Wednesday, May 27, 2020

Breaking the fast

Fasting is hard, though it gets easier with time.  The third day was once again easier than the second.  I felt no pain or hunger, and managed to focus on work.  I thought of food a lot but mostly in a hypothetical way.  It didn’t distract me too much.  This started to change in the afternoon.  The last couple of hours, when the nuts in my backpack were beckoning, stretched uncomfortably long.

Breaking the fast is also hard.  Muslims celebrate this every night during Ramadan with feasts of dates, tajines and lots of merriment, but they fast during daylight hours only and hardly have the time to get hungry.  If the fast is long, breaking it means getting metabolic pathways back into gear that have entered a state of profound inactivity.

A long fast empties the stomach and the intestines.  The body adapts to a complete deprivation of energy.  All non-essential activities are at a standstill.  Cells stop making things, lying statically in their tissues as if dead.  Protein and DNA synthesis are shut down, as are any catabolic pathways.  It’s like hibernation.

Breaking the fast requires getting everything back into gear, and this takes time.  I stuffed my belly with nuts, a hamburger, an apple, bread, cheese and chocolate.  I easily consumed 2000 kcal during dinnertime.  The nuts alone added up to 900.  My belly was not amused.  The food didn’t sit easily and wasn’t digested smoothly.  It took a while until my stomach had cranked up its activity level to deal with this unexpected bounty.  Until this happened, I felt as if someone had piled rocks into my stomach.  I wonder if there's a better way of easing into this.  It might not matter.  Now, four hours later, I sit on the sofa content and as if reborn.  Life is good again - and maybe there’s a little less of the cancer in me than before.

Whether this is a reasonable hypothesis was one of the questions I had for my oncologist today.  To my delight, I found an unexpected ally.  The doctor didn’t dismiss the potential benefits of fasting.  She said she would not recommend it to patients because the jury is still out on whether it helps with therapy, and there are certain risks that should not be underestimated, but she’s happy to encourage it in patients that raise the topic themselves, as long as they are strong and outwardly healthy.

Best of all, she told me of a colleague who is convinced of the rewards of periodic fasting.  This doctor is known to have said that he’d fast himself if he got cancer.  He’s an oncologist and a bit of a nutrition buff.  My doctor will discuss my case with him and come up with a strategy of how to combine fasting with chemotherapy.  My approach would be to fast for two days and start chemo on the third, but I’m happy to be told otherwise.

In keeping with my current cycle, the first session of the second chemo program will probably start in two weeks.  Twelve sessions will continue through the middle of November.  If nothing unexpected happens, Christmas in Argentina is realistic, from my side anyway.  If Argentina continues on its current trajectory, it might take some time until it’s wise to visit, but six months is a long time.  It will take me a dozen more fasting sessions to get there.

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