[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.

[blithedale]

I'm not convinced the 2/3 dropout rate of the FMD didn't simply select for people with less aggressive tumors, given that the Intention-To-Treat analysis found no difference in response rate, and that this paper is telling a nice story that actually happens to reverse cause and effect.

Basically, this?

   HAS AGGRESSIVE TUMOR ---> CANNOT DO THE FMD

   HAS SLOW-GROWING TUMOR ---> ABLE TO MAINTAIN FMD

Since you're researcher in this field and I'm just a weirdo who likes watching scientists argue on Twitter, I'll ask: Anything you can see in the paper that would give a clearer picture regarding possible bias that might have snuck in?

[markus92]

That could very well be a possibility and something that researchers need to address if they wish to investigate this effect a bit further. We can make some educated guesses based on the supplemental table 3. Looking at the staging, grading, tumortype and the hormone receptor status, there don't seem to be any significant differences between the compliant and non-compliant groups. We know that those are the most important factors in assessing how aggressive a breast tumor is, with distinct treatment options and overall survival. So based on this information, I'm inclined to say the cause/effect is not reversed.

Of course, there could be some factors determining aggressiveness and response to chemotherapy that we do not know yet. Unfortunately I'm not in regular patient contact so can't say a whole lot about typical side effect profiles of chemotherapy, but I've heard some anecdotal evidence that for patients treated with immunotherapy, the more severe the side effects, the better the response.

[blithedale]

Thanks for clarifying comments here, much appreciated.

I have to think my initial comment was overly harsh as well, given Supplement 3.

I think all I can say is that it may be possible for this issue to affect their data once they have OS stats accumulated in five years, but it was unlikely to do anything to yield differences in adherence with these kinds of patients over this kind of follow-up length.

[late_groomer]

"The main reason for non-adherence to the FMD was dislike of distinct components of the diet, perhaps induced by chemotherapy [...] The FMD is a 4-day plant-based low amino-acid substitution diet, consisting of soups, broths, liquids and tea"

Occam's razor, patients couldn't stick with the diet.

[NewOrderNow]

I started fasting every Monday for multiple reasons: reduce caloric intake, the recent studies on reduction of cancer growth (family history cancer and heart issues), and optimizing brain functions.

What are some of the downsides to doing this?

[yurishimo]

Hello! Long time faster here (lost over 80lbs in about 9 months with basically zero exercise).

One potential downside to steady regimented fasting _when combined_ with caloric restriction, is a decrease in your basal metabolic rate (BMR).

Our bodies are very good at adapting to "the new normal" and will optimize itself to function on the fuel you give it. This is true in both directions. If you eat less, your body will learn to live on less, and if you eat more, eventually your body will ramp up to try and burn more energy to try and reach an equilibrium.

When fasting, it's important to keep your caloric intake up during brief eating windows. Otherwise, your body will adjust, and when you stop fasting, the slightly increased caloric intake will cause you to gain weight before your body readjusts to the new normal. Many fasting theorists suggest that fasting at random intervals is the best strategy for weight loss without reducing BMR. If your body is used to burning 3000 calories a day just to keep you alive, it can't ramp down those cells immediately so it needs to instead convert stored fat to energy and burn that instead.

These aren't fasting specific, but oftentimes in the western world, we begin fasting as a means to an end (weight loss) and often combine it with other dietary changes, like eating less/healthier.

The other downside is literal starvation or the development of an eating disorder, but those are pretty obvious.

I saw a low-budget documentary on YouTube[0] a couple of weeks ago talking about "fasting retreats" in Russia and now parts of Europe that are seeing great results with patients water fasting for 2+ weeks. They're treating everything from Diabetes to arthritis and dementia. Pretty cool stuff.

Personally, I definitely have seen the light and will likely continue fasting regularly in some form the rest of my life. Since I just turned 26 last month, that's going to be a while! I'm currently half way through a 72 hour fast and feeling great. Just had a cup of coffee and some electrolyte spiked water this morning. I still have about 50 pounds to lose but I'm hopefully for my future now and I'm a lot healthier.

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

[bityard]

It sounds like we are both doing the same thing but through different means. I have been on a successful low-carb, high-fat diet for around 7 years now and will never go back to eating high-carb foods on a daily basis. I lost 45 pounds in the first 9 months with no exercise and have kept it off since. Although the weight loss was nice, it was not my main goal. I originally changed to a LCHF diet because I was tired of being constantly hungry and having my schedule and life dictated by food.

Fasting is one of the things that a lot of LCHF practitioners eventually gravitate towards because once your metabolism is used to burning fat, you're not hungry all the time and eating becomes optional. I typically eat two meals a day but sometimes one is more than enough.

I have tried fasting here and there but getting better at it is one of my goals. My main difficulty right now is easy access to food (being stuck working from home most days) and the social pressure of being the only one in the house who has committed to LCHF.

[yurishimo]

Yeah social pressure within your own home is no joke! My SO doesn't eat LCHF, so the fridge and pantry are littered with foods I cannot eat.

One way I've gotten through this recently is to use a pre-packaged meal delivery service. I order 30 meals at a time for $175 and that lasts me a month or so eating 2 per meal, 4-5 days a week. If I'm hungry, my food options are what's in the freezer, or a bag of popcorn.

I've found one of my biggest motivators for fasting is actually the pride I get from discussing it with friends and family. I'm not a prideful person, but it feels freaking great to boast nonchalantly about not having eaten food in a few days. The results also speak for themself as well.

If you don't have a fasting tracker app, I recommend finding one you like and trying to get some others on board. If you're interested, I have a group from posts on my blog that people hop in and out of [0]. Anyone feel free to join and post updates and I'll keep an extra close eye on it for the next few days.

0: https://lifefastingtracker.app.link/z3D7qHg2W8

[voisin]

> One potential downside to steady regimented fasting _when combined_ with caloric restriction, is a decrease in your basal metabolic rate (BMR).

Check out The Complete Guide to Intermittent Fasting. The research he cites shows that the effect you describe occurs in caloric restriction diets, not fasting. Fasting increases HGH and maintains BMR.

Perhaps what you are describing is the early days of fasting when your body is becoming fat adapted and you feel a bit sluggish, but after a short period your energy levels return to normal (for me it was less than a few weeks, 5 years ago, and my wife just started fasting with me and she is adapted and back to full energy while fasting after two weeks).

[yurishimo]

I've read the book. The same thing still applies and I believe I've seen a video where Fung has confirmed it but I don't have the link handy.

Fasting enables us to not have to focus on calorie restrictions to see a reduction in body weight. However, if you only eat 500 calories a day, eventually you will run out of fat and your BMR will go down as you approach a lower BMI.

It's a very slow and gradual process, but it does happen. If you've got plenty of fat to burn, not a huge issue, but as you lose weight it can start to apply more.

Anecdotal evidence also suggests that people who stick with a very strict IF schedule tend to see slower results and bigger plateaus than those who change things up more often.

[voisin]

Right, I see what you are saying. Your BMR decreases not directly due to fasting but due to the fact that you are a lower weight. The results of fasting (weight loss) leads to lower BMR. Whereas caloric restriction shifts BMR down regardless of whether weight is lost.

I agree with your anecdotal evidence. I do 36 hour fasts 2x per week, and otherwise do 20-22 hour fasts. Every now and then I do a longer, 48-72 hour fast. I am in awe of people that get to 5-10 day fasts and hope to work up to this over time, perhaps on a quarterly basis.

[NewOrderNow]

Outside of my Monday all day fast, I typically intermittent fast throughout the week. I am liking the results

[shekharshan]

I fast regularly and have a 5-6 hour eating window. During that window I just cannot eat more than 1500 calories. If typical caloric reduction can trigger starvation type response in the body, why does it not happen when we reduce calories during fasting?

[voisin]

Caloric restriction does not lead to an increase in Human Growth Hormone. There are a bunch of other hormonal changes that occur when the caloric input is zero, versus when it is something. That’s why study after study shows fasting is superior to caloric restriction.

[shekharshan]

Thanks @voisin, this is very helpful.

[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?

[eperfa]

Absolutely not a doctor, so no way qualified to give professional advice, but the article states that not everyone followed the diet during all treatments, so they included all patients who complied at least during half of the cases, and the positive results are based on this extended group. This, and the suggested mechanism of why they think the method works, would lead me to believe that it makes sense to try it.

Wish you & your wife strength and all the best.

[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.

[markus92]

I'm sorry to hear that about your wife and wish her all the best. As I'm not a medical professional and don't know your wife's exact situation, I'd say it'd be best to bring it up with your wife's oncologist that you'd like to give it a shot. I doubt they'd object for trying it for a cycle or two, but they know best.

[wonder_er]

I'm not a doctor, but after reading Tripping Over the Truth: The Metabolic Theory of Cancer [0] I'd strongly suggest she start fasting, or, far better, order yourself a copy of the book (epubs available for purchase/torrent) and read it, decide for yourself. There are a lot of resources listed in the book for people who have cancer.

I'm trying to get people to read the book. Average people, for sure, but also people on boards of research institutions. I wrote this to one of them: https://josh.works/mike-clayville-can-have-a-huge-impact-on-...

[0] https://www.goodreads.com/book/show/23496164-tripping-over-t...

The ideas contained in the book are explosive, with profound implications. It's a riveting read.

[hengheng]

Why is it that as soon as cancer comes up as a topic, people stop exchanging arguments and start selling books instead, where normally they would be paraphrasing and occasionally referencing something.

[wonder_er]

I left a longer answer to a similar question here: https://news.ycombinator.com/item?id=24260568

A book is nothing but a long, detailed, carefully-researched argument. Or, at least the book I'm recommending is that.

If there are words I can say to convince you to read the book, please tell me them.

I'm literally paying people to read the book.[0]

I would love suggestions on how to improve the average discourse on the topic. What would you suggest?

Could you read through the linked thread, tell me if there's anything there that I should bring over here?

[0]: https://josh.works/mike-clayville-can-have-a-huge-impact-on-...

[hengheng]

Not buying from you, not helping you sell for free.

Idk what brought you on your mission, but your pitches interrupt discussions.

[late_groomer]

"Importantly, DNA damage in T-lymphocytes was less in patients who received the FMD in combination with chemotherapy compared to those receiving chemotherapy while on a regular diet"

Does this not qualify as a protective effect?

[alz]

You may be right, but the reason I put that in the title was because it begins by siting a bunch of other research evidencing that “short-term fasting ...can protect healthy cells against a wide variety of stressors, including chemotherapy”, because in the trial they were able to omit dexamethasone with no negative effects, and because “chemotherapy-induced DNA damage in T-lymphocytes“ was “significantly curtailed”

[cellularmitosis]

Do you have any info as to which fasting schedule is most effective?

[markus92]

Unfortunately that is far outside my expertise. The study here used a diet that is supposed to mimick the effects of fasting by having a low calorie/protein diet. In the discussion, they say the effects on a growth factor can be measured in blood plasma after 48 hours of fasting, or 48 hours of this diet.

My layman guess is that the best schedule is probably the one you can adhere to.

[teraku]

If it's a low protein diet, couldn't the lack of certain aminoacids which promotes cell growth (and by that, also cancer growth) also aid slowing cancer?

Layman here, just popped into my mind.

[unishark]

The explanation in the article is sort of along those lines, if cancer cells' inability to switch to a protective state is due to their faulty programming always keeping them in a growth mode:

"Essentially, fasting causes a switch in healthy cells from a proliferative state towards a maintenance and repair state. Malignant cells, in contrast, seem to be unable to enter this protective state because of oncoprotein activity, and therefore fail to adapt to nutrient scarce conditions. Instead, fasting deprives proliferating cancer cells of nutrients, growth and other factors, which renders them more sensitive to cancer therapy and increases cell death"

[brodouevencode]

Don't cancer cells also require massive amounts of glucose to survive?

[foobiekr]

I think you are referring to the Warburg effect:

https://en.m.wikipedia.org/wiki/Warburg_effect_(oncology)

[rladd]

This is what they mean by fasting mimicking diet, and includes the schedule: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(15)...

[RSchaeffer]

Why make people search instead of quoting the relevant section?

"The human fasting mimicking diet (FMD) program is a plant-based diet program designed to attain fasting-like effects while providing micronutrient nourishment (vitamins, minerals, etc.) and minimize the burden of fasting. It comprises proprietary vegetable-based soups, energy bars, energy drinks, chip snacks, chamomile flower tea, and a vegetable supplement formula tablet (Table S4). The human FMD diet consists of a 5 day regimen: day 1 of the diet supplies ∼1,090 kcal (10% protein, 56% fat, 34% carbohydrate), days 2–5 are identical in formulation and provide 725 kcal (9% protein, 44% fat, 47% carbohydrate)."

"Subjects in the FMD cohort consumed the provided experimental diet consisting of 3 cycles of 5 continuous days of FMD followed by 25 days of normal food intake."