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Measurement of Long-Term Diet Adherence Following a Randomized Controlled Trial of a 6-Month Low-Carbohydrate Intervention on Disease Progression in Men with Recurrent Prostate Cancer

Aubrey Jarman, Lauren Howard, Pao-Hwa Lin and Stephen J Freedland

We previously completed a 6-month randomized trial of ≤20g carbohydrates/day low carbohydrate diet (LCD) intervention vs. no dietary change in men with a rising prostate specific antigen (PSA) after failed local therapy (CAPS2). Men in the LCD group lost significant weight and exploratory analysis suggested slowed tumor growth as measured by longer PSA doubling time. Though patients were not asked to continue the diet post-study, we hypothesized the benefits of weight loss would encourage men to maintain some level of LCD relative to their pre-study diet. Of the 45 participants who completed the CAPS2 trial, 17 (5 control, 12 LCD) participants completed all on-study and follow-up measurements. The median carbohydrate intake for the LCD group at follow up was slightly lower than that of the control group (145g vs 186g; p=0.8). Caloric, macronutrient intake, weight and BMI were similar between groups at follow-up (all p≥0.2). Men randomized to a 6-month LCD, but not advised to maintain it long-term, tend to revert to their pre-study diet after study completion. Considering the benefits that consuming an LCD may have for PC patients, more effective strategies are needed to ensure long-term behavior change and improve diet adherence.