Description  

Here we present a 3-year follow-up report of a case that was originally published in BMJ Case Reports in December 2015.1 Briefly, a 42-year-old woman presented to her primary physician with a palpable mass in her right inguinal region and was subsequently diagnosed with stage IIIa, grade 1 follicular lymphoma (FL). In November 2014, the patient arrived to TrueNorth Health Center (TNHC) and elected to undergo a 21-day medically supervised, water-only fast, after which she refed on an exclusively whole plant food diet free of added salt, oil and sugar (SOS-free), including refined carbohydrates, for 10 days. Over the course of treatment, her enlarged lymph nodes became impalpable. Follow-up CT scans confirmed reduction in size. She did not undergo standard cancer treatment, maintained the SOS-free diet, and was symptom-free at 3-month and 6-month follow-up visits.1

In November 2017, the patient returned to TNHC to complete a second water-only fast for the purpose of maintaining health. She reported following the SOS-free diet with minimal exceptions for the previous 3 years. A routine physical examination combined with complete blood count (CBC) and comprehensive metabolic panel (CMP) laboratory testing indicated overall good health and maintenance of weight loss that occurred during her first visit. Remarkably, her lymph nodes were still impalpable. The patient reported that in December 2016 she had computed tomography (CT)/positron-emission tomography (PET) scans which showed no evidence of active disease, and her oncology visits had been reduced to once per year. In January 2018, follow-up CT/PET scans demonstrated that the axillary, supraclavicular and inguinal lymph nodes were normal in appearance (figure 1), and there was no evidence of hypermetabolic neoplasm. These observations indicate that the patient no longer has evidence of FL. The initial regression has persisted for 3 years with no additional intervention other than dietary change.

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Figure 1

CT images of the (A) axillary, (B) supraclavicular and (C) inguinal lymph nodes following second water-only fast.

The patient’s initial regression directly coincided with the timing of her first water-only fast, strongly suggesting a causal relationship. Nonetheless, we are unable to rule out spontaneous regression (SR), which has been reported for nodal lymphomas of various stages and treatment histories at rates of between 10% and 20%.2–5 The underlying biological mechanisms responsible for SR in cancer have not been fully elucidated, but it is often associated with immune system activation or reactivation independent of treatments recognised as causative.2 6 Importantly, fasting also appears to stimulate biological mechanisms in humans that may potentiate tumour regression, such as decreasing levels of leptin and insulin-like growth factor 1 (IGF-1).7 8 Although data on the effects of fasting on the treatment of human cancer are lacking, animal research suggests that fasting affects cancer cells by reducing nutrients necessary for sustained growth leading to oxidative stress and cell death, activating the immune system or facilitating immune cells to kill cancer cells, and promoting autophagy.9 Therefore, it is possible that water-only fasting stimulates inherent biological mechanisms that are similar to those responsible for SR in cancer.

The outcome presented here, as well as additional anecdotal clinical observations from TNHC and data from published literature, provides a rationale for continued research into the effects of water-only fasting and dietary intervention for the treatment and maintenance of low-grade FL.