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Fasting with Medical Conditions

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Re: Fasting and cancer
01 May 2013, 22:40
Similar to bellalou, I'm doing this to reduce my risk of future cancers having only just finished treatment for thyroid cancer, I'm only 34 so this will be a life long journey for me:) here's to being cancer free!!
Re: Fasting and cancer
02 May 2013, 01:01
Waratah, hats off you for getting through the treatment and I hope those days are over for you for evermore.
Re your treatment you might find the following thread on "throat hunger" of interest:
viewtopic.php?f=1&t=2350
Re: Fasting and cancer
02 May 2013, 01:26
I wanted to add my admiration to those who have gone through this terrible life experience.

I am not sure if this has been posted but thought it was interesting:-



Cancer research history was quietly made at an American university in January.

For the first time ever, a randomized controlled trial that uses calorie restriction as a treatment for cancer — and measures a cancer-related outcome — was approved by the institutional review board at Duke University in Durham, North Carolina, and is on its way to the clinic.

"In the entire field of cancer research, there have only been a handful of studies of calorie restriction as a cancer treatment," Stephen Freedland, MD, from Duke, told Medscape Medical News. But none of them were randomized clinical trials.

In what appears to be a manifestation of zeitgeist, the approval at Duke comes when single-group studies of calorie restriction as a cancer treatment are being planned (in breast cancer at Thomas Jefferson University in Philadelphia, Pennsylvania) or are underway (in pancreatic and lung cancer at the University of Iowa in Ames).

Such clinical trials should be seen in a larger research context, explained an expert.

"During the past 10 years or so, interest in the metabolism of cancer cells has seen a dramatic increase, which is surely why interest in dietary interventions...has increased," said Rainer Klement, MD, a radiation oncologist at the University Hospital of Würzburg in Germany.

The time is definitely ripe.


"The time is definitely ripe to test the various ways of altering cancer patients' metabolism — be it through physical exercise, ketogenic diets, fasting, or calorie restriction. The combination of these lifestyle interventions with the standards of care seems very promising to me," he wrote in an email to Medscape Medical News.

In 2011, Dr. Klement and a colleague published a review of the possible role of carbohydrate restriction in the treatment and prevention of cancer (Nutr Metab. 2011;8:75).

The hypothesis that suppressing carbohydrates could suppress or slow cancer growth is supported by a lot of laboratory science. The pair explain that complex carbohydrates are ultimately digested as glucose, which can cause tumor cells to proliferate.

"First, contrary to normal cells, most malignant cells depend on steady glucose availability in the blood for their energy and biomass-generating demands, and are not able to metabolize significant amounts of fatty acids or ketone bodies due to mitochondrial dysfunction," they write. In other words, cancer cells thrive on glucose and starve on fats and ketones, which are food-derived energy units that are plentiful in low-carbohydrate diets.

The commonplace advice to avoid dietary fat is not a good recommendation to give cancer patients. "They should eat a lot of fat and avoid sugar," Dr. Freedland noted.

The Duke study will involve calorie restriction in men with prostate cancer — specifically, cutting down on carbohydrates. The participants will have "failed" primary therapy for prostate cancer, as evidenced by a rising prostate-specific antigen (PSA) score after surgery, and will have experienced disease progression.

"No treatments have been shown to slow prostate cancer progression after radical prostatectomy. We hypothesize that a carbohydrate-restricted diet will slow prostate cancer growth," the Duke researchers write in their trial description.

A projected 60 men will be randomized to either a low-carbohydrate diet (<20 g/day) or usual care. The outcome measure is PSA doubling time or change in PSA over the 6-month study period. The value of PSA in diagnosing prostate cancer is dubious, but in the treatment of men with diagnosed disease it is a well-established measure of disease progression and stabilization.

The Duke study, which is not yet enrolling patients and has a projected end date of 2016, is funded by the National Cancer Institute and the Atkins Foundation, which is a philanthropic outgrowth of the famed Atkins diet enterprise. The study will employ an "Atkinsesque" diet, said Dr. Freedland, which means carbohydrates are severely limited.

Calorie Restriction Along With Standard Treatment

The planned trial at Jefferson will employ a different calorie-restriction strategy, according to Nicole Simone, MD, a radiation oncologist.

"I have designed a clinical trial that will open at Thomas Jefferson University in the next few weeks. Early-stage breast cancer patients will undergo caloric restriction concurrent with radiation," she told Medscape Medical News in an email.

In this case, the calorie restriction, which includes fasting, is expected to have a synergistic effect with an established treatment, explained Dr. Simone.

"We hypothesize that caloric restriction may augment the effect of cytotoxic targeted therapies in breast cancer, such as radiation, through an IGF-1R pathway-mediated mechanism," she and her colleagues write in their project proposal.

They expand on just how calorie restriction might prime these breast tumor cells for destruction in a review published in the January issue of the Oncologist.

The Jefferson trial design calls for stage 0 and I breast cancer patients who are candidates for breast-conserving therapy to consume a liquid diet 36 hours prior to definitive surgery, and then a diet with a 25% calorie reduction during radiation therapy. Calorie restriction will start the week of radiation planning and continue for the 6 weeks of radiation, for a total of 10 weeks.

The primary end point of this feasibility study, which has the winning name of CAREFOR (Caloric Restriction for Oncology Research), will be acute toxicity. The secondary end points include progression-free and overall survival. If the combination of radiation plus calorie restriction does not add toxicity — Dr. Simone believes it might actually reduce it — the researchers hope to eventually conduct a national multicenter study.

The Jefferson study shares some similarities with research being conducted at the University of Iowa, in which calorie restriction (a ketogenic diet consisting of high fat, adequate protein, low carbohydrates) is being administered at the same time as chemoradiation in separate trials of pancreatic cancer and lung cancer. The phase I trials aim to determine the safety and early efficacy of dietary manipulation during traditional therapy. "Preclinical data from mouse studies indicates a ketogenic diet increases tumor cell killing," write the Iowa researchers in their project descriptions.

The trials are sponsored by the National Cancer Institute, the University of Iowa, and Nutricia North America, and will use the latter's branded ketogenic diet in combination with standard therapy as the intervention.

Other Evidence

Extensive research suggests that restricting calories will improve cancer outcomes, according to Dr. Simone and colleagues. More than 100 years ago, lab research first indicated that mice fed a calorie-restricted diet had "significantly slower" tumor growth than those fed their regular diet, they write.

Human data are also suggestive. Dr. Simone and colleagues explain that "multiple population-based studies of underweight patients have revealed a significantly lower cancer incidence than in the general population."

Furthermore, obesity can lead to a higher risk for cancer, and prospective studies have demonstrated an association between obesity and cancer-specific mortality in multiple sites, they note.

The relation between insulin metabolism, obesity, exercise, and cancer has led to a recent surge of interest in dietary intervention during cancer treatment. "This is exemplified with newer trials, such as the National Cancer Institute of Canada MA.32 trial, which is treating early-stage breast cancer patients with standard therapy and randomizes them to placebo or metformin, which affects several metabolic pathways," write Dr. Simone and colleagues.

Although a lot of research is underway or about to be underway, Dr. Simone still has evidence-based advice to share with her breast cancer patients.

"I discuss decreasing weight with all of my breast cancer patients. From recent literature, we know that most breast cancer patients gain weight during cancer treatment, and this has been linked to worse outcomes," she said.

This research was supported in part by an NCI Cancer Center Support Grant. The authors have disclosed no relevant financial relationships.

Oncologist. 2013;18:97-103. Abstract
Re: Fasting and cancer
02 May 2013, 04:37
Allan, thanks for posting, that is encouraging news. Unfortunately I guess we now have to wait 5 and a bit years to gauge the results. Would also be nice to hear of new studies for stages 3 and 4 patients. In the meantime lets hope for some true magic cures.
Re: Fasting and cancer
02 May 2013, 07:12
Bellalou and Swedey and Waratah, so sorry that you had to go through that awkful chemo, but it's great that you have stayed cancer-free - pain and gain.

Allanr - thanks for posting, it is very encouraging to see these trials commencing.

Skippy - I tried (at last!) to follow up the first link in your original post, but can't get it to work in any way, nor can I find the link on the http://www.fastingconnection.com website. Can you repost it or edit your original post?

So there seem to be 2 main ideas: using fasting on its own against cancer or using it in combination with other interventions such as radiation or chemo. And the general idea (trying to put it in a way that makes sense to me) is that normal body cells are better at dealing with highly stressful interventions than cancer cells. Fasting, radiation and chemotherapy are all highly stressful interventions so individually or combined they can target cancers.

Prof Walter Longo's research suggested a two-fold benefit from fasting with chemo: the fasting made normal cells more resistant to chemo and at the same time made the cancerous cells more susceptible. But Dr Tanya Dorff's trial (referenced in a video that PhilT posted in another topic) is still incomplete so for the moment the evidence for humans is 'hearsay'?
Re: Fasting and cancer
02 May 2013, 07:28
Another here who can vouch for the terrible effects of 'chemo', MrsNog has had similar experience to others here and the reaction to 'chemo' is not very pleasant, which is rather an understatement!
Certainly during the treatment (depending on severity of dose etc) food or diet was not an issue, trying to get something that will stay down/in was the main objective, with apologies to those eating their breakfast.
So fasting whilst having 'chemo' is quite simple, it comes with the deal more often than not.
Re: Fasting and cancer
02 May 2013, 07:50
Thanks for that Old Nog, maybe it is (extended?) fasting before chemo that they are talking about - to render the cancer cells vulnerable to the chemo toxins and to help the normal cells adapt to a low-glucose (ketogenic?) environment which helps them cope better with the chemo?
Re: Fasting and cancer
02 May 2013, 07:52
Certain cancer treatments work by inhibiting the mammalian target of rapamycin (mTOR) which is part of an intracellular signalling pathway that controls proliferation and survival of cells (which is what cancer cells are very good at). mTOR is known as a nutrient sensing pathway in that protein and glucose appear to activate it. Fasting has been shown to result in reduced activity of the mTOR pathway. IGF1 stimulates mTOR. So there we can see a connection between fasting, glucose, protein, IGF1 and cancer prevention and treatment.

Fasting before and during chemo also helps with the side-effects of chemotherapy because it slows the growth of other cells that divide rapidly, such as the stomach lining and hair follicles, which are commonly affected by chemotherapy.
Re: Fasting and cancer
02 May 2013, 14:10
Hi there
In reply to skippy's question I am doing 5:2 while on chemo for metastatic breast cancer (age 42). i have the treatment weekly and always fast the day before and one other day,usually the day after. I believe I am lucky in not reacting badly to my chemo drug but also believe the fasting is helping...if nothing else I feel like I am doing something positive!
I am 11 weeks in with 13 to go so will let you know how I get on. I liked the overall health logic of the fast diet and just decided I couldn't afford to wait around for the clinical trials on humans!
Queen of green xx
Re: Fasting and cancer
02 May 2013, 14:33
Queenofgreen Thank you so much for posting. Judging by everything I have read online it sounds very much like you are doing something extremely positive and I have the utmost respect for you. I sincerely hope that you have a positive outcome. If vinorolbine is on the menu don't forget the lactulose etc. again I wish you the very best and look forward to any of your future posts.
Re: Fasting and cancer
08 May 2013, 02:40
Dominic et al - the post I had linked to on my original posting appears to have been removed, however I did find the doc on another post on their site.
It`s titled "The Place of Fasting in the Treatment of Malignancy" and appears to describe at a high level plus list the various studies on cancer and fasting:

https://docs.google.com/document/d/1hS4 ... XCo6g/edit
Re: Fasting and cancer
09 May 2013, 06:28
Skippy, thank you for the new link, I looked through that document and as you say it contains lots of links and references. Most of it we have touched on here, but I was interested in a comment referring to OXPHOS which is a new one to me, though I don't know whether the information is reliable. The link was broken but I found a similar (extended) text here:
Fasting for more than two days causes the body to start metabolizing stored fats. Fats contain relatively few carbon atoms, so to get the stored adipose into a form the body can use, the liver converts it into lipids. These lipids fuel the TCA Cycle directly, thereby naturally bypassing glycolysis. Your healthy cells, the ones that still have the ability to use OXPHOS, will use the electrons generated from the TCA Cycle to power OXPHOS directly. The tumor cells, having lost the ability to use OXPHOS begin to die because they cannot produce enough energy to finance the essential life-sustaining reactions.
Re: Fasting and cancer
09 May 2013, 08:30
Am afraid I can`t reliably comment on the process of OXPHOS and the TCA/krebs cycle, but it sounds to me like at a high level they are simply referring to cancer cells being unable to generate energy anaerobically and from fat oxidation, the same as is stated in many of the other research docs.
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