGAC. On average, one-third of calories are consumed outside of the home. Since many restaurants, especially fast food, serve large portions of often less healthy food, eating at home is a better choice. Pack a lunch for days when you will be out and about, and unable to return home to eat. And on days when you have to eat out, choose wisely and don’t hesitate to take home a portion of your meal in a doggy bag.

It’s also important to make time to eat with family or friends — studies show that when families share meals, they achieve better nutrition and are at healthier body weights.

Lastly, exercise is important for your overall health. The DGAC recommends engaging in both aerobic and resistance exercise. Growing evidence shows that excessive sitting and sedentary behavior is unhealthy — so go for a walk instead of watching TV, and consider investing in a standing desk at work. Use your Fitbit to track your steps!