Vitamin C and fasting

Have you read enough about vitamin C yet?  I hope not, because here’s another post.  This one will help me understand a recently published paper that shows a Synergistic effect of fasting-mimicking diet and vitamin C against KRAS mutated cancers.  To repeat myself:  I do have a KRAS-mutated cancer.  This research is potentially very relevant to me.  What I don’t have is a fasting-mimicking diet.  I’ll get to that at the very end.  But first, the paper.

As the paper is about five years more recent than the one I discussed yesterday, it takes those results for granted.  KRAS-mutated cancers don’t like high doses of vitamin C, which multiplies the oxidative stress that cancer cells have to deal with as a result of their fast proliferation.  Going beyond the earlier research, the paper envisions what might potentiate the action of vitamin C.  Fasting seems a good candidate as it also leads to increased oxidative stress in cancer cells.

The paper studies the same cell lines as the one I discussed yesterday, cell lines that carry my KRAS mutation, and shows that vitamin C kills those cells.  More cells die if they are grown in conditions that mimic starvation.  Vitamin C and fasting have a comparable individual effect on cancer cells.  The effect depends on oxidative damage and is stronger when both treatments are combined.  Add traditional chemotherapy to the equation and you get a triple whammy that cancer cells have a hard time surviving.

These are exciting results that I need to discuss with my oncologist, but words of warning are in order.  It’s a long way from a laboratory bench to a hospital bedside.  The mice that were used in this study received four grams of vitamin C per kilogram body weight twice a day.  At 62 kg, I would need to handle nearly half a kilogram of vitamin C per day, every day.  This sounds impossible but might simply be a reflection of the differences between men and mice.  Mice easily lose a quarter of their weight when they’re starved for a few days.  I lose a couple of kilograms, something like three to four per cent.  I need to find out the doses that were used in the few clinical trials that have taken place.

There’s a couple more rather obscure observations in the paper with no bearing on a possible therapeutic approach.  I’ll list them here mostly to have a reference later.

• Cancer cells try to keep iron levels down.  Otherwise oxidative stress risks running out of control.  Vitamin C and fasting both help keep a lid on the levels of ferritin, a protein that sequesters iron.  These double negatives are common in biochemistry.  What it means is that both vitamin C and fasting (indirectly) cause iron levels to increase and, collaterally, oxidative stress.  Incidentally, low ferritin levels are correlated with increased survival of patients with KRAS mutated tumors according to the Cancer Genome Atlas Database.
• There’s one example where vitamin C and fasting have opposite effects.  The enzyme heme oxygenase 1 increases ferritin levels.  Somewhat confusingly, vitamin C promotes the expression of this enzyme.  This leads to lower iron levels and less oxidative stress.  To exploit this, tumors often respond to chemotherapy by upregulating heme oxygenase 1 levels.  Fasting, in contrast, drives the levels of heme oxygenase 1 down.  The cells suffer more damage from oxidative stress.  Fewer of them survive.

From these data you could expect fasting to have a stronger effect on cancer cells than vitamin C, but that’s not necessarily the case according to the paper.  You might not think so after reading all this, but biochemistry is relatively straightforward.  Biology, in contrast, is much more complicated.  In living organisms, one plus one is never two.

What is it about the fasting-mimicking diet (FMD for short) that was used in the paper?  It is a way of eating that’s supposed to be easier on the body than total fasting but has much of the same beneficial effects.  FMD can slow tumor growth and make cancer cells respond better to chemotherapy.  This is exactly what is claimed for periodic fasting.  I have a number of papers on my hard drive that discuss the details of FMD.  There will be another vaguely scientific post before too long.  I have to admit it, I rather enjoy being a biochemist at the moment.

Vitamin C and cancer

I have now read a key publication on vitamin C and my type of cancer.  On Wednesday, when I next speak to my oncologist, I will need to demand a modification to my therapy.  I have the feeling that I’m being denied better chances to survive.  The paper claims that Vitamin C selectively kills KRAS and BRAF mutant colorectal cancer cells by targeting GAPDH.  It was published in Science, one of the beacons of scientific publishing, in 2015 with an associated commentary in the same issue.  The reason this paper isn’t just exciting but relevant is that I have a mutation in KRAS.  The two cell lines used in the paper carry the same mutation as my cancer, KRAS^G13D.

Title of Yun et al. (2015).

Let’s get started with the commentary, which should bring a bit more perspective than either research article.  It explains the complicated history of vitamin C and cancer.  It was Linus Pauling of all people who first showed cancer patients’ increased survival when they were injected high doses of vitamin C.  It's ironic that he is now primarily – and less flatteringly – associated with orally administered vitamin C.  It's even more ironic that clinical trials following up on Pauling’s research came back negative – because they also gave vitamin C orally.  It took a long time for science to recover from this mix-up and the resulting confusion.

Vitamin C is taken up by cells through dedicated vitamin C transporters.  This is of no therapeutic interest.  The oxidized form of vitamin C, which is called dehydroascorbate and always exists in equilibrium with regular vitamin C, gets into cells with the help of a glucose transporter.  This is relevant for some cancer cells whose glucose transporters are particularly active.  Inside cells, the reduction of dehydroascorbate back to vitamin C causes a spike in reactive oxygen species that block glucose metabolism (by direct inactivation of a key enzyme called glyceraldehyde 3-phosphate dehydrogenase, the GAPDH in the paper's title).  When the resulting shortage of energy inside the cell reaches crisis point, the cells die.

If the last sentence of the previous paragraph sounds vaguely familiar it’s because I’ve already written about this in a different context.  A drastically reduced food intake does of course also lead to cellular energy crises and, such is the hope behind my periodic fasting strategy, to cell death.  The point that these two approaches are synergistic is made in another paper.  Before I talk about this, I need to get into and clarify some complications.

The glucose receptor behind the uptake of vitamin C is upregulated in KRAS-mutated cancer cells.  This is why they take up more dehydroascorbate than unoxidized vitamin C, but this alone doesn’t explain the cytotoxic effect.  KRAS-mutated cancer cells reprogram their metabolism to proliferate faster.  In the process, they generate a lot of reactive oxygen species.  The antioxidant defenses that are essential for the cells to survive under high oxidative stress are inhibited by vitamin C, which contributes to the killing of the cancer cells.  It is, to make this clear, their high proliferation rate, this key feature of cancer cells that every therapy seeks to reduce, that makes them a target of vitamin C.  This is not only true for solid tumors but also, and especially, for metastatic tumor cells.  They survive the oxidizing environment of the blood by increasing their antioxidant defenses.  Vitamin C is thus expected to kill circulating metastatic tumor cells as well.  This works, as the paper shows, even when the cells are grown in normal glucose conditions.

It’s not as easy as this, of course.  One can’t take basic research and transfer it into the clinic.  What works in cell culture might not work in patients.  From the results it is unclear whether vitamin C has a therapeutic use for the treatment of KRAS-mutated cancers.  At the time the paper was published in 2015, there was an early clinical trial that looked at the effect of vitamin C in conjunction with platinum-based chemotherapy.  I haven’t had the time yet to dig into this and see what the outcome was and whether there have been related trials since then.

This post is full of information that’s not of the most easily digestible kind.  It’s probably best I stop at this point, but not before summarizing in the clearest language I can manage:

Cancer cells with KRAS mutations are killed by high levels of vitamin C.  The biochemistry works like this:

• Cancer cells primarily consume the oxidized form of vitamin C.
• The reduction of oxidized vitamin C inside the cell causes oxidative stress.
• Oxidative stress leads to the inactivation of an enzyme that helps turn glucose into energy.
• Lack of this enzyme leads to a scarcity of available energy to which cells respond by conking out.

The question of a possible synergy between vitamin C and fasting will be the topic of the next post.

Vitamin C

I’m going down a rabbit hole again.  The one paper on the synergistic effects of fasting and vitamin C that my friend sent the other day led me to download a good dozen related publications.  Reading them will take some time.  Synthesizing and condensing all the information will take even longer.  But there’s no reason not to forge ahead with what I've got already.  Let’s get started with vitamin C.  I don’t have to read papers for that.  Wikipedia and the internet in general tell me all I need to know.

Vitamin C is a fairly simple organic compound and an essential nutrient.  It is involved in tissue repair and important for the function of the immune system.  It also functions as an antioxidant, which means it can mitigate oxidative damage to proteins and DNA.  Humans – in contrast to most animals – cannot make it themselves.  It needs to be consumed with food or as dietary supplements.  For most people, a reasonably healthy diet is all it takes to get enough vitamin C.  The story could end here but it doesn’t.

Many decades ago, the great chemist Linus Pauling hypothesized that elevated levels of vitamin C give all sorts of benefits, from beating the common cold to longer, healthier lives.  His megavitamin theory keeps floating around in various incarnations that are promoted by Pauling’s acolytes to this day.  Health food stores sell big tubs of vitamin C, but the idea behind it has been debunked.

The Office of Dietary Supplements, which sounds like a Monty Python sketch but is in reality an information dispensary of the National Institutes of Health, writes that consuming increased amounts of vitamin C is of limited value.  Its tissue and plasma levels are tightly controlled.  The more vitamin C is consumed, the smaller the share that’s absorbed.  Popping more pills won’t do much.  Most of the stuff leaves the body straight away through strained kidneys.  The narrow range of allowed concentrations probably determines the antioxidant properties of vitamin C.

How can high doses of vitamin C then help the body fight cancer?  The key here is that we’re talking about intravenous administration and not oral consumption.  Put vitamin C straight into the blood, and you can reach concentrations around 100 times higher than by ingestion.  Such high levels may change the properties of vitamin C from antioxidant to pro-oxidant.  The potential generation of hydrogen peroxide with selective toxicity toward cancer cells is quite exciting.  In the next post, I’m going to dig through some of the studies of the relationship between vitamin C and my cancer.

Miracle bottle

When I returned the empty pump this afternoon, the nurse asked how it had been.  My honest answer was that I had almost forgotten about it and might have missed the appointment, had it not been for an alert on my phone.  How can this be, with a pin in my chest, a valve taped to my sternum and a plastic bottle on my hip?  The key is fasting.  What follows is exaggerated for dramatic purpose, but not very far from the truth.

The first 24 hours of the pump’s presence, the only thing I think about is food.  I’m running on empty.  Often I don’t think at all.  I hover in a semiconscious state of minimal energy expenditure.  I move slowly.  There seems to be little life in me.  The bottle is the least of my concerns.

In the afternoon of the second day, I start eating.  First a few nuts, then suddenly the entire bag.  I have a cappuccino.  Magic happens.  Life starts flowing back into me.  I gain strength.  I can move with what seems like purpose.  Colors explode around me where before the world was gray.  I couldn’t care less about the bottle.

In the evening I eat a good dinner.  I’m getting ecstatic now.  Life is so good with a full belly.  The night before I could hardly sleep, but now it’s getting midnight, and I’m not tired.  I’m sitting on my balcony snacking on cheese.  There’s dozen papers on vitamins, cancer and diet on my computer.  If I put my mind to it, I could probably read them all, but sense prevails and I go to bed.  I forget to think about the bottle.

The next day is how days should be.  The contrast to the previous morning is stark.  I am elated.  My voice has returned from its starved mutter.  I ride my bike to work and it’s fun.  The day is like any other, but I feel as if I’d just won the lottery.  Nothing can spoil my joy, and certainly not the nearly empty bottle dangling from my hip.

p>The nurse does her job with experience and tenderness.  She apologizes repeatedly for having to rip the tape from my hairy chest.  “Maybe you shave next time”, she suggests.  I tell her not to worry.  The pain is no bother.  She grabs the pin and asks me to inhale.  With one swift motion, I’m disconnected, and the bottle disappears in the bin.  It is as if I’d never had it.

Reading list

I’m lying on a hospital bed enjoying the second chemo session of the second program.  I’ve been fasting again.  The last time I ate was exactly two days ago.  There are still 30 hours to go.  The reason I’m enjoying chemotherapy is that I can lie in a bed without anything to do.  I feel pretty weak.

There are also reasons why I’m not enjoying chemotherapy.  The tiredness is one of them.  I’d much rather be energetic.  Instead of falling asleep to assorted podcasts, I’d like to read or do hospital office.  The other reason is the atropine injection I get before the irinotecan transfusion.  I don’t like needles any more than I did before I was diagnosed with cancer.

My chemotherapy takes just short of four hours.  I sleep through a good share of it.  Walking to the bus afterwards wakes me up a little.  I’m still weak but more alert.  Before I go home I stop by the grocery story for provisions for when I can eat again.  I buy cheese and olives and salami.

At home I get an email from a friend.  He recommends vitamin C and attached a paper that makes the point that fasting and high doses of vitamin C act synergistically in KRAS-dependent cancers.  This is very interesting, but I don’t feel up to reading the paper and two relevant references tonight.  Something for when I’m well-fed.

Even without reading I know that the story of vitamin C is an interesting one.  Some people take it in high doses to prevent all sorts of ailments.  Its antioxidative effect has something to do with it, I seem to remember.  I also remember that too much vitamin C can promote cancer.  Put like this, this is very confusing.  I haven’t read enough on this, but I’m open to changing my strategy as I learn more.

I might have to change my strategy anyway.  This morning, I weighed a bit less than two weeks ago.  This might be an effect of my not riding my trainer anymore.  Without rigorous workouts, I might lose muscle in my legs.  If that’s the case, my weight should stabilize soon.  If it doesn’t, it would indicate that I’m not compensating for the lost calories in the time between two fasting sessions.  This would not be acceptable.  It would not be compatible with a successful therapy.  I need to be strong.  I might have to change my diet from periodic fasting to a fasting-mimicking diet.  This is an established alternative that’s easier on the body, and it’s what was used in the paper mentioned above on the beneficial effects of vitamin C.  I’ll have a lot to read over the weekend.

More on nutrition

Back in the days, when I blogged from Grenoble, most posts were concerned with cycling.  This is how I spent much of my time outside the laboratory.  This was not to everyone’s liking.  Some friends wanted to hear from me but didn’t care so much about cycling.  Some complained to me about it.

I’m afraid this blog is shaping up similarly.  It is of course more monotopical than my previous writing.  You won’t read much beyond cancer.  This is not exactly a cheerful subject, but you know what to expect.  Or at least you thought so.  Within the limited scope of the blog, I have started to sharpen its focus considerably.  The last dozen posts have been almost exclusively about fasting.  Are you sick of this already?

I’m certainly sick of fasting, but I will use this post to summarize what I know about it and some closely related issues of nutrition.  I’m sure there’s much repetition from earlier posts, but I tend to forget things as soon as I write them down.  I could never write a coherent book of consequence.  What follows might still be worth reading.  There will be a few new things from a paper I’ve just finished reading.

The paper on the Effects of short-term fasting on cancer treatment has this statement right in the abstract:  “[Short-term fasting] reinforces stress resistance of healthy cells, while tumor cells become even more sensitive to toxins, perhaps through shortage of nutrients to satisfy their needs in the context of high proliferation rates and/or loss of flexibility to respond to extreme circumstances.”  This contrasting response of healthy and cancerous cells to starvation is called differential stress response.

Here are some of the things that happen in starved tumor cells:

• Glycolysis slows to a crawl (for lack of substrate).  Cells have little energy to sustain their obligatory proliferation.
• Oxidative phosphorylation results in oxidative stress and apoptosis.
• Increased translation drives cells to apoptosis because of unmet energy needs.
• They become more vulnerable to any kind of stress.
• High levels of reactive oxygen species raise the level of chemotherapy-induced DNA damage.
• Elevated antitumor immunity increases the efficacy of chemotherapy.

And this is what happens in healthy cells upon fasting:

• Over about 30 hours, the liver converts all stored glycogen to glucose.  It then switches to glucose synthesis.
• Circulating levels of insulin and insulin-like growth factor 1 decrease.  Cells are driven towards repair and maintenance instead of reproduction and growth.  This explains the increased resistance to chemotherapeutic agents.
• A low metabolic rate avoids oxidative stress and DNA damage.
• Hematopoietic stem cells and circulating immune cells become resistant to chemotherapy.  The patient’s immunity holds up better.

The paper goes on to describe short-term fasting as a clinical intervention in its own right.  Possible side effects include weakness and short-term weight loss.  This doesn’t really need to be spelled out, does it?  On the optimal length of fasting, the jury is still out.  The paper notes ominously that much longer periods might be required compared to what is studied in mice (24-48 hours).  If there were hard data, I’d be happy to give this a try, but for now I’ll stick to what I’ve been doing so far.

Also a bit unclear is the question of how best to break the fast.  Should I slowly ramp up or quickly eat as much as I can?  What should I eat?  A somewhat obscure reference mentions the danger of overfeeding after a period of fasting.  The glucose and insulin spikes will reaccelerate tumor growth.  How much does it take to spoil all the gains made through much pain?

A related issue is how to eat in the interfasting period.  The primary objective is regaining lost weight and strength.  The secondary objective is to withhold from the cancer what it requires for growth.  A diet rich in fat and protein but low on sugar is probably best.  But how far should I take this?

The absolute extreme is a ketogenic diet, where nearly all carbohydrates are removed.  This requires careful planning and management, great effort during shopping and cooking, and should probably not be done without medical supervision.  This is also not how I want to live.  Going without food for three or four days is not particularly pleasant.  In the intervening days, I want to enjoy what I eat.

Still, It’s probably wise to cut down on the carbs and maybe go as far as remove simple sugars.  No more chocolate, jam or ice cream.  Instead, I will have bacon and eggs for breakfast a few times a week and snack on nuts.  Against the zeitgeist and my own convictions, I will eat more meat and grease my food as much as possible.  I always knew butter was good for me.  Now it turns out I was right.  There couldn’t be a better way to end this post.

Temporary freedom

This afternoon, I went to the hospital to get my pumped unhooked.  It was a nice day.  I rode my bicycle and was decked out for a little ride in the woods afterwards, when I would be unencumbered by the pump with its meter of clear tubing from my hip to my chest.

This is not the normal way of cancer patients to arrive for any part of their therapy, but I’m not a normal patient.  Thank goodness for that.  Most of the time, I see the disease as an adventure, a challenge, a trial.  I find it easy to fool myself and draw strength from that.  Earlier today, in the first couple of hours after lunch, fatigue had swept over me.  I very nearly fell asleep on the sofa.  Riding my bike to the hospital got my circulation back in gear and my body back to life.

At the hospital, patients have to undergo a procedure that, in its absurdness, painfully reminds me of the security theater at airports, if anyone still remembers those.  When corona held Switzerland in its thrall, with around 1500 new cases a day for a short time, one had to have an appointment and was given a mask upon entering the hospital.  Visitors were not allowed.

Over the last month and a half, as the virus has retreated to a dozen cases a day, the measures at the hospital have progressively been tightened.  First, there was a wristband.  It came in many colors but without an explanation.  Then one had to show proof of an appointment and not just claim to have one.  Next, you’ll probably have to show your ID, and a member of the security team will escort you to your appointment.  It seems that the pandemic team at the hospital or the canton is trying hard to keep the product of the level of threat and the extent of the countermeasures a constant, instead of designing the measures to be proportional to the threat.  It is hard to take this seriously at this point.

Once I had made it inside, furnished with a green wristband and a deteriorating mood, I wandered through deserted hallways in eerie silence.  It was a holiday, and the ground floor of the hospital appeared abandoned.  The outpatient clinic should have been closed, but a nurse had come in briefly for a few patients with undeniable needs.  There was no receptionist and no clear indicator of where to go, but with only a few rooms, I checked them out one by one until I was welcomed.

As the nurse did her work of removing the pump, flushing the lines and unhooking the needle from the port in my chest, she quizzed me on how I was feeling.  Word had got around that I’m fasting.  The nurse wanted to know about side effects, how long I had been fasting and whether I had eaten.  I felt like a minor celebrity during the ten minutes it took the nurse to send me to freedom.

I am a bit disappointed that the doctor so strongly in support of fasting hasn’t shown yet.  I half expected him to wander in during my first chemo session, to see how I was doing.  I would like to thank him for his support and shout abuse at him for making me suffer.  It would also be interesting to have a longer chat to see if he had any insights that I missed.  Not to worry, there’s plenty of time left for that.

Ready to rest

This afternoon, my third period of serious fasting came to an end.  I can’t say it was a minute too early.  Sticking with the regime of not eating was much harder than the first two times.  The fast felt quite a bit longer.  Mathematically, it was only about eight hours more.  But it stretched over four days instead of three which, mentally, put an additional strain on me.

The two times before, dinner had been my last meal.  Sleeping through the night had then emptied my batteries and surely put my metabolism into some sort of resting state from which I awakened it only two-and-a-half days later.  My body had already settled in before I consciously started fasting.  The first twelve hours were over.  This time, the fast had started after breakfast.  My body was readying itself for a regular day and had no idea of what was coming.

Then there was the chemo.  This can’t make anything easier, even if it – as it does in my lucky case – doesn’t make things much harder.  I was warned of new side effects, in particular diarrhea and excessive sweating.  To keep the sweating at bay, they gave me a shot of atropine – a substance not too dissimilar in effect from what Socrates ingested to end his life.  I didn’t sweat but have no idea whether that was because of the injection.  There was no control.  And diarrhea?  How do you do that with guts thoroughly emptied over two days?

The one effect that I noticed is that I got very tired.  In the second half of the therapy session, I fell asleep while nurses were fiddling with tubes entering my body.  It’s a good way to undergo therapy, but it’s hard to get up and go home afterwards.  On the way, I had to pick up the boy from childcare.  At home, I went to bed as soon as Flucha and the girl arrived and relieved me of child-minding and in particular child-entertaining duties.  I didn’t sleep but had no energy to do anything but rest.  And obviously I wasn’t eating.

In the end I slept rather poorly because my legs tingled with tiredness and what I interpreted as the onset of protein breakdown.  The worry that my body is eating the muscles I built over the past half year didn't give me any peace.  I will need to follow the doctor’s advice and eat lots of protein and especially fat to build up reserves in the ten days between two fasting periods.

I’ve read repeatedly that fasting dampens the side effects of chemotherapy because the starving cells are in their own version of lockdown and resistant to drugs that target rapidly dividing cells.  In line with this, I didn’t feel any discomfort beyond what fasting does to me.  There’s a slight taste of the fluorouracil in my mouth, but that’s really it.  Have I mentioned how lucky I am?  I wouldn’t survive three sessions of chemo with serious nausea, loss of appetite and persistent diarrhea.

Today was not quite as bad as yesterday.  I shrewdly cut my day in half, with a morning at  home – one tea, no food – followed by an afternoon in the office – one tea, no food.  This made the day seem much shorter.  When I arrived in the office, I had to contend with the impossible temptation of an open box of Cailler chocolates that a generous colleague had deposited behind my desk for everyone to share, but then I spent most of the afternoon in meetings.

As the minute hand slowly crawled into the fifth hour, I broke my 78-hour fast.  I was more exhausted – physically and mentally – than hungry and in a kind of stupor.  I finished half a bag of nuts I had in the office and dug into the chocolates, rather mechanically and without real enjoyment.

Tonight, Flucha cooked a fine dinner of tuna steak, princess potatoes and green beans which, remembering my doctor’s words, I generously drenched in butter.  A heavy dessert topped it off, and I was almost full.  A jar of olives and a few thick slices of chorizo de bellota got me through the evening.  I’m still carrying the pump but a restful day lies ahead.  I’ve come to appreciate these a lot lately.

Fate

In parallel with the recent bad news of continued chemotherapy and my infatuation with fasting, I’ve received many messages of support, praising my strength and will to fight.  I appreciate all of them.  Every warm word lifts me up a little.  Unfortunately, they’re all slightly misguided.  I am not a strong person.

I tend not to pursue goals with purpose.  If I’m not ahead, I give up easily.  I slack with passion.  The rigors of prolonged fasting are obviously not something I enjoy.  I’d much rather not do it, but the alternative is grim.  I have to fast because the situation requires it.  Everyone in my position would do the same.

Fasting for three days requires strength and determination if it is done for nebulous reasons like well-being, detoxification or elusive weight loss.  Fasting out of necessity doesn’t.  If there is no alternative, one can’t give up.  I keep going, no matter how painful it is.  How could a little hunger or lack of energy make me lower my chances of beating the cancer and, eventually, surviving?

In the Michael Jordan documentary I mentioned a few posts back (and which was about eight episodes too long), MJ is characterized as a man who most emphatically lives in the present.  No thoughts for things that might go wrong in the future, no regrets for actions taken in the past that weren’t exactly right in retrospect but needed to be taken in the moment.

Seeing this focus on the moment presented as something positive, as the key to his success even, surprised me a bit.  I’ve come to take it for granted that my goals for the next five years are frequently probed.  In contrast, Michael would never worry for a second that a shot he hadn’t taken yet might miss the target.  For Michael, the goal was always to play the best basketball possible.  This can be applied to the next fives years, but it’s not exactly concrete.

I can identify with this.  I fight the cancer during each chemotherapy session as much as I can.  I don’t worry about the outcome.  I don’t think about the sessions ahead.  Things are happening now.  This is where I have to be, and this is where I am.  I also don’t think about the cancer between the sessions.  This time is for recovery.  This attitude helps me not be overwhelmed by hopelessness.

I can take it one step further, and use it to explain how fasting doesn’t take any strength.  I’m a fatalist at heart.  Things happen for a reason, and we all have to deal with them.  Fate has handed me colon cancer, but this is not something dispiriting.  I don’t lose my mind questioning it.  I simply reinterpret this fate and see it as something positive.

And so it has become my fate to fight this cancer and to do everything I can to beat it.  As much as it hurts, I accept this fate and take the actions demanded by it.  I fast for three days until my legs tingle with weakness and my brain becomes jelly.  If that’s what it takes, that’s what I’ll do.

Round three

Tonight is the last night before the third round in my battle against cancer begins.  Cycling metaphors won’t do anymore.  Two wheels can cause a lot of suffering, but this is bigger.  It’s physical now.

The first round was the operation, a.k.a. knife therapy.  I came out ahead, I think.  The cancer was gone, from looking at it.  It had taken a serious hit and suffered great losses.  The tumor was removed, the metastases had been scraped out, but I had also lost half of my colon including the appendix, my gallbladder, a bunch of lymph nodes, and my omentum.  The cancer was down, but it wasn’t out.

During the second round, twelve sessions of chemotherapy stretching nearly half a year, the cancer staged a comeback.  It recovered its forces and landed devious punches that I didn’t notice.  I was lucky they didn’t knock me out.  It’s clear that the cancer has regained the upper hand.

For the third round, I’m stepping up my game.  I feel at full strength and am ready to suffer for an eventual victory.  The first chemo program was easy.  This one probably won’t be.  I will start to fast for 80 hours from tomorrow after breakfast.  Two days later, they will start putting chemicals in my blood in the outpatient clinic at the hospital.

A few hours later, I will be allowed to go home, carrying a pump that will release more chemicals over the course of two more days.  The doctor recommended I break the fast only after 24 hours on the pump.  This means dinner on Wednesday as the first meal after breakfast tomorrow.  I will skip three breakfasts, four lunches and three dinners.

This is not for the faint of heart.  Three-and-a-half days of fasting wears you out.  It exhausts your body and drains your reserves.  I don’t have much to offer in terms of fat metabolism, but I will come through.  I’ve just stepped on the bathroom scale.  At 64.5 kg, I’m at my heaviest ever, 2 kg more than at the beginning of the first chemotherapy program.  My body has something to feed on for the next few days.  The cancer cells – being reliant on glucose and unable to moderate their frenzied proliferation – won’t.  They won’t be much of an opponent for the chemicals this time.

The chemo program that’s about to begin will again run for twelve sessions.  All things going according to plan, the last one will be in the middle of November.  I’m already looking forward to December, to a PET-CT that will show no pathologic activity, the cancer cells all purged from my body.  It will be a merry Christmas indeed.