Low spirits

Another two weeks have passed.  I’m back in the hospital for the fourth chemo session.  When this week is over, the first third of my second treatment program is history.  I have no idea how it is going.

I’m doing well.  I can’t complain.  I still don’t suffer side effects.  Over the course of the last two weeks, there was nothing to report out of the ordinary, which is one reason why I didn’t blog once.  Another reason is that I didn’t read anything interesting.  The third reason was the hot phase of birthday season.  Oma was in town to celebrate the birthdays of the boy and the boy’s father and, quite spectacularly, her own.  It was a busy week, with lots of activities, laughter, excitement and noise.

Throughout, I felt normal, happy, healthy.  With Oma, I hiked through the snow to a lunch spot at 12’000 feet, a glacier under my feet.  Family time was intense, especially when my sister made an unexpected appearance with her family over the weekend, but it was also good.  We don’t do this often enough.  I have no way of telling how I’m doing beneath all this, inside.

Is the therapy effective?  Is it pushing the cancer back?  Without side effects, it’s easy to think that the therapy doesn’t do anything positive either.  A clinical trial where I made the placebo group wouldn’t feel much different.  But I’m also fasting, and there I see clear effects.  Something is happening inside me.  I’m optimistic enough enough to be sure that I’m beating the cancer.

It is curious how my body has adapted to the fasting.  The second day used to be hard.  I couldn’t think of anything besides food.  I wasn’t hungry but suffered constant cravings.  It wasn’t pretty.  Now the second day is just like the first.  I slowly lose energy but that’s easy to accept.  It’s harder to keep the exhaustion from turning into surrender.  It’s a small step.  It would be so easy and so satisfying to just break the fast.  Sometimes I wonder whether, to put it overly dramatic, giving up a week of life each month is worth it.  There are no guarantees.

Another thing that bothers me about fasting is that I get rather irritable and obnoxious by the end of the second day.  I cease to be a pleasant person to be around.  The children deal with this in their lovely innocent way.  They just make more efforts to make me happy and show me their love.  For Flucha, who is also exhausted after work and housework or after dealing with the children all day, it’s more difficult.  She is almost as stubborn as me.  We end up having fights where we shouldn’t.  This drags my spirits down.  I want to eat again and go back to being the person I know.  This is not always the person I would like to be, but immeasurably better than the fasting caricature of myself.

Overall – and no matter how Flucha suffers from it – these are minor issues.  I also have problems with the solidity of my excretions.  Subsisting on water does that to you.  Again, this is not a big deal.  It resolves itself when I start eating again.  What really matters is that I’m beating this cancer.  For this, I’ll do and endure anything.

Five and three

Today was my third chemo session of the second round.  It was and still is surrounded by my fifth fasting period.  Almost everything went as before.  I continue to experience no side effects.  The nurses give me three pills to swallow at the beginning of the therapy and then an injection before they give me irinotecan.  It would be interesting to see how things go without those pills and the injection, but as they go well with them, I see no point in challenging the regime.  Fasting is said to help mitigate the side effects, but I don’t want to explore if it’s enough to replace the pills and the injection.

Fasting is easy.  It’s like not fasting, except you don’t eat.  Fasting is entirely passive.  There’s nothing to do.  I just don’t eat and wait for the period to end.  It also gets easier with time.  This time around I don’t have burning cravings for food.  I’m exhausted and feeble, but I don’t suffer.  When I first tried fasting, the second day was a mighty struggle.  It was tempting to quit.  Now I’m almost cruising through, though it is certainly not pleasant.

I am looking forward to breaking the fast each time.  Fasting and the desire to break it have a curious upshot.  The chemotherapy sessions have become something to look forward to.  Chemo allows me to lie on a bed for five hours with absolutely nothing to do.  It’s relaxing.  I tend to sleep.  There’s nothing negative to it.  Even the atropine injection doesn’t scare me.  And the end of the therapy at the hospital, when I go home with the bottle of fluorouracil, marks the beginning of the last 24 hours of fasting.  This fills me with joy.  As strange as it sounds, chemotherapy has become the highlight of my week.

I like to eat, but eating has become difficult for me.  I’m trying to square several conflicting objectives.  I need to regain the weight I lost during fasting.  I need to eat healthily, though maybe that’s the least of my worries at the moment.  Heart disease and diabetes wouldn’t be high up on my list of worries if I kept one.  And I need to starve the tumor of energy it can use and of growth factors.  How to get the balance right?

The solution I’ve come up with is threefold.

• I consume lots of fat.  It took me a while to dial this in, but I think I’m getting there now.  There’s good fat and bad fat.  Bad fat, essentially trans fatty acids, should be avoided.  They are in fries and industrially-produced baked goods.  I don’t eat much of either.  Good fat comes from vegetable oils.  Drenching your food in oil is a good idea if you want to gain weight.  Olive oil is great, but adds a strong flavor that doesn’t always work.  I’ve come to like rape seed oil for its milder taste, and I appreciate that it’s probably healthier than butter.  Strange that I would suddenly construct my diet based on what’s healthy instead of what tastes good, but these are the days.
• Protein is good.  When I come back from a bicycle ride, especially one that involved climbs, I consume a big protein shake.  Out of my enthusiasm for fat described above, I mixed the shake with heavy cream instead of milk the other day.  Not a good idea.  The mix quickly became sort of solid in the blender.  I could spoon it out, but it wasn’t what I had expected.  Meat also gives lots of protein, and it tastes good.  I have already substantially increased my meat consumption.  It’s now a race between me and the world.  Who’s going to die first?
• Carbohydrates are ambiguous.  They are necessary for brain function and generally the primary source of energy.  In an effort to starve the cancer even in the inter-fasting periods, I tried limiting my carbohydrate as much as possible after the previous chemo/fasting session.  This wasn’t too hard, but the effect was.  I didn’t feel good.  I didn’t feel myself.  I need carbohydrates.  But I will avoid simple sugar, which lead to an immediate and strong spike in the levels of insulin and insulin-like growth factors.  Is there a way to blunt this spike?  With family birthday season – all within a month and a half – in full swing, this is a difficult thing to do.

Fat and protein are easy.  There are clear advantages and few drawbacks if you do it right.  I don’t have to change my eating habits much to do things right.  Carbohydrates are difficult.  I’m still very confused about their effects.  Not being a nutritionist doesn’t help.  Unfortunately, my hospital doesn’t have any nutritionists that specialize on the importance of diet for cancer.  This is almost criminal, but nothing I can change.  The only thing I can change is my understanding.  I need to read more.

Gaining weight is very difficult.  From looking at the world and the women’s magazines near the checkout at the grocery store, this can’t be true, but for me it is.  I still haven’t stabilized my weight between chemo sessions, which means I’m not regaining all I’ve lost during the three-plus days of fasting.  I’m still above my weight back in Utah, but not my much, and it’s worrying me.  I don’t want to have to stop fasting.  I’m convinced that fasting is good for me.  But how do I gain enough weight to stay stable over time?

What do people do to gain weight?  There are no magazine covers that address this question.  Eating crap and not moving much probably has a lot do with it.  I’m not much into either.  What do I do?  A bit of crap probably doesn’t hurt, and maybe I can move a little less.  It was probably not a good idea to go on a 20 km bike ride on Monday in search of gloves lost the previous day on a family outing by the river – not just on an empty stomach, but on a stomach that had been empty for 24 hours already.  Maybe I should take the bus to work or the hospital from time to time.  Maybe I should think less.  This uses a lot of energy.

I am trying to find a balance more than I ever have in my life.  To some extent, my life hangs in this balance.  There is obviously no guarantee that anything I do will make the slightest difference in the end, but the possibility is there, and I would be foolish not to try my hardest.  Brace yourselves.  There will be more posts on nutrition in the future.

Fake fasting

Over the past few days, I’ve mostly stuck to a low-carbohydrate diet.  I've had protein bread and peanut butter for breakfast, lots of nuts during the day and a vaguely keto dinner at night.  I've gone without chocolate, sweets or ice cream, and I’ve dropped the sugar that used to sweeten my espresso after lunch.  It’s been a strange experience.

After reading about fasting and vitamin C (and also watching the Arte documentary that my friend had in mind when he recommended fasting late last year), the thing that remained was finding out about the fasting mimicking diet that was shown to act synergistically with vitamin C.  It’s not that fasting is an unbearable burden, but if the same end can be achieved with less drastic means, I’d probably go for it.

I had great hopes in the read, but A periodic diet that mimics fasting promotes multi-system regeneration, enhanced cognitive performance, and healthspan is a dubious paper, to say the very least.  There are some fasting yeast, old mice that might live longer and navigate a maze slightly better than their well-fed companions, and a small number of humans that might have been fasting.  Their blood sugar and insulin levels indicate so.  The consequences are unclear.  There is no data.

The paper would be only half as pointless if it managed to explain the diet that mimics fasting (and made it into the title of the paper).  It doesn’t.  It’s not just short of detail, it’s free of any useful information.  Empty waffle, such as plant-based, calorie-restricted, low sugar, low protein, and high-fat, is presented as if it were informaion.  What does any of this mean?  Where are the numbers?  Where are the recipes or at least meal plans?  What did the volunteers who were not quite fasting do?

There are some numbers.  During fasting cycles, the volunteers restricted their caloric intake by between 46% and 66%.  Their diet was around 10% proteins, 50% fat and 40% carbohydrates.  That seems like an awful lot of carbohydrates.  And how do you get 50% from plants?  An avocado is 60% fat, but how many can you really eat over a three day period?  What did the volunteers eat?

The paper mentions “proprietary vegetable-based soups, energy bars, energy drinks, chip snacks, chamomile flower tea, and a vegetable supplement formula tablet”.  What is a chip snack?  Where do the vegetable supplement formula tablets come from?  Chamomile flower tea?  Are these guys just taking the piss?  It seems they are.  They refer to Table S4 as if it meant something, while all it contains are the same meaningless numbers that were already mentioned in the text.

Do you need a table for this?

How you get something with such shitty methods published is beyond me.  Who reviewed this paper?  It’s effectively impossible to replicate the experiments.  It’s as if I reported a crystal structure and wrote that the protein was crystallized in chemicals.  The authors dare to write that “the components and levels of micro- and macro-nutrients in the human FMD were selected based on their ability to reduce IGF-1”, but are silent on what these levels or indeed the nutrients are.  This is not science, it’s bogus.  And what are “proprietary vegetable-based soups”?  Where do they come from?  Does Fasting mimicking diet® have its own webstore?  Is this a scam?

It’s hard to tell.  Valter Longo, the senior author of this paper and many others on the beneficial effects of fasting, including the most recent connection to vitamin C, has written a book about what he calls the Longevity diet and put together a website to promote it.  You can even find some recipes there.  They don’t look particularly special, though.  How is eating these meals like fasting?  What has been removed from a normal diet besides a few calories?

This fiasco with FMD made me question what I’m doing.  I will for sure stick to my rigorous fasting regime where I understand the biochemical reasons for its beneficial effects.  On Monday, I’m starting another 80 hours.  But I have given up on the low-carbohydrate diet.  It made me feel sluggish and weak, almost as if I were still fasting.  If you can mimic fasting on 40% of carbohydrates, I shouldn’t deprive myself of them when I’m refeeding.  Apart from the sugar, I’m now back to normal with my diet, and I feel much better already.