Fasting during/after chemo

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Zkr
Posts: 1
Joined: Sun Mar 31, 2019 1:51 pm

Fasting during/after chemo

Postby Zkr » Sun Mar 31, 2019 2:58 pm

Hi Everyone,

I have been looking for information regarding fasting during or after taking Capecitabine (Xeloda). There has been a lot of discussion regarding fasting before/after taking 5-Fluorouracil (5-FU), which is given periodically (once per week?). It has been clinically tested whether fasting 48 hours before the chemo and 24 hours after the chemo, can reduce the side effects and increase the efficiency of the chemo. But because I take Capecitabine on a daily basis for the period of 5 weeks and 3 days, I cannot fast in that manner.

I have been receiving radiochemotherapy since February 25th on a daily basis (Radiotherapy only on weekdays). I have 3 more therapy days to go. Although I am almost done, the radiation burns have been so dramatic in the last week that painkillers, including Tramadol, have been useless. I have the frequent urgency of going to toilet, something like 10 times for the "big business". Most of the time my stool consists of dead colon skin and gas though. Still each time is just a hell for me. It takes something like 10-15 minutes and feels like I am sitting on an electric chair. Todays things got even worse. I had to visit bathroom 7 times within 3 hours and, I believe, my hemorrhoids got a lot worse. I have no idea how I can manage my next bathroom visit. But I want to give a try to fasting so that I can have some rest from my toilet nightmare.
I spoke with my oncologist about fasting before. She wasn't happy about it and strongly advised me against it. She just doesn't want to do anything which is outside the German medical guidelines for colorectal cancer. So I feel the need for advice or an opinion, if there is anything that I have to be careful about my planned adventure with fasting over 3+ days. Apart from my rectal cancer diagnosis, I am a healthy young male, who was preparing to run the Hamburg marathon at the end of April in 2 hours 50 minutes.
I know that I have to be careful with my weight (63kg currently, 175cm tall). But I used to be 60kg until the age of 25 and felt perfectly healthy. So I think I can lose 3kg with no health problem. I have some fat around my waist that I can get rid of.

Would really appreciate to hear your thoughts on this issue.

Greetings from Germany!
Zkr
Early February 2019 diagnosed with colorectal cancer T2N1M0. Age 36, male, married, two kids (2 and 6).
February 25th started my radiochemotherapy. Daily intake of Capacetabine 1500 mornings and 1500 evenings (64kg of weight and 175cm tall). 28 rounds of radiotherapy only on weekdays.
March 22nd till 26th. Because of low red blood counts (around 2700, if I remember correctly) had to take a break from chemo. Thereafter my red blood counts went back where they are supposed to be (over 4000).

zephyr
Posts: 222
Joined: Thu Aug 18, 2016 7:31 am

Re: Fasting during/after chemo

Postby zephyr » Sun Mar 31, 2019 6:52 pm

Hi Zkr,

I don't have an answer for you just yet but I will have one soon. I can tell you that when I was on 5fu, and especially Folfiri, fasting saved me. I would not have been able to tolerate the side effects (bathroom at the top of the list) for much longer had I not started fasting. What a difference it made! But I now find myself in your shoes: xeloda. I'm going to be seeing my naturopathic oncologist this week and I plan to ask her the same question. I'll report back.

When you fast, it's not a complete fast, just a reduced calorie one. You can have up to 500 calories per day.

Edited to add: can you try sitting in a warm sitz bath next time you go to the bathroom? Another suggestion from my naturopathic oncologist. When I was battling anal fissures and hemorrhoids from all the chemo, going in warm water was the only relief I found. One other semi-solution - but it might not be legal in Germany - is a drop of Rick Simpson Oil under your tongue before bed. It's a form of medical marijuana and you would take it to slow down your system so you could get some sleep. On bad nights during Folfiri, I would be up every hour going to the bathroom and it was very painful. If I took a drop (the size of a grain of rice) of RSO, it stopped everything and I don't think I moved for about 8 hours. It also gave my back end a rest. On those nights I also used an Anusol HC (prescription hydrocortisone) suppository.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
April-2019 Xeloda + Avastin

Pyro
Posts: 237
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Fasting during/after chemo

Postby Pyro » Mon Apr 01, 2019 8:04 am

You guys are crazy, but hey, if it works. I say this b/c while I was on ox, I was never hungry, but when I was I would eat everything in the house expecting I will not be hungry again for days. I’ve heard of the chemo fast, had people recommend it, not for me.
Aug 2015- Diag Stage 4 CC with mets to liver (38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not a surgery candidate for liver
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MDA liver surgery, Dr. Vauthey
Mar 2016 -30% of left lobe rem, PVE
May 2016 - 70% of liver rem
Jun 2016-Rad
Jan 2017-perm colost @MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Rad
Mar 2019 - Keytruda, CEA @36, treatment failure

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betsydoglover
Posts: 967
Joined: Mon Aug 14, 2006 2:31 pm
Facebook Username: Betsy Lindh Williams
Location: Maryland - outside DC

Re: Fasting during/after chemo

Postby betsydoglover » Mon Apr 01, 2019 2:00 pm

The recommendation when taking Xeloda is to take it 20-30 minutes after a meal - that is the way it was tested. That is the way it was tested, and as you say you really can't fast with Xeloda unless you want to stop eating.

I and several others set a timer so that we would remember to take it within the 20-30min timeframe.

Take care,
Betsy
diag. Stage IV, 5/05, liver met
lap sigmoid colectomy, 6/05
6 cycles Xeloda/oxaliplatin/Avastin (NED after 2)
11/08 9x13mm right lower lobe lung nodule; removed via VATS 4/09
NED
6 cycles Xeloda + Avastin
Avastin only 10/09-5/11
Still NED 06/18

zephyr
Posts: 222
Joined: Thu Aug 18, 2016 7:31 am

Re: Fasting during/after chemo

Postby zephyr » Mon Apr 01, 2019 2:37 pm

betsydoglover wrote:The recommendation when taking Xeloda is to take it 20-30 minutes after a meal - that is the way it was tested.


Thanks betsydoglover. That is some very important information to know. Admittedly, the directions say to take it within 30 minutes after a meal but I assumed it was because it was hard on the GI system (what chemo isn't?) ... which would be bad but not nearly as bad as it not working because one didn't take it as tested. They really should make a bigger deal of that point.

That said, it still might be possible to fast and take xeloda depending on your xeloda schedule. When you fast for chemo, it's not a complete fast - just a restricted calorie fast. It's surprising how much food you can consume and still stay within 500 calories per day. My xeloda schedule is 5 days on, 2 day off. I could make up the calories on my 2 day weekend, maybe. For those doing 1-2 weeks on and then a week off, I don't know how you could make fasting work and still stay healthy. But I will check ...
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
April-2019 Xeloda + Avastin

zephyr
Posts: 222
Joined: Thu Aug 18, 2016 7:31 am

Re: Fasting during/after chemo

Postby zephyr » Mon Apr 01, 2019 6:05 pm

Zkr wrote: But I want to give a try to fasting so that I can have some rest from my toilet nightmare.


I am sorry to report that fasting is not an answer with the xeloda schedule - at least not for me and probably not for you either. However, I learned that in combination with high dose Vitamin C IVs, it may be more effective because the Vitamin C can help it work better metabolically and help prevent toxicity. Your mileage may vary.

I'm not a doctor or nurse or anything medical except another patient trying to figure this out.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
April-2019 Xeloda + Avastin

CF_69
Posts: 48
Joined: Sat Dec 22, 2018 9:44 pm

Re: Fasting during/after chemo

Postby CF_69 » Mon Apr 01, 2019 8:46 pm

Why don’t you try a modified intermittent fasting approach?

Stop eating after your 2nd Xeloda of the day.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0 after pathology
CEA 1.9
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
5 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.

zephyr
Posts: 222
Joined: Thu Aug 18, 2016 7:31 am

Re: Fasting during/after chemo

Postby zephyr » Mon Apr 01, 2019 9:15 pm

CF_69 wrote:Why don’t you try a modified intermittent fasting approach?

Stop eating after your 2nd Xeloda of the day.


I don't think it works that way. The whole idea behind starting 2 days before chemo is that it puts your cells into a kind of hibernation. They think there's a famine so they check out EXCEPT that cancer cells have no such regulating mechanism so they just get hungrier and hungrier. By the time the chemo hits your system, your "normal" cells are asleep (my words) and not taking in as much chemo (e.g., less toxicity) but the cancer cells think they just found an all-you-can-eat buffet and gobble up that chemo like candy. By stopping after the 2nd Xeloda, you don't get any of those benefits because there hasn't been enough time to put your normal cells to sleep.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
April-2019 Xeloda + Avastin

CF_69
Posts: 48
Joined: Sat Dec 22, 2018 9:44 pm

Re: Fasting during/after chemo

Postby CF_69 » Mon Apr 01, 2019 9:26 pm

Oh I see. I didn’t realize any of that, I just know some of the reported benefits of intermittent fasting.
47 year old male
Distal sigmoid near rectosigmoid junction adjacent to upper rectum
Adenocarcinoma
2.8 x 1.8 x 3.5 cm
G2
T3N0M0 after pathology
CEA 1.9
Xeloda / radiation x 25
Laparoscopic LAR April 2019
0 of 12 nodes
Stage 2A
5 cycles of adjuvant Xeloda
MRI on liver for 2mm hypodensity not suspicious.

Caat55
Posts: 658
Joined: Sat Dec 23, 2017 6:01 pm

Re: Fasting during/after chemo

Postby Caat55 » Tue Apr 02, 2019 12:08 am

I felt your pain, literally the only relief I got was soaking. I frequently fell asleep in the bathtub. I also got the fissures, and according to doctor's rectal prolapse. It was actually a relief to get the ileo so my skin could heal. It does get better in time. I found vitamins for hair, nails and skin. My GI doctor recently suggested hyperbaric ox. treatment and I am looking into that as well.
Mild foods, low residual diet worked for me. Take care, we have all been there.
S
55 y.o. Female
Dx 9/26/17 RC Stage 3
Completed 33 rad. tx, xeolda 12/8/17
MRI and PET 1/18 sign. regression
Surgery 1/31/18 Ileostomy, clean margins, no lymph node involved
Port 3/1/2018
Oxaliplatin and Xeloda start 3/22/18
Last Oxaliplatin 7/5/18, 5 rounds
CT NED 9/2018
PET NED 12/18
Clear Colonoscopy 2/19

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CRguy
Posts: 9887
Joined: Sun Feb 10, 2008 6:00 pm

Re: Fasting during/after chemo

Postby CRguy » Tue Apr 02, 2019 10:12 pm

zephyr wrote:Thanks betsydoglover. That is some very important information to know. Admittedly, the directions say to take it within 30 minutes after a meal but I assumed it was because it was hard on the GI system (what chemo isn't?) ... which would be bad but not nearly as bad as it not working because one didn't take it as tested. They really should make a bigger deal of that point.
I assumed it was because it was hard on the GI system

NO,
It has to do with pharmacodynamics and pharmacokinetics of how it was validated for clinical use ....
and every Onc SHOULD have made a BIG issue of giving the proper instructions for the medication.
One major concern with many Oncs is :
patients will NOT follow the proper oral regimen and therefore negate the benefit of doing out-patient oral therapy as opposed to sitting in an infusion unit for IV 5FU/leucovorin

Patients MUST educate themselves as to what is being used in their bodies ... AND
.... WHY ... and HOW it works

Xeloda (capecitabine) is a pro-drug and MUST be absorbed / metabolized / transported to the tumor site in order to achieve its level of efficacy.
Can Xeloda have GIT side effects ... HELL YEAH ... BUTT that has nothing to do with the need to follow the "after food" requirement,
so you actually get your "treatment" dosage as required ....

That is why this very forum is SO beneficial to those on the Journey !
WE know stuff here !!!!!

Best wishes and always BE INFORMED !!!!

CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
12 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

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O Stoma Mia
Posts: 1600
Joined: Sat Jun 22, 2013 6:29 am

Re: Fasting during/after chemo

Postby O Stoma Mia » Wed Apr 03, 2019 12:26 am

CRguy wrote:... Patients MUST educate themselves as to what is being used in their bodies ... AND
.... WHY ... and HOW it works

Xeloda (capecitabine) is a pro-drug and MUST be absorbed / metabolized / transported to the tumor site ...



Image

zephyr
Posts: 222
Joined: Thu Aug 18, 2016 7:31 am

Re: Fasting during/after chemo

Postby zephyr » Wed Apr 03, 2019 10:14 am

CRguy wrote:
Xeloda (capecitabine) is a pro-drug and MUST be absorbed / metabolized / transported to the tumor site in order to achieve its level of efficacy.
Can Xeloda have GIT side effects ... HELL YEAH ... BUTT that has nothing to do with the need to follow the "after food" requirement,
so you actually get your "treatment" dosage as required ....


O Stoma Mia wrote:Enzymatic activation of Xeloda


Thanks to you both for the explanation.
Nov-2009 Early stage CRC found during routine colonoscopy
2010, 2011, 2014 Follow up colonoscopies, all clear
Jun-2016 CRC found during routine follow up colonoscopy, surgery, Stage 4, KRAS, MSS, inoperable lung mets
Aug-2016-May-2018 Folfox, 5FU & Avastin, 5FU, Folfiri & Cyramza
Aug/Sep-2018 YAG laser surgeries (Germany) on both lungs, 11 nodules (9 mets) removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
April-2019 Xeloda + Avastin

mpbser
Posts: 904
Joined: Wed Apr 19, 2017 11:52 am

Re: Fasting during/after chemo

Postby mpbser » Wed Apr 03, 2019 1:31 pm

Of relevance to this topic from https://www.lifeextension.com/Protocols ... py/Page-08:

Mitigating Chemotherapy Side Effects with Intermittent Fasting
Fasting induces an array of biochemical and physiological changes that may delay aging and the onset of chronic degenerative diseases, including cancer (Lee 2011; Brandhorst 2015; Stipp 2015; Safdie 2012). Some forms of fasting or caloric restriction may also protect animals and cancer patients from some chemotherapy side effects and sensitize cancer cells to the effects of chemotherapy (Lee 2011; Brandhorst 2013; Horne 2014; Stipp 2015; Safdie 2012). Interestingly, preliminary reports suggest that fasting for several days followed by normal food consumption may protect patients against chemotherapy toxicity without causing long-term weight loss (Lee 2011).

In a randomized early-stage trial, a 48-hour fast reduced chemotherapy immunotoxicity in women with breast cancer. Thirteen women with HER2-negative stage II or III breast cancer participated in the study. Seven women fasted for 24 hours before and after receiving neo-adjuvant chemotherapy, while the remaining women ate normally. The women received a chemotherapy regimen that included docetaxel, doxorubicin, and cyclophosphamide. Laboratory studies of subjects’ blood 30 minutes after chemotherapy revealed significantly less DNA damage in lymphocytes and monocytes in blood samples from the fasting women compared with those from the women who ate normally. This protective effect was still detectable seven days after chemotherapy treatment (de Groot 2015).

There are several potential mechanisms by which fasting may interfere with tumor progression and protect healthy cells against chemotherapy toxicity, but reductions in levels of glucose and insulin-like growth factor-1 (IGF-1) are often cited as important mediators of these benefits (Lee 2010; Hine 2014; Safdie 2009; Cheng 2014; Brandhorst 2013). In a chemotherapy toxicity study, one group of mice underwent a 48-hour fast, while another group underwent a 48-hour fast but also received injections of IGF-1. Both groups received injections of the cytotoxic agent doxorubicin. In the fasting-only group, the survival rate after injection of doxorubicin was 100%; in the group who fasted and received IGF-1 injections, the survival rate was only 38% (Lee 2010).

Fasting triggers healthy cells to switch into a “protected mode” that confers resistance to toxins, including chemotherapy. In cancer cells, pro-cancer genes called oncogenes prevent this switch. In other words, under fasting conditions, healthy cells are protected against toxicity from chemotherapy but cancer cells are not. This phenomenon has been called differential stress resistance (Raffaghello 2010).

In a report on 10 cases, subjects with various types of cancer voluntarily fasted for 48–140 hours before receiving chemotherapy and/or 5–56 hours after chemotherapy. Six of the patients underwent chemotherapy in both a fed and a fasted state at different times; they reported reduced fatigue, weakness, and gastrointestinal side effects while fasting. The other four subjects underwent all of their chemotherapy treatments while fasting; the severity of most side effects was reported to be low relative to typical experience. In cases in which cancer progression could be assessed, fasting did not reduce the efficacy of chemotherapy (Safdie 2009).

Abundant preclinical evidence indicates fasting itself may retard cancer growth. A series of studies in cancer cell lines showed cycles of fasting were as effective as chemotherapy in delaying the progression of various tumors. Moreover, fasting increased the ability of chemotherapy to kill several types of cancer cells. The researchers who conducted this investigation concluded “These studies suggest that multiple cycles of fasting promote differential stress sensitization in a wide range of tumors and could potentially replace or augment the efficacy of certain chemotherapy drugs in the treatment of various cancers” (Lee, Raffaghello 2012).
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
lymph nodes: 9 of 96
CEA: 2.9 to 2.2
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry Normal
Tumor: MTOR, APC, TP53
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly hemorrhaged to death
6/10/19 5FU


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