
Fasting improves chemotherapy results and protects from side effects: study - alz
https://www.nature.com/articles/s41467-020-16138-3
======
markus92
Interesting study with, as always, a lot of caveats. The most we can take from
this is that it's worth to study more, the effect is existing but not extreme.

I don't get the submitted title here claiming that it protects from side
effects. The study does not mention this at all, just that the side effects
are similar despite omission of dexamethason in the fasting arm of the trial -
it increases appetite, so makes sense to omit it if you want any reasonable
compliance rate.

As with any fasting and dieting study, compliance is moderate at best. In this
study, only 33% of patients were compliant for at least 4 cycles of
chemotherapy, out of 12 cycles total. Most of them were compliant with at
least once cycle though.

Overall, we need some more research on this in a larger trial. This paper is a
call for funders to do just that - the trial ended prematurely due to needing
to include more patients but there was a lack of funding to do so.

I'm currently doing research on a similar patient population, so open to
answer any questions.

~~~
keithwarren
My wife is Stage 3, ++- (43 yo) and half way through the taxol phase of an ACT
regimen; she is progressing well but I know she has the discipline to do a
fasting diet if we thought it would help. Any thoughts on starting this mid-
way through the treatment?

~~~
Funes-
Try it. My mom (she left us last year at only 53, unfortunately) and I did
intermittent fasting (>=16 hours), and ate a super clean and mainly
ovolactovegetarian diet for most of her illness. Her life expectancy was only
six months, with breast cancer and methastasis; she endured six _years_.

Do anything you can to help her be healthy. Diet is of extreme impoortance.

------
Cro_on
If there were ever a panacea, it would be fasting. The more tight and
widespread the research becomes, the more that we prove what humanity has
known anecdotally throughout civilisation.

From being a Roman cure for epileptic seizures, through the integral practice
in most religions, and to the 21st century where we start to prove that it
increases both healthspan and lifespan.

I find it quite interesting that something so simple, which practically
anybody can do, can have such a positive effect on one's life. You are
literally healing and regenerating yourself by doing nothing! And instead of
compounding medical bills you actually save money!

Thank you modern science for validating my no longer fringe medical beliefs :)

~~~
mmhsieh
while on fasts, you get an energy level and mental clarity that has to be felt
to be believed. everyone should try it at least once.

~~~
hourislate
I have fasted 100 lbs away over the last 2 years. I adhere to an 18/6 time
delay eating schedule but have done 2-3 day fasts with 1 refeed meal for a
month at a time. I've also done countless 5-7 day fasts. I've gone as long as
12 days with nothing but water. There were many months where I could count the
number of times I ate on one hand. My last go was every other day with just
one meal on my eating days. I did that this year for all of January to the end
of March and would never recommend alternate day fasting to anyone. You will
mess your self and your metabolism up. You will lose a lot of muscle.
Alternate day fasting should be avoided.

Never over two years did I feel any of the mental clarity or more energy you
speak of. I follow guys like Cole (snake diet) and even he speaks of the
feeling of dying and lying in bed shivering on a 5-7 day.

Are you sure about the metal clarity and energy levels, because I and the
folks I know who fast don't seem to have those affects.

~~~
me_me_me
> I've gone as long as 12 days with nothing but water.

This is dangerous and please don't encourage others to do only water fast.
Pure water fast is dangerous beyond 4 days or so.

You need to supplement minerals while on per-longed fast. Salt, magnesium and
potassium are vital to regulatory processes in your body.

When your body uses up all reserves it will not be able to sustain those
processes. It is serious business so please read up on the subject while
trying anything longer than 3 days.

> feeling of dying and lying in bed shivering on a 5-7 day.

This is body telling you something is wrong, ignoring is outright stupid. Like
ignoring that you are bleeding.

> I have fasted 100 lbs away Congratulations

~~~
roystonvassey
Interesting. Any studies that validate the first point? I recall research
talking about how there’s little muscle wastage until day 21 in normal healthy
adults.

Keen to know if we have learned more in this space

~~~
PoachedSausage
The figure I have seen is that muscle wasting drops to less than 0.2 kg per
day once the body fully enter ketosis. Obviously, anyone considering a fast
longer than a few days should do so under the supervision of a doctor who can
monitor electrolyte levels etc. They can also check for the rare enzyme defect
called Medium-chain acyl-CoA dehydrogenase deficiency, those with it are
unable to fast safely.

~~~
s1artibartfast
Isn't 0.2 kg per day is a huge amount of muscle?? Thats half a pound a day!

------
caymanjim
Cancer needs sugar. One of the primary ways they detect cancer is via a PET-CT
with a radioactive glucose tracer. It lights up where glucose uptake is the
highest. This article talks about starving cells going into defensive repair
mode, but also about how energy-hungry cancer cells are.

I had cancer (lymphoma) and did three years of chemo (mostly
maintenance/preventative, as it was wiped out in the first couple months). I
actually gained an enormous amount of weight, because the steroids I was on
(and all the weed I smoked) made me ravenously hungry. If I end up in that
situation again, I'm going to make a concerted effort to dramatically reduce
my calorie intake, and in particularly carbs, because I've read a lot about
the potential benefits of starving the cancer out.

~~~
agumonkey
A young biology researcher pitched in to explain the warburg factor in tumors,
he made a long paragraph explaining the oh so twisted metabolysm of cancerous
cells. The amount of counter intuitive disruptions that mechanically benefited
the tumoral tissue was .. almost impressive.

~~~
faeyanpiraat
Could you give examples?

~~~
agumonkey
I forgot but let me try:

\- cancerous cells often break the mitochondria forcing cell into a secondary
respiration mode

\- they also trigger vascular growth but chaotically

\- since the cell is in this alternative respiration, they don't need normal
arteries to get energy so the chaotic arterial network they grow is not a
problem

\- IIRC this network also impedes chemotoxins to reach the cell as fast as
normal cells

\- if you starve your body from sugar, you'll hurt the normal cells (which are
in full respiration mode) while the cancerous will keep their metabolysm

It was a bunch of things like this but when you take distance, you have a
dysfunctional cell that somehow is setup to construct a near perfect bed of
survival in his own destructive processes.. it's almost smart.

~~~
blithedale
Good stuff.

Also of note is tumor heterogenity. Not only are cancers different between
cell origin and across different patients, cancer is not one uniform genetic
entity even inside a single person.

Why? The cancer's ability to repair DNA mutations is crap, so different chunks
of tumor can rapidly evolve different mutations.

You might be able to drug one portion of the tumor based on a fancy
receptor/biomarker, but that tumor chunk will get outcompeted by a different
cancer blob that doesn't express that.

~~~
agumonkey
Yes, and this was ignored for quite a while at least at the mainstream level.

I've read not too long ago that a tumor is actually mostly an outer layer of
active cells, the inner is made up of dead tumors probably serving as nutrient
(<= very blurry on this). yet another part of that strange anti-life living
form named cancer.

------
eperfa
Looks like this study was initiated/sponsored by this company, specifically
testing the effectiveness on what they call Fasting Mimicking Diet.

[https://l-nutra.com/pages/fasting-mimicking-
diet](https://l-nutra.com/pages/fasting-mimicking-diet)

If I understand correctly this is a low-calorie diet, which is easier to
follow than a strict water-only diet, but they claim it is equally effective.
They recommend it also for healthy individuals, 5 days a month. Does anyone
have experience with it?

~~~
wtetzner
Just from personal experience, I've found that fasting is actually easier that
something like a fast-mimicking diet. Maybe there's something physiological
going on, or maybe it's just psychological, but I find it much harder to eat a
little bit than to just not eat. Then when I do get to eat, I can eat enough
to feel satisfied.

~~~
abledon
drinking light vegetable broth?

------
blithedale
ARGH. ARGH ARGH ARGH.

Almost no one reads these papers when stuff like this gets posted on HN.

And there is shameful statistical fuckery afoot in this paper. People are only
repeating the hype statistics at the top of the paper.

Their "pathological response" rates touted at the top of paper only come from
the 1/3 of women able to actually carry out the diet. This is the "per-
protocol" language in the abstract. An honest evaluation here would be
"intention to treat" and analyze chemo responses in every assigned to each
arm.

And they do that evaulation, but bury it later in their paper. Turns out when
you account for the 2/3 of women who can't do that fasting, there's NO
DIFFERENCE in response rate:

    
    
       "The overall pCR rate was 11.7% and did not differ between the two groups (10.8% in FMD group versus 12.7% in control group; OR 0.830, 95% CI 0.282–2.442, P = 0.735."
    

Argh...

~~~
blithedale
A lot of people might think "Ah, well, fasting is clearly effective for the
1/3 that are able to carry it out, just gotta make sure you have the willpower
to be the 1/3."

But hold on. Slow down. There's a good chance the "women who fasted had better
chemo responses" story completely REVERSES cause and effect. Here's how:

    
    
        WOMEN 1 - Has indolent biology, slower growing tumor than your average breast cancer at this stage.
     - Symptoms: Less pain, neuropathy, less swelling, tumors not affecting distant organs as much
    
        WOMEN 2 - Has aggressive biology, faster growing tumor than your average breast cancer at this stage.
     - Symptoms: More pain, neuropathy, more swelling, tumors begin to affect distant organs
    

So ask yourself: Which women is more likely to be able to follow a strictly
regimented diet?

Clearly WOMEN 1.

~~~
blithedale
This is like making people with cancer do an Ironman triathalon.

People about to enter hospice and pass on in a few weeks are gonna be way less
able to complete it than someone who has months left to live.

But all you've done is stratify your patients.

The triathalon doesn't make anyone live longer.

------
CamelCaseName
Correct me if I'm missing something, but this isn't the type of fasting most
people in the thread are talking about.

In the study they say "FMD" or "Fasting mimicking diet", in particular,
Xentigen (ProLon?), which is sold by L-Nutra. These are "healthy plant-based
meals". [0]

[0] [https://l-nutra.com/pages/prolon-nutritional-
information](https://l-nutra.com/pages/prolon-nutritional-information)

~~~
projektfu
At approximately 200 calories per day for 3 days.

------
jungletime
If this turns out to be true, then the practice through the centuries, of a
"Religious Pilgrimage" might be effective too. Walking all day, with little
food, would put someone in a calorie deficit, combined the stress of
extraneous exercise might trigger cell death in cancer cells.

Perhaps, completely changing one's environment. Example going from a city to
live in a forrest, might also trigger different genetic pathways, and awaken
the immune system.

Many narrative stories have this pattern of someone getting sick and
retreating, going into nature, in pursuit of fresh air or sunshine.

------
lawlorino
Since this is likely to attract a lot of fasting practicioners to the comments
I want to ask - I've occasionally tried out fasting or severe calorie
restriction in the past but I always seem to get dizzy, weak and shaky in the
first 24 hours and have to give up. This seems like a normal physiological
response to be honest, how are people either avoiding or coping with this?

~~~
wincy
I’m by no means an expert, but I think there’s some amount of adaptation that
occurs. I feel like I had to “train” my body to fast. I had a similar problem
and it was really unpleasant the first time I tried a fast, but recently did a
three day fast with no discomfort right until the end. The end was weird
because I told myself I was going to break my fast, and my stomach kicked into
action too early, making me sick. Like I went from very little hunger to
RAVENOUS. Had to break my fast at a drive through (best chalupa I’ve ever
tasted!)

For me at least I go into fasting by first skipping breakfast for a few days,
then skipping breakfast and lunch. Skipping dinner is mostly a mental hurdle
because there’s so much psychological signaling that you should eat at dinner
time and don’t really know what else to do with yourself. Going to bed without
eating in a day feels weird at first.

I also make sure to get lots of electrolytes during all of this, magnesium
glycinate and lite salt seem to do the trick. Otherwise I start to get shaky
and have bad headaches.

~~~
narwally
I had a similar experience with my first extended fast. I was just going to do
three days, but I felt really good and not at all hungry at that point, so I
extended it a day. But when went to break the fast, as soon as I started
eating the light salad and broth I had made, I became instantly ravenous and
no longer had any self control. So what started as a light salad ended with
mozzarella sticks and a whole pack of Oreos. I no longer keep junk food in the
house if I'm doing a fast.

The salt and other electrolytes is crucial as you mentioned. If you don't
supplement you'll actually get some pretty intense cravings. It was the first
time I understood why deer love salt licks. I would have licked on one of
those like it was a tootsie pop.

~~~
curiousllama
huh, I guess this is why I love pickles and kimchi when I'm cutting calories

------
Yizahi
I'm not doubting the results (yet), but I just can't understand how is this
possible. Chemotherapy basically damages host cells, with a lot of collateral
damage. It already can cause all sorts of digestive tract problems and weight
loss among other things. And now they propose to cut energy intake even more.
How is this beneficial I can't understand.

~~~
inglor_cz
Chemotherapy is tuned to kill cells that divide. Cancer cells happen to divide
a lot, but sometimes normal healthy cells do too. (Not all of them.) Thus they
become collateral damage along the cancerous ones. Hence nausea and other
unpleasant effects.

If you can persuade the normal healthy cells to hunker down and stop dividing
for a while, the killing effect of the drugs will concentrate on the cancerous
cells alone. This is what fasting is expected to achieve. It is not alone in
this regard, anything that inhibits mTOR (e.g. rapamycin) should in theory
have similar effect.

~~~
Yizahi
Got it, thanks for explanation

------
tyingq
Interesting. Though cancers that force you to fast, like stomach or esophageal
cancer don't have great 5 year survival rates.

~~~
kevinmchugh
That's what I keep thinking. One wrinkle here is that the calorie restricted
days are those leading up to chemo, which were the only days my dad (who had
esophageal cancer) could eat very much.

How could we know if this was survivorship bias? What if the folks who can
best comply with the calorie restrictions are those who are already in a good
state?

~~~
blithedale
Their "better response rate" touted at the top ignores the 2/3 of women who
couldn't carry out the assigned FMD.

When you fold back in those 2/3 of people on that arm, the response rate is
the same:

    
    
       "The overall pCR rate was 11.7% and did not differ between the two groups (10.8% in FMD group versus 12.7% in control group; OR 0.830, 95% CI 0.282–2.442, P = 0.735)."

------
luxurytent
What are the recommended ways to fast? I did intermittent fasting for about 5
months to shed 25lbs. It likely contributed, but I was also laser focused on
dropping.

~~~
valar_m
I've been doing intermittent fasting for 5 weeks as of today and in that time
have lost 22 pounds. I have more energy and have noticed a generally
heightened sense of well-being (though perhaps as a result of the weight loss
and improved appearance).

I am doing 18:6, so I generally eat from 12pm to 6pm. During that time I
typically eat two meals, and one or two small snacks. I try to eat pretty
healthy, but there have been plenty of times in the past 5 weeks when I've
just pigged out at Waffle House. I still have lost significant weight.

I have two major recommendations: first, drink tons of water. I try to drink
about 16oz of water every hour. Besides hydration, it helps a lot with hunger.
You _will_ get hungry at times. For me it isn't every day - some days it's
easy to stay on track. Others, it's tough. When you're feeling hungry, chug
water. It really helps. (tip: try sparkling water to change things up if you
get sick of regular flat water).

Second, I recommend using an app to track your fasting. Mine was free and
tracks your start and end times for fasting and tells you how long until your
fasting period is over. It also lets you track your weight, and even water
drinking progress if you want.

Last thing - the hardest day of fasting, by far, is the very first day. After
that, it will get easier.

ETA another tip: If you're doing it for weight loss, don't weigh yourself
every day. Your weight will fluctuate a pound or two from one day to the next,
and even throughout the day. It can be demoralizing to fast for a day and then
the scales tell you that you're up a pound. Instead, weigh yourself maybe
twice a week, and always near the end of your fasting period.

------
ideals
If you aggressively fast on chemo you must must must take vitamins. Have seen
personally what can happen when one does this without supplementing and have a
result of low levels of thiamine which is lethal and has life long effects
when it isn't.

------
nabla9
I wonder how much the effect is slowing metabolism relative to cancer cells.

~~~
wombatmobile
Fasting has been practiced for millennia, but only recently studies have shed
light on its role in adaptive cellular responses that reduce oxidative damage
and inflammation, optimize energy metabolism and bolster cellular protection.
In lower eukaryotes, chronic fasting extends longevity in part by
reprogramming metabolic and stress resistance pathways. In rodents
intermittent or periodic fasting protects against diabetes, cancers, heart
disease and neurodegeneration, while in humans it helps reduce obesity,
hypertension, asthma and rheumatoid arthritis. Thus, fasting has the potential
to delay aging and help prevent and treat diseases while minimizing the side
effects caused by chronic dietary interventions.

\-- Longo and Mattson

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946160/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946160/)

------
resoluteteeth
I haven't read the article yet but I just want to point out something that may
be fairly important to understand here: chemotherapy drugs target cellular
division. This means that if fasting slows down cellular division in normal
cells but not cancer cells, it could make the chemotherapy drugs able to
target the cancer cells more selectively than normal. However, this would not
necessarily translate into anything relating to situations in which
chemotherapy drugs are not being taken.

------
throw5543245
> Essentially, fasting causes a switch in healthy cells from a proliferative
> state towards a maintenance and repair state.

Is this autophagy?

In this interview with Dr. Eileen White, Chief Scientific Officer at the
Rutgers Cancer Institute, she mentions that certain types of cancer cells can
actually use the effects of autophagy to survive.

[https://peterattiamd.com/eileenwhite/](https://peterattiamd.com/eileenwhite/)

------
voisin
If you read “Tripping over the Truth: The Metabolic Theory of Cancer”[0], the
fundamentals of this are discussed quite extensively. Highly recommended for
anyone interested in both fasting and cancer.

[0]
[https://www.goodreads.com/book/show/23496164](https://www.goodreads.com/book/show/23496164)

------
givan
Fasting also has excellent results for treating many illnesses including
mental ones. There is a documentary that covers two clinics that offer fasting
as a treatment and scientific research in this area.

[https://www.youtube.com/watch?v=t1b08X-GvRs](https://www.youtube.com/watch?v=t1b08X-GvRs)

------
perl4ever
In case anyone else, like me, saw "pCR" and didn't know what it meant, I
believe that it means "pathologic complete response". Not "polymerase chain
reaction" which is all you get by googling.

It's really unfortunate people use overloaded acronyms like this without a
definition.

------
mensetmanusman
Wish fasting was a part of our culture more regularly.

With almost half of America now obese, we are seeing the downside of ignoring
good diet as COVID devastates those suffering from obesity and diabetes.

------
valuearb
Reproducibility crisis.

------
maerF0x0
EDIT: I had a misled belief. Here's a better source:
[https://www.cancer.org/treatment/treatments-and-side-
effects...](https://www.cancer.org/treatment/treatments-and-side-
effects/complementary-and-alternative-medicine/marijuana-and-cancer.html)

Ignore below...

Wasn't the whole impetus for getting "medicinal" marijuana for the snacking?
Seems like someone is talking out both sides of their mouth.

Nonetheless glad to see additional evidence for fasting's multiple benefits.

~~~
bitdizzy
The use of marijuana for chemo patients is to manage the extreme nausea that
accompanies the treatment. It's not about the munchies per se.

~~~
maerF0x0
Noted, thank you

------
wdroz
I wonder if a regular keto diet would work. In the study they use the term
"fasting mimicking diet".

------
vmchale
Did not expect this.

------
scott31
> Fasting improves chemotherapy results

Does it mean more deaths or less?

------
chipaca
In mice.

~~~
markus92
Have you clicked on the link? It's a result from an RCT in women with locally
advanced breast cancer.

~~~
cinntaile
In his defence the abstract starts by talking about mice, which is a bit
confusing. Sure they talk about patients as well but it's not immediately
clear that mice can't be considered patients. If you read on it becomes clear
though!

~~~
markus92
The title saying it's a multi-centre phase 2 trial makes it extremely clear.
You don't do those in animals.

------
feralimal
Or perhaps, fasting is the cure, and can even undo the harm from chemo!

~~~
0-_-0
If I'm reading this correctly, the "harm from chemo" to the person was about
the same, but the "harm from chemo" to the cancer was much more significant in
the fasting group.

~~~
feralimal
Yes. But there are alternative healing ideas that fasting and juicing in
themselves can cure cancer.

~~~
SketchySeaBeast
Wouldn't that be relatively easy to find evidence for? We could look at the
change in cancer of Muslim communities during Ramadan?

~~~
feralimal
Well, there are lots of types of fasting. Juice or water or nothing. Skipping
a meal, or not eating solid foods for 3 months. IMO not eating during the day
but then eating a lot at night might not be the best type of fast.

But even so, it would be interesting to see numbers anyway.

------
abledon
If you have to provide a simple (ELI5, if you mention one scientific word
their eyes rollup into their skull etc..) way to view how fasting 'controls'
the cancerous growth in the body... sadhguru makes an easily digestible
concept of 'crime' in the body [1]. [1]
[https://www.youtube.com/watch?v=JWnyTJ96upw](https://www.youtube.com/watch?v=JWnyTJ96upw)

~~~
ramblerman
ELI5 means break down the science into simple concepts that a 5 year old could
understand.

Not here is some Deepak Chopra figure to explain it to you in voodoo

