Fasting and TKIs

2/12/2002

Day 3 FMD

weight 171.7 pounds = 77.88 kilos

As I suspected, yesterday's leg workout most likely accelerated my entry into keto/autophagy.

Very little hunger today. Very alert. Very energized. I now know what people mean by the euphoria. Gym session was not much different than when my caloric intake is high.

Sprycel arrived in the mail. Will start my 100mg per day regimen tomorrow. I worry 100mg is too aggressive. Will monitor my next lab and go from there.

Morning: 2 cups black coffee with nothing added

Skipped breakfast and lunch.

Gym: I was running late so skipped cardio. Did approximately 45 minutes of vertical push/vertical pull supersets; first unilateral, then bilateral. 30 minutes in sauna with stretching.

Also had time to go shopping so added kale and red bell peppers to my meal. Store did not have brazil nuts but did pick up a multivitamin

Only had 5 pieces of walnut because of the tomato soup with chopped onions and kale I had today. Also had 2 tbsp apple cider vinegar.

Otherwise, the food is the same as yesterday.

30 broccoli florets, chopped up 40 minutes or longer before steaming. This process supposedly activates the sulforaphane. To further enhance the sulforaphane, I sprinkle at least 1 gram of mustard seed powder.

1 cup broccoli sprouts

1 cup of carrots.

Broccoli, sprouts, and carrots topped with 4 tbsps of balsamic vinegar.

Eaten separately from the above is half cup kimchi for the benefits of fermented vegetables.

1 tbsp nutritional yeast

7000 IUs D3

1 multivitamin

Approximately 4 liters of water throughout the day. Increasing himalayan salt to approx 3/4 tsp (not all at once) at various times did help.

Scuba, thanks for dropping by. Yes, I'll definitely post my next bcr-abl.

I'm also going to closely monitor if I get the dreaded pleural effusion while on sprycel. According to the pharmacist I spoke to, this occurs to about 20-28% of users.

If I end up being in that unlucky group, I'm going ask to be put on another TKI. Hell, I'll demand it.

Also going to follow your lead and order some turmeric/black pepper capsules. As I go back in my 6-month bosulif history, the numbers were promising when I: 1) supplemented with turmeric; 2) spent time outdoors during the summer. Well, I stopped doing both several months ago and perhaps it's no coincidence the bcr-abl spiked to scary levels.

Update

After some research, I believe what I am experiencing today is keto flu

If anyone has any other theories, please let me know.

Regardless, when I stop the FMD, I'll gradually reduce my carbs. I'll also continue to intermittent fast as I have been since the second week of November. I will simply have to be more precise in my carb quantity and timing.

Day 5 FMD  - Final day

weight: 172.2 pounds = 78.11 kilos

Weight is up from day 3 but down from day 1 by 5.6 pounds (2.51 kilos).

Original plan was to skip breakfast and lunch but still felt remnants of keto flu.

Breakfast: 2tbsp peanut butter and half scoop of plant-based protein powder (it does contain stevia so I don't know if this breaks FMD rules). 2 cups black coffee with nothing added.

Gym session went well due to the breakfast. Calf raises. Anti-extension/anti-rotation core work. Unilateral horizontal push superset with unilateral horizontal pull. 1 set pull ups. 3 sets rear delt work on the machine. No sauna as I already hit 6 sessions this week.

The euphoria I felt on day 3 was a one day phenomenon.

Lunch: 2 cups vegetable broth and 2 cups water. Added 3 cups kale, 2 cups red/yellow/orange bell peppers, half cup chopped onions, 2 chopped garlic cloves, 7 ounces tofu, half tsp salt. Absolutely delicious and looked impressive as well. Eaten separately 1 cup kimchee and half cup broccoli sprouts. Taken separately 2 tbsp apple cider vinegar. 1 cup green tea.

7000 IUs D3 and multivitamin taken with breakfast (the idea being fat-soluble vitamins will be better absorbed with the peanut butter).

Close to 4 liters of water at the time of this writing; should easily reach it in a few hours.

Will also have approximately 3 cups of broccoli with 4 tbsp balsamic vinegar for dinner.

Valter Longo's FMD experiments, as far as I can tell, did not involve a population of exclusively very active participants who may be able to reach keto/autophagy sooner. If one can deplete his glucose stores via a low-carb diet leading up to the fast and exercise vigorously on the lead up and during the fast, I think it's feasible to accelerate the process.

In other words, I suspect someone like myself CAN reach the desired effects on the 3rd or 4th day of FMD rather than the 5th. It is possible, of course, I'm rationalizing an excuse to take a shortcut because I did not enjoy FMD.

Furthermore, I did not follow the exact percentages for the macros (other than keeping protein very low on days 2-5). So I concede I may not even have followed a "true" FMD.

I do, however, very much enjoy intermittent fasting on a 17/7, 18/6, 19/5 schedule. I will go lower carbs overall and continue to experiment with fasting and TKIs because I strongly believe in the potential.

As I understand it (and please correct me if I'm wrong), autophagy peaks when the Glucose-Ketone Index (GKI) is 1:1. This appears to be best reached on a 3-day or longer water fast.

Here is my question...Can we reach close to this coveted 1:1 ratio (maybe fall a little short) and still induce enough of an autophagic response? This could start the chain reaction of events which will make the LSCs more vulnerable to the TKI.

I suspect it's possible via intermittent fasting. Although, my hunch is it should be greater than the popular 16/8. I think 19/5, 20/4, or all the way to OMAD (one meal a day) would speed up the process towards a favorable GKI.

Furthermore, I theorize we can further accelerate the process with strenuous exercise (to deplete glucose and create cell stress), sauna (again, cell stress), and a mostly keto diet (to keep glucose levels consistently low).

If this works, rather than doing 3-5 day water fasts spread out several times in a year, the intermittent fasting approach may make smaller but steady attacks against LSCs.

Just make sure you have TKI in your system during the refeed.

Can both yield similar results in fight for TFR?

If anyone out there has any theories, please feel free to share.

Scuba, excellent info!

Yes, I agree that as I continue to practice various forms of fasting, my body, as you put it, should become more efficient at utilizing ketones and thus spare glucose.

The following statement in your post made me very optimistic I am on the right path:

"The muscles will draw sugar out of the blood when exercising intensely AND this triggers your liver to make more glucose than it was doing. To make more requires more enzymes to metabolize fat + protein (coming from old blood) into needed glucose (gluconeogenesis)."

1) It is widely agreed by oncologists that losing excess fat (as long as it does not create eating disorders, etc.) can only help. And there is, of course, the other health benefits involved.

2) The protein from the old blood should help clear out the debris and put my body in a more receptive state for TKI treatment.

Currently, I'm on a 19/5 or 20/4 IF schedule. I've also adjusted my medication schedule:

a) 200mg allopurinal taken earlier in the day

b) D3, multivitamin taken with my 1st refeed - which is very low to zero net carb (avocado with himalayan salt, 2 tbsp organic peanut butter with no oils/fillers/etc added, broccoli, broccoli sprouts, other vegetables)

c) prior to my second and final meal of the day, 100mg of sprycel; this, unless I'm mistaken, follows what you wrote about regarding the TKI in one's system to pounce on the LSCs

d) eat my second and final meal - which does include glucose such as black beans, quinoa, wild blueberries

The overall net carbs for the day is not low enough to qualify as keto. However, I am very active so I suspect (or is "hope" a better word?) I will have converted to a keto state by the following day before my first meal.

So I should become more efficient at going in and out of keto and thus converting fat+protein (from the cellular debris), 

Of course, if I do have to drop my daily net carbs to <50 grams or even <25, I'll do so. However, I don't want to play that card just yet.

Update:

I'm doing more research on autophagy and learning about the importance of mTOR and its role in cancer proliferation. As I currently understand it, if mTOR is triggered, autophagy/cell regeneration is halted.

Very low protein intake and suppression of insulin has been shown to suppress mTOR, which explains why Valter Longo designed his FMD.

Based on this and other research, my IF schedule moving forward will continue to be 19/5 to 20/4 on a regular basis. And I'll continue to make sure my 1st refeed of the day will suppress mTOR as much as possible. The low-hanging fruit is to keep that 1st meal zero-net carbs and avoid protein shakes as even low carb ones can promote insulin and thus trigger mTOR.

Hell, I may just transition to OMAD.

Furthermore, once a month I'll do either FMD or water fast; most likely a water fast as it is more cost effective and leaves next to no possibility of accidentally triggering mTOR.

Scuba - excellent points. Thank you.

Yes, I agree it's necessary to "turn on" mTOR and not try to keep it suppressed constantly. Same can be said for insulin/IGF-1.

My post from 7/12/2022 meant the first refeed after an IF or pro-longed fast will attempt to keep mTOR fairly down regulated.

My next meal following IF or pro-longed fast will absolutely turn mTOR on due to the protein and carbs. This part was not explicitly stated in the 7/12 post but it was and is my intention for the second meal to contain carbs/protein.

And if I do switch to OMAD, I will obviously have to trigger mTOR with that single meal because I will be eating protein and carbs. But this won't be a concern to me because the OMAD schedule guarantees that the fasting portion of my IF day will be even that much longer.

After 6+ months on a predominantly whole foods plant based diet, I'm reticent about eating animal products. I look, feel, and even smell cleaner since making the switch!

However, if there's one thing I learned from cml - one must be able to re-evaluate and make changes if/when necessary. Pride has no place in a search for TFR.

Thanks again

I am becoming more and more converted to the power of fasting.

As I research mTOR and AMPK, I am convinced the two pathways were out of balance in my body.

From late April to late October 2022:

1) the only "fasting" I did was when I slept (typically 7-8 hours per night)

2) very physically active - and exercise is generally agreed to raise mTOR

3) whole-food plant-based diet but an over consumption of both carbs and protein

This is a recipe to keep mTOR elevated at the expense of AMPK!

Could this be why my bcr-able spiked to 80% after 6 months on bosulif? There most likely are other reasons. However, I cannot help but suspect that, in my attempt to live a healthy lifestyle, I was instead creating an environment in which my body was less receptive to the TKI treatment.

Based on this theory, I will:

1) continue to fast - both IF and 24-72 hours to raise AMPK

2) keep carbs moderate and predominantly complex so the fiber reduces spikes

3) keep exercising for the numerous health benefits

4) lower my protein intake

The exercise routine I engage in already elicits a mTOR response. I don't think it's a good idea to pile on with a high protein diet. I've seen the articles which state AMPK is also activated by exercise but I still believe it wasn't at an optimal level in my body.

Furthermore, since autophagy signals to the body to recycle senescent cells, I don't believe I need to worry about the sacred 1-2 grams of protein per lean kilo mass paradigm. After all, I am not a competitive athlete, a population for whom a higher protein intake can arguably make sense.

This, as any of my current beliefs, are subject to change based on new information. For now, I will actively focus on bringing my AMPK to mTOR more in harmony.

As always, comments are welcome.