 Changes in your diet not only affect you physically, physiologically inside, but also mentally, how well you think, psychologically, how well you feel. But you'll never know just how good you can feel until you put it to the test and try eating healthier. Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger. Today we follow a fascinating case study on the reversal of stage 3 cancer with fasting. After a cancer diagnosis, the focus is understandably on monitoring the spread and resurgence of the cancer. But patients often also want to know what additional steps they themselves can take to support their body's fight. Previously addressed what to eat after a cancer diagnosis, what about eating nothing at all? Fasting is purported to ameliorate cancers, but to support such claims, they cite studies like this on castrated mice. That's because there are no human studies of efficacy, though there are a few case reports. For example, water-only fasting and exclusively plant foods diet in the management of follicular lymphoma. Traditional chemotherapy has been the mainstay of treatment for follicular lymphoma, but in the majority of patients, the cancer surges back within a few years, and the chemo is associated with immediate and enduring toxicities, including secondary malignancies, meaning new cancers caused by the chemo drugs themselves, raising the question of whether chemotherapy should be abandoned for the disease. OK, so anyway, 42-year-old woman presented to her primary care provider with palpable mass in her groin was immediately sent for a CT scan. Surgical biopsies confirmed the diagnosis of a low-grade follicular lymphoma. They then found involvement in the lymph nodes in her armpit, which would make it a stage 3, meaning spread throughout the body. Because it didn't appear to be aggressive, she was just advised to follow up every three months to monitor its spread, but she didn't want to just sit around, so she contacted the Trudan Earth Health Center in California to explore medically-supervised water-only fasting. She never smoked tobacco, but she had consumed the standard American diet. So they started her on a whole-food plant foods diet free of added salt, oil, and sugar. Then she did 21 days on water only, before transitioning back to a diet of minimally-processed plant foods, including fresh raw fruits and vegetables, steamed and baked vegetables, whole grains, and legumes, in about an ounce a day of nuts and seeds. OK, so what happened? On physical exam, her cancerous lymph nodes seemed to be shrinking, and indeed, on CT scan, her enlarged nodes shrunk up to 90%, and no longer seemed to be active before and after. What could it have been? I mean, she did lose weight about 20 pounds, but follicular lymphoma does not appear to be associated with obesity, nor does BMI appear to affect clinical outcomes. It's possible the plant-based diet alone helped. Follicular lymphoma is the second most common type of non-Hodgkin's lymphoma, which itself is the most common type of blood cancer in adults. Iron takes of dietary fiber, whole grains, and several fruits and vegetables are reported to reduce the risk of non-Hodgkin's lymphoma, whereas animal-derived proteins and fat and meat and dairy may increase it. A dietary pattern high in meats, fats, and sweets was associated with three times the risk of follicular lymphoma, or just the fat and meat associated with up to five-fold higher risk. But why? The thought that foods of animal origin may increase the risk of blood cancers originated from the frequent finding of an increased incidence among people who are occupationally exposed to animals and meats, like livestock and poultry farmers, butchers, and slaughterhouse workers, must be acknowledged that animal foods are a potential source of infection by cancer causing viruses. But it may just be the animal protein-excessive consumption of animal protein. It may encourage malignant changes through chronic persistent stimulation. The thought is that continuous exposure to these foreign proteins may act like a chronic irritant. The animal protein theory is bolstered by the fact that straight protein, casein milk protein, increased the number of lymphomas and rats, but that doesn't mean the same applies to people. Maybe it's the hormones and antibiotics contained in meat or just the saturated fat, which may both impair the immune system and promote chronic inflammation, which may play a role in lymphoma. And it appears to just be animal fat consumption, so maybe it's just like something building up in the animal fat. There may be a link between exposure to industrial pollutants and non-Hodgkin's lymphoma. And food, especially meat, milk, and fish, is the immediate source of almost all dioxins and PCBs in the general population. Dioxin-like pollutants build up in animal fat, which can then be passed along to consumers. Vegetarians may only be exposed to about 2% of the dioxin dose compared to the general population. The highest single levels in the US have been found in chicken. But thankfully, the contamination levels are declining in all meats across the board. Furthermore, consumers may further reduce exposures to dioxin-like compounds by trimming fat before and after cooking and by thoroughly draining fat from cooked meat. What about buying organic meat when it comes to carcinogenic contaminants? The difference between organically and conventionally produced meats were surprisingly minimal, exceeding the maximum limits regardless of what kind of meat we buy. Strangely, not only does the consumption of organically produced meat not diminish the carcinogenic risk, but for some meat it appeared even worse. What can decrease your exposure to fat soluble pesticides is fiber, and then our good gut floric end turn fiber into butyrate, which absorbs back in our body from the colon and acts as a tumor suppressor, demonstrated in more than 100 published studies, including protecting against lymphoma. It also has potent anti-inflammatory effects that may help explain why fruit and vegetable consumption has not only been associated with decreased risk of developing lymphoma but also been linked to improved survival. Maybe it's all the antioxidants in plant foods, which appear protective when it comes to follicular lymphoma, but not necessarily when in supplement form. Vitamin C intake from foods, for example, may be protective, but not from supplements. Some of the reasons that lymphomas and cancers of the bone marrow tissues are significantly lower in vegetarians and vegans is not just because of what they're avoiding, but all the goodies that they're getting more, the phytochemicals and antioxidants and fruits and vegetables may inhibit tumor progression via variety of mechanisms beyond just the potential adverse effects of meat. Given the link between fruit and vegetable intake and lymphoma survival, maybe a lymphoma diagnosis can be an important teachable moment to improve diet in patients. That certainly seemed to be the case here at her six- and nine-month follow-up. She reported strict compliance with her whole food plant-based diet and her lymph nodes remained unpalpable. Okay, but this was published 2015. How's she doing now? We'll find out next. In 2015, a remarkable case report was published, in which a woman with stage 3 follicular lymphoma underwent a medically supervised 21-day water-only fast, after which her enlarged lymph nodes were substantially reduced in size. The patient then remained on a whole food plant-based diet and at six- and nine-months follow-up visits, she remained asymptomatic. In 2018, her three-year follow-up was published. Remarkably, she appeared to remain cancer-free. Confirmed by CT and PET scans, her cancer appeared to have been knocked down and out. The initial regression has persisted for three years, with no additional intervention other than the dietary change. Could it have just been a coincidence? Sure, but the initial regression directly coincided with the timing of her water-only fast. Suggesting a causal relationship and there are biological mechanisms by which fasting may potentiate tumor regression, such as decreasing levels of IGF-1. The term spontaneous regression of cancer is a misnomer. Obviously, there was something that caused the regression, whether or not we know what it is. Presumably, the immune system plays a role. The fact that you can get a market increase in cancer rates when your immunosuppress suggests that cancers are popping up all the time, but your immune system is normally able to keep them at bay. There was an example, for instance, of a regression after a transfusion of blood from a patient who had previously sustained a spontaneous regression, or cases of patients who had been free of metastases for 15 or 20 years only to develop rapidly fatal metastases after some type of stress or shock that apparently sharply reduced their resistance. For most cancers, spontaneous regression is exceedingly rare, but lymphoma is an exception. Of 140 cases of nodular lymphoma, which is what they used to call follicular lymphoma, there were 18 cases of at least partial and 6 cases of complete regression. So like 1 in 25 cases just go away on their own. So when you have follicular lymphoma cases, in which tumors shrink after any kind of treatment, in this case after some herbal supplement, you always have to ask, is this cause and effect or just coincidence? Elevated natural killing activity may be one of the possible mechanisms responsible for a spontaneous regression of malignant lymphoma. Natural killer cells may be part of our first line of defense against cancer by destroying tumor cells. And if you compare the natural killer cell activity of those with malignant lymphoma that spontaneously regressed versus those whose cancer didn't or control group, the spontaneous regression group do seem to be on the high end. How do we increase natural killer cell activity? Exercise can do it unless apparently you're eating a high fat diet. Those randomized to undergo an exercise training program on a high fat diet actually suffered a decline in natural killer cell activity, suggesting training on a high fat diet is detrimental to the immune system. Eating lots of contaminated fatty fish may also adversely affect NK cell levels, but put people on a low-fat diet. And you can dramatically increase natural killer cell activity within a matter of months by about 50%, suggesting that dietary fat might increase the formation of cancer by depressing the tumor surveillance capacity of the immune system. The bottom line in terms of fasting is that at present long-term fasting and cancer treatment is supported only by some case reports. So more research desperately needed. Sadly, there is no current clinical research evaluating the effects of water-only fasting in a whole-food plant-based diet, on follicular lymphoma in humans. Long-term fasting is certainly not without a risk. In this case, a guy opted to try a 60-day fast instead of chemotherapy for non-Nahogians lymphoma, ending up hospitalized in a coma and respiratory failure because of Wernicke and cephalopathy, a life-threatening neurological emergency caused by thiamine deficiency. But starting on a healthier diet seems like a win-win, no-brainer. Just putting people on a plant-based whole-food, you know, sugar-oil-solve-free diet with or without fasting is sometimes sufficient to induce an intense, healing response. We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to nutritionfacts.org-slash-testimonials with may be able to share it on social media to help inspire others. If you'd like to see any of the graphs, charts, graphics, images, or studies mentioned here, go to the Nutrition Facts Podcast landing base there you'll find all the detailed information you need plus links to all the sources we cite for each of these topics. My last two books were a How to Survive a Pandemic and my How Not to Diet Cookbook. Get ready this year for the launch of How Not to Age and of course all the proceeds for the sales of all my books goes directly to charity. NutritionFacts.org is a non-profit science-based public service where you can sign up for free daily updates on the latest new nutrition research with bite-sized videos and articles uploaded nearly every day. Everything on the website is free. There are no ads, no corporate sponsorships, no kickbacks, it's strictly non-commercial, not selling anything. I just put it up as a public service as a labor of love as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.