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Old 06-09-2013, 03:01 PM   #1
chay
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Our Experiment Fasting Around Chemo

My wife was diagnosed with HER2+, ER-/PR- IDC on December 6, 2012. I've written about our experience at keepingabreast.lrng.org.

In particular, we researched fasting and decided to try fasting before, during, and after chemo (Taxotere, Carboplatin) hoping that it would amplify our cancer suppression efforts while minimizing associated adverse effects ("differential stress resistance" theory).

I summarized that experience here. In that piece, I also included links to articles and research that influenced our decision to give it a try.

Edit 2015: This link no longer works, so I copied the content below.
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Old 06-09-2013, 03:20 PM   #2
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Re: Our Experiment Fasting Around Chemo

I just picked up on the advice given "thickdescription" before she decided to try fasting around chemo.

Quote:
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, don’t 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.
That seems like good advice, and her experience will be interesting to track.
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Old 08-22-2013, 09:58 PM   #3
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Re: Our Experiment Fasting Around Chemo

Hi, Thanks for that post. It was very interesting and challenging. If you are following up those 2013 trials, please post again if you find out how they went.

I've only just started my TCH therapy, unfortunately with some marked side effects to my gut (diarrhea with anorectal ulceration) by Day 6 and hospital admission on Day 7with febrile neutropenia. I now qualify under the Australian health system for a Neulasta white cell boosting injection so that last bit shouldn't happen again.

I think you were amazing to do that fasting, especially doing it together. I don't know if I am prepared for that extent of fasting. I feel nauseous and faint if I miss a meal, but I am thinking of restricting calories in the hope of reducing the gut effects.

Hope you are both going strong.
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Old 08-23-2013, 12:24 AM   #4
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Re: Our Experiment Fasting Around Chemo

Hi Aussie Girl,

Thanks for your kind note. I hope your next rounds go more smoothly. I hope, too, that you have people supporting you. Don't hesitate to ask questions this way. If you feel like it, let me know how your next round goes, too.

If I run across more fasting research, I'll share.

Best wishes,

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Old 06-08-2014, 11:10 AM   #5
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Re: Our Experiment Fasting Around Chemo

Here's an update summarizing on-going research on fasting.
https://news.usc.edu/63669/fasting-t...immune-system/

Excerpt:
Quote:
“PKA is the key gene that needs to shut down in order for these stem cells to switch into regenerative mode. It gives the OK for stem cells to go ahead and begin proliferating and rebuild the entire system,” explained Longo, noting the potential of clinical applications that mimic the effects of prolonged fasting to rejuvenate the immune system. “And the good news is that the body got rid of the parts of the system that might be damaged or old, the inefficient parts, during the fasting. Now, if you start with a system heavily damaged by chemotherapy or aging, fasting cycles can generate, literally, a new immune system.”

Prolonged fasting also protected against toxicity in a pilot clinical trial in which a small group of patients fasted for a 72-hour period prior to chemotherapy, extending Longo’s influential past research.

“While chemotherapy saves lives, it causes significant collateral damage to the immune system. The results of this study suggest that fasting may mitigate some of the harmful effects of chemotherapy,” said co-author Tanya Dorff, assistant professor of clinical medicine at the USC Norris Comprehensive Cancer Center and Hospital. “More clinical studies are needed, and any such dietary intervention should be undertaken only under the guidance of a physician.”
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Old 06-18-2014, 04:23 AM   #6
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Re: Our Experiment Fasting Around Chemo

In particular, we researched fasting and decided to try fasting before, during, and after chemo hoping that it would .

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Old 08-16-2014, 10:00 AM   #7
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Re: Our Experiment Fasting Around Chemo

I water-only fasted for 18 hours before round 5 of TCHP and noted the following:

Uncontrollable diarrhea in the evening, didn't make it to the toilet in time and no sign of digestive distress before it happened

Anal puritis (itching butt) for several days afterwards, probably due to the chemo-diarrhea. Cleared up after a few days though I used a topical steroid cream to help control the itching for a day or two.

Lesser side effects during the ten days after treatment

Hear started growing again - I used penguin cold caps but had lost hair on the sides above my ears. By three weeks later, after my 6th dose, it was apparent that fasting stopped the affects on my hair follicles.

I forgot to take my steroids before treatment since I wasn't eating. Someone on the breastcancer.org site said she took her pre-meds with coconut oil to maintain ketosis so that might be a work around as the steroids say to take with food.

It was really interesting to do. I hope this is helpful for someone else.
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Old 04-06-2015, 04:52 PM   #8
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Re: Our Experiment Fasting Around Chemo

2015
Having sold the domain, the website I linked to earlier now is not available.

This is a copy of the referenced post:

19 May 2013

Update: Heidi wrapped up her sixth and last three-week cycle of chemo (Taxotere/Docetaxel, Carboplatin/Paraplatin). She also was taking Herceptin (targeted antibody) on a weekly basis. She'll continue with Herceptin on a three-week cycle until the end of the year. We may try to wrap the Herceptin treatments up a little bit early in order to avoid a third round of $12,000 deductibles that will start again at the beginning of next year. Or not. Not sure, yet.

We are way-happy to put the chemo part behind us, and to do so without having had to endure the nausea, vomiting, neuropathy, fatigue, exhaustion, diarrhea, mouth sores, nail loss, heart trouble, body aches, and all that morbidity we were prepared to expect. Our negative side effects were alopecia (hair loss) and some myelosuppression that contributed to lower platelet counts, which were addressed with Prednisone (a corticosteroid that comes with its own huge shotgun list of possible adverse side effects). We'll start tapering off the Prednisone in a couple of weeks after Heidi has had a chance to pass the Carboplatin she was infused with last week.

As I've written earlier, from the beginning we approached this cancer experience with the aim to do everything we could to minimize adverse impacts and never to have to do it again. Balance? Meditation, guided visualization, positive attitude, daily yoga, morning music, journaling, periodic caring cranial therapy from Heidi's brother-in-law, time for sleep, time for family and friends, continuing work, evidence-based, home-cooked diet of mostly plants, exercise -- and chemo-fasting. Heidi was awesome. Oh. At one point in January, I visited a therapist, too.

Here, I want to write about our chemo-fasting, which we did by bracketing chemo infusions with 80 hours of <100 kcal/day+water fasting. That typically would begin after dinner on a Monday, and end with the most absolutely welcome breakfasts on Friday. That would be for an infusion on a Thursday late morning and early afternoon. Because it is advised to take Prednisone with food, during fast Heidi would take her morning daily Prednisone with half a cup of yogurt, and sometimes as a treat for ourselves on the evenings on day 2 and day 3 we would sip on a cup of vegetable broth. After our first fasts, I experimented also with airborne and virtually no-calorie dill pickles. On the last fast at Heidi's invite, on a Tuesday at the utility board meeting I ate a small soup, salad and bread for lunch and a vegetable 6" subway sandwich for dinner. We did not drink juices.

I found fasting to be a really interesting experience, but here I want to go some way to explain our experience of choosing to try chemo-fasting.
Among the more than 400 cancer-related articles and papers I've downloaded, read, highlighted, tagged, and catalogued since the diagnosis, a good handful relate to experiments with fasting, fasting and cancer, calorie restricted diets and cancer, calorie restriction and longevity, and "starvation-dependent differential stress resistance."

Some titles:

* "Fasting Cycles Retard Growth of Tumors and Sensitize a Range of Cancer Cell Types to Chemotherapy," (Science Translational Medicine, 2012)
* "Starvation-dependent differential stress resistance protects normal but not cancer cells against high-dose chemotherapy," (2008)
* "Fasting and cancer treatment in humans: A case series report, (2009)
* "Glucose restriction can extend normal cell lifespan and impair precancerous cells through epigenetic control of hTERT and p16 expression," (2009)
* "Short-term calorie and protein restriction provide partial protection from chemotoxicity but do not delay glioma progression," (2013)
* "Caloric Restriction Has a Protective Effect on Chromosomes" (2013)
* "The Way You Eat May Affect Your Risk For Breast Cancer," (2013)
* "Fasting Enhances the Response of Glioma to Chemo and Radiation Therapy," (2012)
* "How Cells Brace Themselves For Starvation," (2012)
* "Caloric Restriction Leads Scientists to Molecular Pathways that Slow Aging, Improve Health," (2010)
* "Link Between Tumor Suppressors and Starvation Survival Suggested," (2013)
* "The Calorie-Restriction Experiment," (NYT, 2009)
* "Less is More When Restraining Calories Boosts Immunity," (2010)
* "Dieting on Radiation Therapy May Improve Outcomes for Breast Cancer Patients," (2013)
* "Fasting and cancer: Starving the beast," (2012)
* "Fasting Might Boost Chemo's Cancer-Busting Properties," (Scientific American, 2012)
* "Starvation, detoxification, and multidrug resistance in cancer therapy," (2012)
* "Turning Back the Clock: Fasting Prolongs Reproductive Lifespan," (2009)
* "Calorie Restricted Diet Prevents Pancreatic Inflammation and Cancer, Study Suggests," (2008)
* "Calorie Restriction and Exercise Show Breast Cancer Prevention Differences in Postmenopausal Women," (2008)
* "Calorie Restriction Limits -- and Obesity Fuels -- Development of Epithelial Cancers," (2008)
* "Dietary Energy Balance Modulates Multistage Epithelial Carcinogenesis in Mouse Skin," (2008)
* "Extending Healthy Life Span -- From Yeast to Humans," (2010)
* "Calorie Restriction Does Not Appear To Induce Bone Loss In Overweight Adults," (2013)
* "When It Comes To Living Longer, It's Better To Go Hungry Than Go Running, Mouse Study Suggests," (2008)
* "Aging and Longevity Tied To Specific Brain Region In Mice," (2010)
* "Controlling Key Enzyme in Brain (Sirt1) Offers Clue for Future Obesity Treatment," (2009)
* "Calorie Intake Linked to Cell Lifespan, Cancer Development," (2009)
* "Fasting May Equal Calorie-Restricted Diets," (Scientific American, 2008)
* "Two New Studies Suggest that Caloric Restriction In Monkeys May Extend Their Life and Health," (1997)
* "Meal Skipping Helps Rodents Resist Diabetes, Brain Damage," (2003)
* "Intermittent Fasting May Help Those With Diabetes and Cardiovascular Disease, Study Suggests," (2013)
* "Periodic Dieting May Cut Breast Cancer Risk," (2009)
* "Intermittent fasting" (wikipedia)

The articles and papers referenced above contained information that generally informed or reinforced our decision to try our chemo-fast. Two pieces I encountered, however, gave reason for skepticism:

* "Calorie Restriction Does Not Affect Survival: Study of Monkeys Also Suggests Some Health Benefits," (2012)
* "Eating Less May Not Extend Human Life: Caloric Restriction May Benefit Only Obese Mice," (2009)

For us, the concept and evidence in support of "differential stress resistance," as an explanation for why fasting during chemo might reduce adverse side affects while simultaneously amplifying tumor suppression made sense. That said, evidence at the scale of human studies was weak involving only one population of ten people and a couple of online-forum-level anecdotes. New controlled human trials are just underway:

* "Short-term Fasting: Impact on Toxicity" (Trial recruitment, 2013)
* "Short-term Fasting Before Chemotherapy in Treating Patients With Cancer," (Trial recruitment, 2013)
* "A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults" (2007)

Before our first round of chemo, we discussed our idea to try chemo-fasting with our oncologist. We recognized that Heidi's ability to regain her weight that she'd lose during fasting would be important. As it turns out, both of us would lose about six pounds during our fasts. Heidi always returned to her baseline weight in relatively short order, although she had to work harder (eat more consciously than me) to do so. Also, she did not gain weight during chemo. Evidence suggests if she had gained weight it would have increased her risk factor. Gaining weight is common among breast cancer patients, and even more common among people on Prednisone, as I understand.

We decided to try once to see how the fasting and post-chemo experiences went, and proceed from there. The fasting was mentally challenging, (once we started, more challenging for me than Heidi), but interesting. As Heidi's adverse side effects after chemo were minimal to non-existent after each round, increasingly we came to think we didn't want to try not fasting. Not even for the experiment's sake.

So we don't really know if chemo-fasting may have helped in cancer suppression as we hope, or if it contributed to her minimal adverse side effects during chemo. In Heidi's case, she is a population of one, and we had no control events to compare with her experience, but it seems so far like it didn't hurt, and who knows? Maybe it gave Heidi another bit of "high performance profile" edge. It was another something we could do in our case with little obvious negative risk and a little more positive possibility. It also gave us focus, and helped us feel more like active participants in Heidi's therapy; and a little less just like dead meat feeding a significantly-predatory insurance-and-health care system.

PostScript:
Another woman received some guidance on fasting, which is recorded on a HER2 support forum.

2015 PostScript: Heidi currently shows no signs of disease.
07-29-2018 PostScript: Heidi still shows no signs of disease.
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Old 04-06-2015, 04:56 PM   #9
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Re: Our Experiment Fasting Around Chemo

Here is a link at "Science Daily" to more current information on the topic:

Fasting and less-toxic cancer drug may work as well as chemotherapy
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Old 04-16-2015, 11:52 AM   #10
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Re: Our Experiment Fasting Around Chemo

Thank you, chay, for posting your experience. I had found this thread earlier this month while researching fasting around my own upcoming chemo. I must have read this just before you updated with your summary. Thanks for sharing that. I made the decision to fast for my first round of chemo and my oncologist was willing to let me try, her concern mainly being weight loss, as I am slim to begin with. That is my major concern as well, as I have always had a difficult time keeping muscle mass over the years. My first chemo was on 4/9 and I fasted from 4/7 to 4/11, breaking my fast that afternoon on the 11th (~46 hours after my chemo was completed on the 9th).

I am ER+, PR+, HER2+ receiving TCHP with a neulasta shot the day after. I did a water-only fast, except for taking my steriods, where I drank about 4oz of milk. Breaking my fast went fairly smoothly and my nausea was very low. I did start getting diarrhea 4 days after the chemo and have been trying to manage that (I think I got a little too fast with foods on that day as I was both hungry and very concerned about starting to get calories back in after the fast).

I lost about 5 lbs during the fast, but I've dropped another pound this week with the diarrhea, so hoping to correct that quickly so I can get my weight back up.

I am also using the chemo cold caps and haven't noticed much hair loss, but I've only had one treatment just a week ago, so that is still left to see. I will post as I go along to document my side effects. So far, I think that the fasting is good and I will do it again on the next round, as long as I get my weight back up.
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Old 04-16-2015, 12:18 PM   #11
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Re: Our Experiment Fasting Around Chemo

I look forward to your reports, PeaceMomma, and I'm sending all good energy your way. Thank you.
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Old 04-16-2015, 01:46 PM   #12
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Re: Our Experiment Fasting Around Chemo

In 2009 I fasted prior to my first chemo and for the day after. My very first scan after 2 treatment cycles showed that the mets in my lungs and bones were gone. Taxotere and Herceptin. Fasting does work.
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Decline chemotherapy (decision I regret)
Nov 2009 Mets to lungs and bones.
Dec 2009 Start Taxotere and Herceptin, T1, T3 heal completely and lungs are clear, T2 and first rib have lytic lesions. First rib becomes sclerotic. Considered stable.
May 2011, Onc calls progression and I cross over from comparison arm of clinical trial to TDM-1
Brain scan in Sept 2011 showed small tumor in right cerebellum, did Novalis radiation.


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Took a six week break, bone scan showed small uptake on left first rib. CT showed hypodensities in liver (too small to biopsy) and small nodule in lungs (mediastinal).
Started Navelbine weekly. Did one round with Herceptin.
Skipped next 2 rounds, due to neutropenia. Next chemo 7th Nov - have had 3 Neupogen shots, so WBC should look better... Did not tolerate Navelbine well.
December 2013 scans show no sign of active cancer.
March 2014 - currently only on Herceptin - brain MRI clear, PET/CT two nodules in right lung show uptake
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Sept 22, 2014 Brain MRI clear :) PET/CT Progression in lungs.
Sept 2014, Xeloda, Tykerb and Herceptin.
Nov 2014 - Decide to take a break from all treatment.
May 2015 - Brain met radiated with Novalis
July 2015 - Have progression in right lung.
Sept 2015 - Perjeta and Herceptin alone after a 9 month break from all treatment.
Nov 2015 - Thoracentesis 1500ml removed from right lung.
Dec 2015 - Two tiny 1mm brain mets radiated in right cerebellum.
Feb 2016 - Thoracentesis 2200ml drained from right lung
Feb 2016 - Stopped Perjeta and Herceptin and started back on Kadcyla as I had no previous progression on it. After 1 cycle of Kadcyla markers begin to drop. On second cycle add Keytruda.
March 2016 - Thoracentesis 1650ml drained from right lung.
April 2016 – Thoracentesis 1500 ml drained from right lung.
June 2016 – CT scan shows progression in right lung, as well as moderate pleural effusion requiring Thoracentesis.
June 2016 – Decide to stop Keytruda, and will do chemosensitivity test through Rational Therapeutics. Plan to continue on Kadcyla for next two cycles.
July 2016 - Start weekly Abraxane with Herceptin. WBRT with hippocampal sparing, Taking Namenda. 15 sessions over 3 weeks.
Aug - Dec 2016 - 2 infusions of Navelbine, very hard on my body and still dealing with anasarca (generalized edema) 1 infusion of Havalen
My doctor wants to put me on hospice.
Dec 23rd 2016 - I am granted compassionate use of Neratanib.
May 31st 2017 - still on Neratinib, feeling good.
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Old 04-18-2015, 08:48 AM   #13
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Re: Our Experiment Fasting Around Chemo

I am very curious if the fasting will affect liver enzyme counts and bilirubin. My counts have been on the high side making it difficult to be considered for any clinical trials. I had six cycles of taxotere, Herceptin, and perjeta between November of 2013 and February of 2014. Now I receive Herceptin and perjeta infusions every three weeks with no end in sight. I would love to alleviate the high liver counts naturally (if possible) because I am a stage IV HER2+ "thriver" and plan on being around for a long time.
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Old 04-19-2015, 09:28 AM   #14
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Re: Our Experiment Fasting Around Chemo

This may seem like a stupid question but does fasting help the immune system when not on chemo? And wish I had seen this before I started chemo because I would've tried it to see if it helped with the side effects. I'm done with chemo but seem to still have immune system issues. :-/

PeaceMomma - did you discuss the cold caps with your oncologist? I considered them before my chemo started but my oncologist didn't recommend it.

Colleen - are you ER-? If so, you might try milk thistle to help with the liver enzymes. If you're ER+ though, you can't take it because it elevates the estrogen in your blood (or something to that effect).
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Old 04-19-2015, 10:09 AM   #15
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Re: Our Experiment Fasting Around Chemo

Lucy, I am er-. Thank you for the suggestion, I will try milk thistle.
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Old 04-19-2015, 10:25 PM   #16
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Re: Our Experiment Fasting Around Chemo

Lucy, I did discuss the cold caps with my oncologist. The lady who runs the chemo cold caps was a patient of hers and she gave me her contact information. Did your oncologist say why it was not recommended?

I've felt fairly good over the weekend. Even went for a short run yesterday (just 1 mile), which felt mostly good except for my feet - apparently my socks were rough and caused blisters on my toes.

Other than that (and the dry skin on my face and a drier-than-normal mouth), I felt almost normal, which was nice.
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Old 04-20-2015, 10:31 AM   #17
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Re: Our Experiment Fasting Around Chemo

PeaceMomma, she said there seemed to be a correlation between cold caps and brain cancer. She didn't tell me not to do it but the chance it might cause brain cancer was enough for me not to try it. Not everyone believes this but it wasn't worth the risk for me.
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Old 11-02-2015, 01:03 AM   #18
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Re: Our Experiment Fasting Around Chemo

There's a report of a small study for non-Her2 patients this year ...

BMC Cancer. 2015 Oct 5;15:652. doi: 10.1186/s12885-015-1663-5.
The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study.
de Groot S1, Vreeswijk MP2, Welters MJ3, Gravesteijn G4, Boei JJ5, Jochems A6, Houtsma D7, Putter H8, van der Hoeven JJ9, Nortier JW10, Pijl H11, Kroep JR12.
Author information
Abstract
BACKGROUND:
Preclinical evidence shows that short-term fasting (STF) protects healthy cells against side effects of chemotherapy and makes cancer cells more vulnerable to it. This pilot study examines the feasibility of STF and its effects on tolerance of chemotherapy in a homogeneous patient group with early breast cancer (BC).
METHODS:
Eligible patients had HER2-negative, stage II/III BC. Women receiving (neo)-adjuvant TAC (docetaxel/doxorubicin/cyclophosphamide) were randomized to fast 24 h before and after commencing chemotherapy, or to eat according to the guidelines for healthy nutrition. Toxicity in the two groups was compared. Chemotherapy-induced DNA damage in peripheral blood mononuclear cells (PBMCs) was quantified by the level of γ-H2AX analyzed by flow cytometry.
RESULTS:
Thirteen patients were included of whom seven were randomized to the STF arm. STF was well tolerated. Mean erythrocyte- and thrombocyte counts 7 days post-chemotherapy were significantly higher (P = 0.007, 95 % CI 0.106-0.638 and P = 0.00007, 95 % CI 38.7-104, respectively) in the STF group compared to the non-STF group. Non-hematological toxicity did not differ between the groups. Levels of γ-H2AX were significantly increased 30 min post-chemotherapy in CD45 + CD3- cells in non-STF, but not in STF patients.
CONCLUSIONS:
STF during chemotherapy was well tolerated and reduced hematological toxicity of TAC in HER2-negative BC patients. Moreover, STF may reduce a transient increase in, and/or induce a faster recovery of DNA damage in PBMCs after chemotherapy. Larger studies, investigating a longer fasting period, are required to generate more insight into the possible benefits of STF during chemotherapy.
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Old 01-13-2016, 02:39 PM   #19
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Re: Our Experiment Fasting Around Chemo

I promised a report on my fasting during chemo and I have yet to produce that - life has gotten a little in the way, but I still intend to put my story on here soon. Please have patience with me.

In the meantime, I am still getting herceptin/perjeta infusions every 3 weeks and during my first 2, I continued to fast, but then for 3 & 4, I only fasted the day of the infusion and for 5-7, I did not fast at all. I'm considering fasting with my next infusion because I think I did not feel as good after infusions 5-7, mostly gastrointestinally, but also, I'm wondering if there is any benefit to the fasting during these infusions. I would think that starving the cancer of the sugars during this time would be good, but I'm not sure what schedule to do for these infusions. My regular chemo infusions were on Thursdays and I would start my fast on Monday evening and break it on Saturday afternoon. Since H&P isn't

Anyone else fasting during herceptin-only or H&P infusions? If so, what is your schedule? Just curious what others are finding helpful.
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