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Old 05-08-2013, 06:01 PM   #1
thickdescription
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Fasting pre, during, post chemo

Has anybody out there tried fasting prior to, during and post chemo? My oncologist suggested I look into it, which I did. The theory is that it reduces side effects from chemo, and enhances the effects of the chemo on the cancer cells. Mouse models have been very convincing, and a very small scale trial on humans was generally positive, but otherwise this is and untested strategy.

Here's an article.

http://www.scientificamerican.com/ar...ht-boost-chemo

Would love to hear from anyone who has tried this. I'm on my second day of no food, three more days to go. My oncologist is so cautious and evidence driven, he wouldn't have suggested this if he wasn't pretty sure it was worthwhile and otherwise harmless.

I emailed for guidance on nutrition and received this:



If the oncologist agrees, the patient can fast for 3 days before and 1 day after chemo. Depending on what type of chemo is being administered and at what intervals this could change. Patients should avoid re-feeding (resuming their regular diet) until the chemotherapy is below toxic blood levels (usually 24-48 hours after administration). Although we have rarely seen negative side effects caused by fasting (high liver toxicity markers in 1 patient fasting and receiving a chemo cocktail) there are some potential risks so keep that in mind. For example, an early re-feeding immediately after the chemo could cause liver damage, because of the combination of hepatotoxic drugs with the proliferation of the liver caused by fasting. For this reason is important to have a minimum of 24 hours after the chemotherapy is administered. Also, several patients have fainted while taking hot showers after several days of fasting probably because of the major reduction in blood pressure and glucose levels after day 1 of fasting. The patient should not drive or operate machinery or should be accompanied by someone during the fasting period. Most people can drive while they are fasting but for a few this could be a problem so unless you know fasting does not affet your ability to drive, dont drive. Starting 24 hours after the chemotherapy, the patient should only eat rice, pasta or a similar source of carbohydrates + soups + fruit juices for a period of 24 hours. Then, a normal diet can be resumed, paying particular attention to nourishment (vitamins, minerals, proteins, essential fats). The patient should also try to return to within 2-3% of their body weight before doing another fasting cycle. Obese patients should consult their doctors on whether some of the weight loss caused by fasting is advisable and whether they should try to remain at the lower body weight. Diabetic patients should not undergo fasting unless this is approved by their diabetologist. Subjects on hypertension medication should also talk to their doctor about the blood pressure drop caused by fasting and the risk of combining fasting with medications. Until clinical trials are completed fasting will remain an experimental procedure and should only be considered with the approval of the oncologist and when other viable options are not available or are known to be ineffective.
Between fasting cycles, a low sugar accompanied by a mostly plant based 0.8 grams/kg of body weight/day protein intake diet (approximately 10% calories from proteins) is recommended but a registered dietician should be consulted to avoid malnourishment and unwanted weight loss.
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Old 05-09-2013, 03:33 PM   #2
IrvineFriend
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Re: Fasting pre, during, post chemo

Please let us know if your side effects were reduced by fasting. If so, I will give this is a go for my next (and LAST) TCH treatment. The last couple have NOT been fun.
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Old 05-09-2013, 06:05 PM   #3
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Re: Fasting pre, during, post chemo

This will be my first chemo so I won't have a point of comparison - but will happily share

R
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DX Dec 2012: ER-/PR- HER2+
Stage 1, Grade 3
Lumpectomy Feb 1: 6 of 6 nodes clear
Re-excision Apr 5: no malignancy.
6 3-wkly cycles of Carboplatin/Taxotere from 5/10/13
Herceptin for one year from 3/28/13
Radiation X 37
Herceptin related cardiotoxicity: ACE inhibitors and Beta blockers prescribed
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Old 05-12-2013, 04:19 AM   #4
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Re: Fasting pre, during, post chemo

Hi Folks:

This is my first day of non-fasting... haven't eaten anything solid yet, but will.

Here is a log of my fast and I'm going to keep track over the next few days. Please bear in mind that other than a little cancer I'm in excellent physical shape, work out an hour every morning, walk two miles to work daily. No diabetes, high blood pressure, low white blood cell count or anything else. I also have no point of comparison - this is my first fast.


Fasted for three days prior to chemo.
Day 1, water with lemon only. Worked out in am. Black coffee and green tea in am. Hungry but fine.
Day 2, Worked out in am water with lemon only, but very hungry. Evening broke down and had vegetable broth with a bouillon cube. Went straight through me.
Day 3: Continued water fast, but had to have food with meds twice a day a cup of milk and a cup of yogurt about 270 calories, no fat. Continued water fast. Worked out in am, but had to stop felt weak and weird. Went to acupuncturist.
5/10/13
Day 4: First Chemo day: Worked out in am. Felt great. Coffee and yogurt with meds in am. Showed up to chemo. Pumped full of Benadryl, very drowsy. Was given Zofran against nausea. Chemo was fine. Felt a little strange afterwards, but hard to tell if its the effects of fasting, the Benadryl, or the chemo. Went home and was very drowsy. Had a little yogurt with the meds. No nausea, diarrhea or vomiting. Nothing in my stomach anyway J. Took Zofran at night against nausea.
5/11/13
Day 5: Day after chemo. A little weak no way to know if its the fasting or the chemo. Worked out at gym a little gently. Milky coffee with the meds. Took Zofran against nausea. Feeling a little foggy and off-color but this got better throughout the day. No sense of nausea or diarrhea.
Yogurt with meds in the evening.
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DX Dec 2012: ER-/PR- HER2+
Stage 1, Grade 3
Lumpectomy Feb 1: 6 of 6 nodes clear
Re-excision Apr 5: no malignancy.
6 3-wkly cycles of Carboplatin/Taxotere from 5/10/13
Herceptin for one year from 3/28/13
Radiation X 37
Herceptin related cardiotoxicity: ACE inhibitors and Beta blockers prescribed
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Old 05-12-2013, 06:54 PM   #5
'lizbeth
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Re: Fasting pre, during, post chemo

Wow seriously you are tough. I have a rough time fasting. I'm celebrating my wedding anniversary in a couple days but I might join you in a fast next time. I finished chemo in 2008, but need to lose lots of weight.
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Old 05-13-2013, 11:07 AM   #6
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Re: Fasting pre, during, post chemo

Yes, you are tough. I would have been afraid to fast during chemo and I'm not a good "faster" anyway - makes me too jittery.

All people and docs are different. My oncologist wanted me to eat in order to keep up my strength - preferably a well balanced diet but whatever tasted decent to me in order to maintain my weight.

I didn't have any issues at all with nausea during chemo (took meds) but major issue was GI/diahrrea, regardless of what I ate or didn't. I would be curious to hear how your side effects progress over the next couple of chemo cycles.

'lizbeth - fasting doesn't help you lose weight, it helps to cleanse your system. Your metabolism slows down in response to the calories your system takes in.

Best

Janis
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June, 2000: Tamox 4.5 years,Femara for 5 years (end in Jan. 2010)
Sept, 2012: 61, Via mamm, ultrasound, biopsy, right breast, 2.3cm tumor, ER+/PR-/Her2+++, poorly diff, KI67 60-70%
BRCA 1 and 2 negative
October, 2012: Bi Mast with tissue expanders, port placement
Final Path: IDC 2.8cm, DCIS, 1/4 sentinal nodes positive (@#$%). Stage IIB
Nov 29, 2012: Begin TCH/6x/every 3 wks, H for 1 year/every 3 weeks.
March 14, 2013: Finished chemo
April 9, 2013: Begin radiation 28x
May 22, 2013: Finished rads
June 1st, 2013: Started Aromasin for 5 yrs.
July 15, 2013: Switched to Letrozole (Femara). Probably for the rest of my life
October 16, 2013: Exchange surgery
October 31, 2013: Finished Herceptin
December 5, 2013: Port removed
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Old 05-13-2013, 01:09 PM   #7
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Re: Fasting pre, during, post chemo

Jaykay, I too had mainly GI issues with my first round of chemo. From cracks in the corners of my mouth to liquid at the other end. One thing that was a little helpful was the my MO told me to use Lactaid or a similar product (preferably chewable) before eating milk products. I also take acidophilus.

My MO is anti-vitamin, so won't allow me to take anything other than Vitamin D, Calcium, Omega-3, acidolphilus & fiber, but if I were to add anything to that for the cracked tongue, cracked corners of mouth and mouth sores it would be B-vitamins. I'm in the middle of researching what foods would be best to help with that.

My hubby, who is a scientist, says the chemo is probably killing the e coli which is naturally occurring in the intestine -- but who would give me a supplement of that?!?! lol
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3/14/13 - Mammo & Dx Biopsy, Rt Breast
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3/29/13 - Lumpectomy & sentinal lymph node bx with balloon placement for MammoSite radiation
4/10/13 - Hemorrhage from MammoSite location, but completed last radiation treatment
4/12/13 - Final Path, Stage 1c, Lymph node negative, Grade 2 with focal DCIS, 2 tumors, 1.8cm & 6mm
4/12/13 - Treatment Plan determined DD AC w/D2 Newlasta -> TH -> H - Yipes 62 weeks total!
4/23/13 - PortaCath Placement
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Old 05-13-2013, 02:00 PM   #8
jaykay
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Re: Fasting pre, during, post chemo

That's exactly what the chemo does to the intestines, Lynn. I am now pretty much recovered from that delightful side effect :-)

Try Biotin for the dry mouth, etc. Mouthwash, gel, spray - they help maintain moisture levels in the mouth. Any drugstore carries it. My dentist recommended it. That's another side effect fo the chemo! Your oncologist can also give you a prescription for "magic mouthwash" - a combo of anti-fungal, lidocaine and something else that escapes me.

I'm addicted to aquafor for chapped lips

Janis
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March, 2000: 48, Post menopausal (5 yrs HRT) Left breast, IDC 3mm/DCIS 1.6cm, ER+/PR-/Her2+++, mod differentiated, MIB low, lumpectomy, node neg via SNB, rads=33 Stage 1a
June, 2000: Tamox 4.5 years,Femara for 5 years (end in Jan. 2010)
Sept, 2012: 61, Via mamm, ultrasound, biopsy, right breast, 2.3cm tumor, ER+/PR-/Her2+++, poorly diff, KI67 60-70%
BRCA 1 and 2 negative
October, 2012: Bi Mast with tissue expanders, port placement
Final Path: IDC 2.8cm, DCIS, 1/4 sentinal nodes positive (@#$%). Stage IIB
Nov 29, 2012: Begin TCH/6x/every 3 wks, H for 1 year/every 3 weeks.
March 14, 2013: Finished chemo
April 9, 2013: Begin radiation 28x
May 22, 2013: Finished rads
June 1st, 2013: Started Aromasin for 5 yrs.
July 15, 2013: Switched to Letrozole (Femara). Probably for the rest of my life
October 16, 2013: Exchange surgery
October 31, 2013: Finished Herceptin
December 5, 2013: Port removed
Glad this year is over!
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Old 05-15-2013, 07:24 AM   #9
TanyaRD
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Re: Fasting pre, during, post chemo

Thick--I'll be interested to see how this works for you. You are very dedicated. I have not tried this with any of my patients and would be very nervous to do so. What if someone has weekly treatments (ie 3 weeks on 1 week off)? Seems as though they would be fasting more than eating. I would just encourage you to be sure you get adequate protein when not fasting as you have several days without protein intake. Also, adequate hydration is known to minimize side effects of treatment so be sure to be very well hydrated while fasting. Keep open communication with your MO too...sounds like you do that already.

Best wishes
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Old 05-15-2013, 05:58 PM   #10
thickdescription
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Re: Fasting pre, during, post chemo

Thanks Tanya!

I have no point of comparison, but since chemo on Friday and lying low over the weekend, I've been working out and walking to work each day since. Can't say I feel great, but each day I feel a little better and certainly better than I expected.

The weight loss/protein thing is major and I'm working hard to eat as much excellent, high-quality food as possible. Haven't completely figured out how to do this yet but working at it.

Based on my experience and limited side effects, I'm inclined to do this again next cycle. It's five days out of each 21. If I drop too much weight I'll think again.

I've been trying to drink 3-4 quarts daily so am definitely well-hydrated.
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DX Dec 2012: ER-/PR- HER2+
Stage 1, Grade 3
Lumpectomy Feb 1: 6 of 6 nodes clear
Re-excision Apr 5: no malignancy.
6 3-wkly cycles of Carboplatin/Taxotere from 5/10/13
Herceptin for one year from 3/28/13
Radiation X 37
Herceptin related cardiotoxicity: ACE inhibitors and Beta blockers prescribed
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Old 06-09-2013, 03:27 PM   #11
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Re: Fasting pre, during, post chemo

We just went through a protocol of six Taxotere/Carboplatin infusions on 3 week intervals. We bracketed the chemo infusions with ~84 hour fasts. I wrote about it here. Best wishes.
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Old 06-09-2013, 07:11 PM   #12
thickdescription
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Re: Fasting pre, during, post chemo

Just did my second cycle of taxotere and carboplatin. Fasted for 3 days prior, day of and one day after. Some tiredness, a little upset stomach, but otherwise fine. Have continued to go to gym daily, walk two mile to work and then work 8 hours. Feeling good enough about this that I plan to fast for cycle three on June 21.

Chay - who posted above - has links to a lot of fasting related articles on his blog.
__________________
DX Dec 2012: ER-/PR- HER2+
Stage 1, Grade 3
Lumpectomy Feb 1: 6 of 6 nodes clear
Re-excision Apr 5: no malignancy.
6 3-wkly cycles of Carboplatin/Taxotere from 5/10/13
Herceptin for one year from 3/28/13
Radiation X 37
Herceptin related cardiotoxicity: ACE inhibitors and Beta blockers prescribed
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Old 08-10-2013, 08:14 AM   #13
thickdescription
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Re: Fasting pre, during, post chemo

Follow up on Fasting

I fasted for the third TCH cycle too and had very few side effects. However, my heart check up showed reduced heart function and on consultation with my oncologist, decided that fasting might be putting a strain on the heart. I decided not to fast for the fourth and fifth cycle. NB. When I met with a cardiologist and asked him about whether fasting would affect heart function he said it was unlikely if fasting only for five days. However, obviously, anyone considering this should consult with their own medical team.

Fourth cycle - no fasting - slightly increased nausea (first and only vomiting episode), considerably increased weakness and tiredness. However, hard to know whether this is related to not fasting or whether it is related to an increase in side effects over the duration of chemo.

Fifth chemo cycle yesterday. Thus far - side effects seem comparable to cycles 1-3. Perhaps significantly, cycle 4, I ate a standard diet. For cycle five, I decided to reduce simple carbohydrate intake as much as possible and focus on protein and complex carbohydrate.

NB. Am now on betablockers for heart function. Not sure how this plays out.

My understanding is that there have been no stage 2 clinical trials on human subjects and that this science is still in its infancy.

However, I have had an exceptionally easy time with chemo - this may be related to fasting, but is probably also related to my very high exercise level and water intake.

Anyway, that's my follow up for now.

Would love to hear of other experiences.
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DX Dec 2012: ER-/PR- HER2+
Stage 1, Grade 3
Lumpectomy Feb 1: 6 of 6 nodes clear
Re-excision Apr 5: no malignancy.
6 3-wkly cycles of Carboplatin/Taxotere from 5/10/13
Herceptin for one year from 3/28/13
Radiation X 37
Herceptin related cardiotoxicity: ACE inhibitors and Beta blockers prescribed
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