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Every year, 8.8 million people worldwide die of cancer and although the recovery rates are increasing, it is estimated that these figures will reach 13 million in 2030. Recently, the journal BMC Cancer published the results of a new clinical trial confirming the benefits of fasting on the quality of life for women diagnosed with breast and ovarian cancer and undergoing chemotherapy, and specifically in the ability of fasting to alleviate fatigue [1]. The paper is authored by a team of researchers from the Department of Internal and Integrative Medicine at the Immanuel Krankenhaus Center, in collaboration with the Institute of Social Medicine, Epidemiology and Health Economics of the Freie University, both in Berlin.

Today, chemotherapy— together with radiotherapy and surgery, is the predominant and most effective treatment to fight cancer. However, cancer patients have long weighed the effectiveness of chemotherapy with its heavy toll on the quality of life. As such, modern medicine—even in the field of oncology— is beginning to pay greater attention to experimental therapeutic approaches. One approach that deserves special recognition are fasting and mimicking diets. This innovative intervention has increasingly produced promising results, both in basic research and clinical trials.

The clinical trial conducted in Berlin studied the effects of fasting on a pool of 34 patients, with an average age of 51 years and no less than 18— all with a diagnosis of breast cancer or ovarian cancer and medical recommendations to undergo standard chemotherapy treatment. The fasting regime, which began 36 hours before the chemotherapy cycles and ended 24 hours after, was administered in two forms: the first group, about half of the patients, underwent Fasting Mimicking Diet (FMD) in the initial phase of chemo, while the second group fasted in the final stage. During the fasting period, patients followed a FMD whose 350 kcal per diem limit—consisting of tea,and vegetable juices and broth. Patients were monitored for the duration of treatment and, in all the observed cases, FMD proved tolerable, causing only minor headaches, nausea or hunger that did not interfere with normal daily activities. Weight loss and reduction of body mass index, typical consequences of chemotherapy, were also limited, with an average variation of less than 1.5 kg in both groups. The improvement in quality of life and reduction of fatigue were more evident for patients who underwent fasting in the initial phase of chemo cycles. This result could be attributed to several factors, notably that fasting appears more effective in preventing the side effects of therapy, than in reversing them.

While the results of this pilot study are certainly encouraging, the implementation of this procedure still requires a degree of prudence in order to avoid potential risks to patients’ health. In particular, it should be noted that not all cancer patients can undergo fasting. Body mass index values lower than 19 kg / m², a frail physical constitution, and major diseases are incompatible with therapeutic fasting. Rather, for other patients, fasting during chemotherapy treatments is not only feasible but potentially effective. This study confirms as well as adds to the conclusions of previous experimental studies that, since 2008, have demonstrated the efficacy of therapeutic fasting to diminish side effects in mice, but also contributes to the findings of various pilot clinical trials. Regardless of the type of tumor, different fasting protocols in combination with chemotherapy have proven to be safe and even capable of reducing the side effects of pharmacological treatment [2-4]. Hence, fasting can be used as an important tool to enhance the efficacy of chemotherapy. Its primary contribution appears to be that it helps the chemotherapy drugs to identify the cancer cells—under the correct environmental conditions.

Nonetheless, as the antitumor drugs are increasingly specific and selective, detrimental effects on healthy and actively proliferating cells, such as blood cells, hair follicles or reproductive organs, remain unavoidable. Although at the termination of the therapy, in most cases, such cells resume normal activity, it is undeniable that the problem of cytotoxicity can have negative consequences both for the effectiveness of the therapy itself, triggering even some degree of resistance to the chemo drugs, as well as the formation of secondary tumors, especially after several years of treatment.

Under -nutrient-poor conditions (fasting), cancer cells exhibit greater sensitivity to antineoplastic drugs than do normal cells. This phenomenon, referred to as “differential stress resistance”, demonstrates a different metabolic behavior in healthy cells than it does in diseased cells, and is commonly observed in both the simplest and the most complex organisms, such as humans [5-6]. From a biochemical point of view, the protective effect of fasting translates into a significant reduction in blood glucose, insulin, and IGF-1 (Insulin-like Growth Factor) levels, which can facilitate cancer growth. In such a context, where the efficacy of chemotherapeutics is naturally enhanced, the need to increase their doses or to develop more aggressive drugs can be reduced. Thus, investing in such research is costly, but represents a crucial resource in terms of producing tangible benefits for patients.

Indeed, FMD can be an enhancement of conventional cancer therapies given that it does not require an excessive financial investment and is potentially effective both in protecting against various cancer treatments and in increasing their anti-tumor toxicity. Still, further clinical trials are necessary to confirm the efficacy of this approach and thus obtain unanimous recognition by the scientific community.

Sources:

1. Bauersfeld S.P. et al. (2018) The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study. BMC Cancer 18: 476.
2. Safdie F.M. et al. (2009) Fasting and cancer treatment in humans: A case series report. Aging (Albany NY).1:988-1007.
3. de Groot S. et al. (2015) The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study. BMC Cancer 15:652.
4. Dorff T.B. et al. (2016) Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer 16:360.
5. Lee C and Longo VD. (2011) Fasting vs dietary restriction in cellular protection and cancer treatment: from model organisms to patients. 30:3305–16.
6. Raffaghello L. et al. (2008) Starvation-dependent differential stress resistance protects normal but not cancer cells against high-dose chemotherapy. Proc Natl Acad Sci U S A 105:8215–20.

NICOLETTA GUARAGNELLA

Researcher at the Institute of Biomembranes,
Bioenergetics and Molecular Biotechnologies of the National Research Council, Bari
Scientific communicator

Healthy diet and weight, not smoking and regular exercise are associated with a 12-14 years longer lifespan and an over 65% reduction in the risk of mortality from cancer and cardiovascular disease.

A study conducted at Harvard on more than 120,000 men and women, and published in the journal Circulation, reports that following several healthy lifestyles can increase life expectancy, reduce mortality from cardiovascular disease by 82% and tumors by 65%. Discover how to improve your life style reading the following article!

According to the research of Professor Longo, new guidelines show that a healthy lifestyle can reduce the risk of cardiovascular diseases up to 80%, and the risk of tumors up to 60%.

Three out of four deaths from cardiovascular diseases and half of deaths from cancer are likely caused by an unhealthy lifestyle. Is there hope for beating these odds? Can anything be done to improve our chances before such diseases?

To answer these questions, researchers led by Professor Frank B. Hu of Harvard University drew on the data of two extensive studies that analyzed the US population.

The findings are astonishing: small changes in lifestyle can increase life expectancy by years.

What does this new study offer?

Published in the April 2018 issue of the prestigious journal Circulation, the findings of the research team at Harvard University, confirm findings previously reported in other scientific journals—yet, with a key difference. Whereas previous studies examined the populations of various countries, this study conducted a thorough and quantitative analysis targeting the US population only. Instead, a 2012 meta-analysis collected the data from more than a half million participants from the US, Europe, China, and Japan, for an average of 13 years. The data suggested that more than half (66%) of premature deaths are associated with an unhealthy lifestyle that includes smoking, excessive alcohol consumption, lack of exercise, poor dietary choices, and obesity.

The data pool was drawn from more than 120,000 people (78,865 women and 44,354 men, chosen from two groups commonly used as research subjects in epidemiology; these groups’ traits are listed in below).

1. Who were the participants in the study?

The Harvard research team led by Professor Frank B. Hu used the data of  two extensive studies that were conducted over 30 years and profiled over thousands of US  health professionals, including both women (NHS, “Nurses Health Study”) and men (HPFS, “Health Professionals Follow-up Study”). The participants regularly fill out questionnaires on diet, health and other personal information (age, ethnicity, use of medicine, etc.)

This data was then integrated with that of the official program that evaluates the nutritional status of adults and children in the US (NHANES, The National Health and Nutritional Examination Survey”), and with an online database used to analyze data on public health (CDC WONDER, “Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research”).

The results? In contrast to less regimented peers of the same age, women who follow a healthy lifestyle can live as many as 14 years longer, while men have the potential to add 12 years to their lives. This means that when 50 years old, the life expectancy is increased by 43 years for women, and approximately 38 years for men—great news for those hoping to enjoy their retirement years with grandchildren or traveling around the world. The most important aspect is that these people also are healthier in their later years. In fact, the study determined that by following the proper guidelines, people have an 82% less chance of dying from cardiovascular diseases and 65% less chance of dying from tumors.

What does it mean to follow “a healthy lifestyle”?

Diet is without a doubt ranked at the top of factors determining overall health. In the Harvard-based study, a healthy diet is defined as one that emphasizes vegetables, fruit, nuts, whole grains, polyunsaturated fats and long-chain omega-3 fatty acids (prevalent in fish, for example, and nuts like walnuts and almonds, as well as extra-virgin olive oil). Instead, it restricts the consumption of red meat, sugary beverages, animal fats and sodium (too much salt).  Harvard researchers measured a healthy diet by using an index called The Alternate Healthy Eating Index, which awards points based on the consumption of more or fewer of the above dietary products. Those participants scoring more than 40% are deemed to have a healthy diet as they consume food items considered healthy while limiting the unhealthy items.

Diet must be accompanied by a sufficient amount of moderate or intense physical activity at least 30 minutes a day (no need to join a gym—brisk or fast walking also counts!)

Not surprisingly, smoking should be avoided at all costs. Moreover, alcohol should be consumed in moderation; for men, this means approximately 2 small glasses of wine, 2 bottles of beer or 2 small shot glasses of hard alcohol (40 ml) a day, while for women half these amounts.

The last risk factor is weight, or rather Body Mass Index, known by the English acronym BMI, which is calculated by dividing your weight in kg by your height in meters.  Your BMI should be between 18.5 and 24.9. For example, a person 1.6 meters should weigh between 47.5 and 64 kg, 55 kg being the ideal.

Do you want to find out if you have a healthy lifestyle? Answer the questions below.

2. What is your score?

Your lifestyle can be considered “healthy” if you responded “Yes” to these questions.

1. How does your diet compare to the Longevity Diet? Does it follow the same or similar guidelines?

2. Do you do a minimum of 30 minutes of exercise each day?

3. Are you a non-smoker?

4. Do you drink no more than 1 glass of wine per day (for women) or 2 for men?

5. Is your BMI between 18.5 and 24.9?

Why are these findings so important?

Well-being is not necessarily the same as good health. The US spends more than 17% of its GDP on healthcare. More resources are spent on developing new drugs and providing treatment than on prevention. Like all industrialized nations, the US has witnessed a decrease in quality of life due to health issues connected to so-called chronic and non-communicable diseases (e.g., diabetes, obesity, cardiovascular diseases, autoimmune diseases, neurodegenerative diseases). Knowing how to change your lifestyle can help prevent these illnesses and improve your health. The larger benefit is that improvement in individual health, in turn, means vast benefits for the healthcare system of the entire nation.

Strengths and Limits of This Study

The study discussed in this article is epidemiologic in nature. As a discipline, epidemiology examines the effects of the behavior of an entire population or group of people, in this case more than 120,000 people.

Still, the approach at the core of epidemiology is only one of five “Pillars” proposed by Professor Longo. This pillar allows us to sift through the massive amounts of information on nutrition, longevity, and health in order to identify the key factors that make for a healthy lifestyle. The other pillars include research focused on longevity; clinical studies; studies of individuals who are 100 years and over and populations with the highest longevity rates; and, finally, the study of complex systems.

Each pillar can provide useful information, but as each has strengths and limits, Professor Longo claims that it is only by using all five pillars in unison that we can produce the most reliable and durable indicators.

The multidisciplinary approach of the Pillars of Longevity lays out a solid and in-depth foundation from which to choose the best diet, while it minimizes, as much as possible, a key variable: change in dietary habits. If the choice of diet is made based on all 5 pillars, it is highly unlikely that such a choice will be wrong or invalidated by new research.

What can an individual do on a practical level to ensure better health and longevity?

If you did not answer “Yes” to all the questions in text box 2, your lifestyle has room to improve. Besides quitting smoking and reducing alcohol consumption, the first change that can improve your health is a healthy diet such as the Longevity Diet proposed by Prof. Longo, in the book of the same name and summarized in text box 3.  The Longevity Diet is rich in plant- based foods such as vegetables and legumes, nuts, and primarily whole grains; good fats found in fish (best if small in size); and extra-virgin olive oil. Instead, it limits animal products (especially red meat, cold cuts or cured meats, and dairy products) and sugar.

As for physical activity, all types of sports are equally effective. Best is to take up any activity that can be done on a daily basis, even past the age of 100! Brisk or fast walking; climbing the stairs instead of taking the elevator; and taking long walks on the weekend are small changes, but they can have significant effects on health. For more advice from Professor Longo regarding physical activity, click here.

The combination of a healthy diet and adequate physical activity will then naturally result in a healthy weight.

So then the question remains: “Are health problems inevitable? Or is there something we can do?” According to the studies cited in this article, making even small changes to one’s daily routine can be just as decisive a factor in ensuring good health as genetic predisposition.

Sources:  

1. Yanping Li, An Pan, Dong D. Wang, Xiaoran Liu, KlodianDhana, Oscar H. Franco, Stephen Kaptoge, Emanuele Di Angelantonio, Meir Stampfer, Walter C. Willett, Frank B. Hu. “Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population.”Circulation.2018 Apr 30. doi: 10.1161/Circulation aha.117.032047

1. Loef M, Walach H. “The Combined Effects of Healthy Lifestyle Behaviors on All Cause Mortality: a Systematic Review and Meta-Analysis.”PrevMed. 2012;55:163–170. doi: 10.1016/j.ypmed.2012.06.017.

1. Longo,Valter. The Longevity Diet, Penguin, 2016