Lead: Eleah Stringer

We know that food choices can impact cancer risk, but what if the timing plays a role as well? 

Over the past several decades, overconsumption of food has contributed to an increase in a number of diseases, including cancer. 

  • What if disease progression could be slowed down—or even reversed—by fasting?
  • Could these trends improve the response of cancer to chemotherapy?
  • Could simply changing one's eating patterns to reduce overall dietary intake be a successful strategy prevent and/or manage cancer?

Investigators are undertaking new initiatives to study how nutrition and dietary behaviours affect people with cancer to answer these important questions.

Background:

Thirty to fifty percent of all cancer cases are estimated to be preventable through adoption of healthy lifestyles and avoidance of environmental carcinogens and infections (“A Summary of the Third Expert Report", 2018). This evidence suggests that diet plays a significant role in cancer prevention and has led to the development of population-level, evidence-based dietary recommendations to minimize cancer risk. However, individuals can experience different responses to the same diet. As reported by De Roos and Brennan in their 2017 study, Personalised Interventions-A Precision Approach for the Next Generation of Dietary Intervention Studies, this variability “may result from a range of determinants including age, sex, habitual dietary habits, genetics, epigenetics, and gut microbiota. This will affect the absorption, distribution, metabolism, and excretion of compounds and metabolites, and thus affect bioavailability and biological responsiveness (De Roos & Brennan, 2017), which may hold implications in cancer.
 
As described by Locasale & Cantley (2011) and Hirschey et al. (2015), in the process of oncogenesis, cells undergo a complex metabolic rearrangement resulting in dysregulation of cellular metabolism—a hallmark of cancer. This metabolic dysregulation can be exploited as a target for cancer treatment (Hirschey et al., 2015). Understanding the intersection of metabolism, dietary profiles, and the gut microbiome holds potential to uncover acceptable and feasible nutrition interventions that are clinically beneficial, safe, and less toxic to be used in adjunct to our current standard of care

A review of clinical trials on intermittent fasting in cancer can be found here: https://pubmed.ncbi.nlm.nih.gov/35639262/

 

Study 1 - Feasibility Study of Intermittent Fasting in Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (CLL/SLL) Patients at BC Cancer- Victoria

Summary

Under the watchful eye of Dr. Nicol MacPherson (Medical Oncologist and Principal Investigator) and with autophagy studies and metabolomics led by Dr. Julian Lum (Cancer Immunologist), our investigators examined the effects of intermittent fasting (IF), also known as time restricted feeding, in patients with Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL). CLL and SLL are considered to be one disease with different manifestations. It is the most common leukemia in adults in Western countries, is most often diagnosed in older adults, and is presently incurable. The advantage of choosing this patient population is that the cancer is easily assessed with a blood test measuring the amount of cancerous white blood cells (lymphocytes). With the support of an Oncology Dietitian, participants constrained their daily food consumption within an 8-hour window. This was maintained for six days per week, for a duration of either 3 or 6 months. Participants did not need to limit their total caloric intake or follow specific food recommendations.

Through a series of blood tests, stool samples, and qualitative surveys, this study investigated the biochemical effects of IF on CLL tumour control and autophagy induction by using a case-controlled study of CLL/SLL patients at BC Cancer- Victoria. The study also quantified the duration of the biochemical effects after completing the IF.

Sponsorship

This research is generously funded by the Grewal family and the BC Cancer Foundation.

Status

This study was completed in October 2022. Please send any questions to Eleah Stringer (Research Lead) at eleah.stringer@bccancer.bc.ca 

Read the pre-print of the results here:  https://www.medrxiv.org/content/10.1101/2024.12.16.24319108v1 

 

Study 2 - Does timing matter? A case crossover study of intermittent fasting in patients with CLL/SLL at BC Cancer- Victoria

Summary

We know that food choices can impact cancer risk, but what if timing plays a role as well? Evidence shows that fasting may slow cancer growth via a cellular degradation mechanism called autophagy. Our team is currently completing a study investigating the effects of intermittent fasting (IF) in patients with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL).  Intermittent fasting will be maintained for three to six months by splitting the day into 16 hour fasting and 8 hour feeding windows. While early results look promising, we do not yet know how other fasting methods compare, nor do we know which fasting method is preferred by patients.

We plan to compare two common IF routines to see if they exert differential effects on tumour proliferation (lymphocyte count), markers of autophagy, inflammation, and gut bacteria-derived metabolites. We also want to learn which strategy patients prefer.

Sponsorship

This research is generously funded by the BC Cancer Foundation.

Status

This study began fall 2022. Any questions can be sent to Eleah Stringer (Research Lead) at eleah.stringer@bccancer.bc.ca 

 

Study 3 - Does timing matter? A trial of intermittent fasting in haematological malignancies

Summary

While new and emerging evidence continues to support a myriad of health benefits with intermittent fasting (IF), randomized control trials in cancer patients remain scant (Giannakou et al., 2020). Additionally, there is a paucity of literature on adherence and acceptability of IF. Understanding the patient experience with these dietary interventions is paramount as “non-adherence to lifestyle changes raises an important issue since adherence level to dietary advice is a key determinant of the effectiveness of dietary treatment” (Desroches et al., 2011). Furthermore, the study team is unaware of any precision nutrition research that directly investigates the clinical and cellular response of IF while considering the patients’ safety, experience, and quality of life. Though our feasibility work appears promising, results will not be quantified to statistical significance, limiting the confidence in findings. 

This research will statistically clarify the impact of IF on clinical outcomes (e.g. lymphocyte count), correlative biomarkers of autophagy, quality of life, and the gut microbiome while describing the patient experience. Sex and gender will be integrated in this research to enhance gender-equity. 

Sponsorship

This research is generously funded by the BC Cancer Foundation, the Lum Lab, Michael Smith Health Research BC Health Professional-Investigator Award, and the Lotte & John Hecht Memorial Foundation.

Status

This study is anticipated to begin in 2025. If you have been diagnosed with CLL/SLL, are not receiving anti-cancer treatment, live in British Columbia, and would like to receive an update when the study is open for recruitment, please email Eleah Stringer at eleah.stringer@bccancer.bc.ca. 

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