Fasting and fasting-mimicking diets around chemotherapy
Eating very little for a few days around each chemotherapy dose might protect normal cells and sensitise the tumour. Early trials are intriguing but small, and it is not something to try without a dietitian.
Short-term fasting lowers glucose, insulin and IGF-1 and shifts normal cells into a protective, low-proliferation state ('differential stress resistance') while cancer cells, unable to slow down, may become more chemosensitive. Mouse data are strong. In humans, the DIRECT trial (Netherlands, 131 patients with HER2-negative early breast cancer, Nature Communications 2020) randomised a plant-based fasting-mimicking diet for three days before and on the day of each neoadjuvant chemotherapy cycle: radiological response was better (OR 3.2) and a 90-100% tumour cell loss more frequent in the diet arm, but adherence collapsed (fewer than 20% completed all cycles) and pathological complete response did not differ. Phase 2 trials in breast, colorectal and lung cancer are running; none has a survival endpoint yet. Weight loss and sarcopenia are real risks, and fasting is contraindicated in cachexia.
How it works
Nutrient deprivation lowers systemic growth signalling (insulin, IGF-1) and induces protective stress responses in normal tissue, potentially widening the therapeutic window of cytotoxics.
- Strong preclinical rationale
- Randomised signal on radiological response in DIRECT
- Very cheap
- Adherence is poor
- No survival or pCR benefit shown
- Risk of muscle loss; unsuitable for malnourished patients
Latest papers
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