Does Timing Matter? Treatment Outcomes and Cancer Fatigue

Full Episode - Cancer Timing

[00:00:00] Leah Sherman, ND: today what we're talking about is, I like these words. Chrono nutrition and chrono,

[00:00:09] Leah Sherman, ND: it says chemotherapy, but it's chrono immunotherapy.

[00:00:12] Tina Kaczor, ND, FABNO: Yes, chrono chronological time based.

[00:00:18] Leah Sherman, ND: Yeah. So like What influence does time have on your nutrition? What we're talking about is following cancer treatment, like the role of the timing of when you eat and. fatigue. And then also when you get your immunotherapy, does the time of day you receive treatment make a difference?

[00:00:42] Tina Kaczor, ND, FABNO: Yeah. Yeah. And I think this is something everyone should be talking about, medical oncologists, the oncology nurses, the patients themselves. This should be all made common knowledge. So I'm excited to, uh, share some simple things to do to make sure you get the most out of an immunotherapy if you're receiving one.

I. And then we can talk about the fatigue as well, and, and how timing your meals may affect your fatigue.

[00:01:04] Leah Sherman, ND: Tina, before we start today's episode, think we should thank Amy who is a new member

[00:01:11] Tina Kaczor, ND, FABNO: I,

[00:01:12] Leah Sherman, ND: the Cancer Pod

[00:01:13] Tina Kaczor, ND, FABNO: yay. Thank you, Amy for joining. 

[00:01:15] Leah Sherman, ND: Super exciting. Um, thanks Amy for joining our membership, which is through Buy Me a Coffee.

[00:01:23] Tina Kaczor, ND, FABNO: Yep. There's levels at $3, $9, $19, and you get more benefits with each one. 

[00:01:28] Leah Sherman, ND: the top level you get, uh, free swag, uh, and the bottom level is

[00:01:35] Tina Kaczor, ND, FABNO: I.

[00:01:35] Leah Sherman, ND: like, thank you. We support you and we want. You as a podcast. Keep going. It's just kinda like, you know, it's like a Thank you. It's like a monthly Thank you.

[00:01:47] Tina Kaczor, ND, FABNO: Yeah. Well, and they can join us on a YouTube live with that as well if there's specific questions. Yep.

[00:01:53] Leah Sherman, ND: yeah. They get one live a year and then, the other levels, there's a quarterly live and a monthly

[00:02:01] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:02:02] Leah Sherman, ND: so. We really look forward to having members joining. supporting membership helps us to keep bringing all the content that you all love and you get to be part of the cancer prod community.

How cool is that?

Oh, and speaking of support, and buy me a coffee. Um, Brandon, thank you, Glenda. Thank you. And anonymous, someone

[00:02:29] Tina Kaczor, ND, FABNO: Someone,

[00:02:29] Leah Sherman, ND: you are? Yeah.

[00:02:31] Tina Kaczor, ND, FABNO: we know who you are, but, and you know who you are,

[00:02:34] Leah Sherman, ND: yes, but we're keeping it.

[00:02:36] Tina Kaczor, ND, FABNO: we will maintain your anonymity.

[00:02:38] Leah Sherman, ND: There you go. They all bought us coffees. so again, thanks for supporting the cancer pod. and then I wanna read Brandon's, he left a little comment and it was really sweet. So, Brandon says, love this pod. I listened to several integrative and functional medicine podcasts, and this duo by far offers the most reasonable evidence centered and substantive health promotion material, anyone personally affected by cancer will derive benefit from any of the a hundred plus episodes in their audio library.

[00:03:09] Tina Kaczor, ND, FABNO: I know that was awfully sweet.

[00:03:11] Leah Sherman, ND: Very sweet.

[00:03:12] Tina Kaczor, ND, FABNO: It's interesting, you know, contributions are awesome, but, you know, taking the time to actually write something, I'm like, Aw, you took time. Like, like almost like time is more valuable than money. 

[00:03:23] Leah Sherman, ND: He offered both and I, no, I, I love when people

[00:03:26] Tina Kaczor, ND, FABNO: yeah.

[00:03:27] Leah Sherman, ND: and so if you are listening on Spotify or Apple Podcasts or wherever you're listening, remember to give us a rating and to a comment, leave a review,

[00:03:38] Tina Kaczor, ND, FABNO: would be great.

[00:03:38] Leah Sherman, ND: how more people can find

[00:03:40] Tina Kaczor, ND, FABNO: Yes. Yes. I would be much appreciated because our whole goal is to reach as many people as possible, and as we grow, we of course are never satisfied. We wanna grow faster and, uh, reach more people so we can help more people out. I. And our, our website Also, I just wanna say this, our, our website is also growing, so we're making sure that we post some of this information so that it's more readily available 

 And, uh, in 2025, our goal is to continue expanding on our blog space and, and our little storefront on there that has a few items that are useful for folks who are going through treatment or past treatment.

[00:04:13] Leah Sherman, ND: And then if this episode or of any episode that you've listened to makes you think of someone who would benefit, pass it along.

[00:04:20] Tina Kaczor, ND, FABNO: Yeah, that would be great. Just share it with someone you think this might be useful for. And, uh, that's all we ask really. I mean, if you could do that, that would be excellent. 'cause again, our whole goal is just to help people out, and a whole lot more people than we can help one-on-one. Right. So right now I.

The thousands of folks who listen to us, it's kind of nice. You know, we might never meet them, but we know we're helping people. So that is, at the end of the day, all that counts.

[00:04:43] Leah Sherman, ND: So share the podcast, spread the word, and thanks for being here. With us, the cancer pod. I'm Dr Tina Kaczor 

[00:04:50] Leah: and I'm Dr Leah Sherman 

[00:04:52] Tina: And we're two naturopathic doctors who practice integrative cancer care 

[00:04:56] Leah: But we're not your doctors

[00:04:58] Tina: This is for education entertainment and informational purposes only

[00:05:03] Leah: do not apply any of this information without first speaking to your doctor

[00:05:07] Tina: The views and opinions expressed on this podcast by the hosts and their guests are solely their own 

[00:05:13] Leah: Welcome to the cancer pod 

[00:05:19] Leah Sherman, ND: Hi Tina.

[00:05:20] Tina Kaczor, ND, FABNO: Hey, Leah.

[00:05:21] Leah Sherman, ND: So today we're talking about timing and cancer, whether it's related to your fatigue as a cancer survivor, or it's related to when you get your treatment

[00:05:36] Tina Kaczor, ND, FABNO: Yeah.

[00:05:37] Leah Sherman, ND: patient.

[00:05:37] Tina Kaczor, ND, FABNO: Yeah. And at the end of the day, we can talk theoretically why things might be, but what we're gonna be talking about are some papers that came out that show the timing of getting your immunotherapy. Like what time of day, morning, afternoon, and evening affects.

The response rate and whether you're likely to derive benefit or not. So that can actually be put right next to the other things that we know help people with their immunotherapies, right? So there's, there's anything you can do that's non-toxic that may help you respond to treatment. I feel like it's fair game if you can do it.

So, so I would put timing in that category of easy things to do that give you a better chance. Of getting a good effect from your immunotherapy.

[00:06:22] Leah Sherman, ND: And fewer side effects.

[00:06:23] Tina Kaczor, ND, FABNO: Hopefully fewer side effects.

[00:06:25] Leah Sherman, ND: So, um, you mentioned this study, uh, that talking about is specifically one, it's called the effective immunotherapy infusion, time of day on survival of patients with advanced cancers. And that was a

[00:06:40] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:06:41] Leah Sherman, ND: And so they looked at 13 studies

[00:06:44] Tina Kaczor, ND, FABNO: Involving

1,663 patients.

[00:06:47] Leah Sherman, ND: That's a lot of

[00:06:47] Tina Kaczor, ND, FABNO: That's a lot of patients.

[00:06:49] Leah Sherman, ND: so that's a good size study. And so they were looking at the relationship of the time of day that they received immune checkpoint inhibitors and how affected their cancer progression, it was progression-free survival or overall

[00:07:05] Tina Kaczor, ND, FABNO: Yes,

[00:07:06] Leah Sherman, ND: key points they were looking at. So well let's, first, let's talk about what they mean by immunotherapy and then specifically these, you know, immune checkpoint inhibitors.

[00:07:16] Tina Kaczor, ND, FABNO: yes. So immunotherapy is exactly what it sounds like. It's a therapy that works with your immune system rather than just chemotherapy, which is. Directly toxic, cytotoxic cell toxic, right? So immune therapy or immunotherapy, means that it's affecting your immune system in such a way as to allow your immune system to see the cancer and attack the cancer the way it was supposed to do it in the first place, ultimately, right?

So. Usually cancer tumors arise because there is a glitch a way that the immune system is told to stand down and not recognize the tumor. So what are called checkpoint? Blockade. checkpoint inhibitors.

These are those commercials. If you're watching tv, you see for Keytruda or Opdivo. Those are common commercials out there right now. Um, those are called checkpoint inhibitors. And a checkpoint is exactly what it sounds like. It's a point where the tumor normally says to the immune system, stand down, don't attack me.

So when you inhibit that or you block that signal. Now the immune system gets to go ahead and attack the tumor. So checkpoint inhibitors, checkpoint blockade, we are basically removing that stand down order that the tumor is normally giving to the immune system. That's the simplest way I think I have to, uh, explain it.

[00:08:37] Leah Sherman, ND: Yeah. And so some of the other words you mentioned, a couple of the, immunotherapies that people may be familiar with. you may have also have heard things like the PD one inhibitors, PD L one inhibitor. Um. Also there's a CTLA four inhibitor. Those are all words that patients may have

[00:08:55] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:08:56] Leah Sherman, ND: so that would make it more familiar.

Yeah.

[00:08:58] Tina Kaczor, ND, FABNO: those are all checkpoint inhibitors? Yes. Yeah.

[00:09:01] Leah Sherman, ND: And so the names of the medications are usually the ones that you look at and you're like, I can't pronounce them ,

[00:09:06] Tina Kaczor, ND, FABNO: Yes,

[00:09:07] Leah Sherman, ND: they like the, the, the generic name. But they do come up with clever names, like, you know, Yervoy and,

Keytruda, like you were saying.

[00:09:13] Tina Kaczor, ND, FABNO: yes. So yes, the generic names like ipi, ipilimumab, or 

[00:09:17] Leah Sherman, ND: nivolumab.

[00:09:19] Tina Kaczor, ND, FABNO: those are, those may be becoming more familiar as we head out of the patented names and into generics. But yes, no matter what, if it's a checkpoint inhibitor, what you're doing is you're overcoming, uh, a stand down order. I call it that because it's, it's a really, it, it is, looks a little more complicated than that when you look at it in pictures and if we really got into the, to the weeds of it.

But that's all you need to know is that your, your own immune system is unleashed. That's the best part of immunotherapies. What I love about immunotherapies is not just that we now have. much better therapies to offer people with lung cancer or metastatic melanoma among other cancers, renal cancers, bladder cancers, all sorts of different tumors out there.

It's also, in some ways, a way to unleash your natural tendency to attack the tumor. One of the side effects of that, of course, is that if you are unleashing the immune system, it goes too far and begins to attack other normal tissues. So the biggest issue with toxicity with these checkpoint inhibitors is that you end up having normal tissue also being attacked and what looks to be a lot like an autoimmune reaction, right?

So you might have colitis or thyroiditis or all sorts of different ways that we could have a. The immune system unleashed too generally, in which case they have to calm it down with something that suppresses your immune system, and that would be something like steroids. So it's a balance, it's, it's a fine balance.

[00:10:41] Leah Sherman, ND: Yeah, I was gonna, I was gonna pop in and say that it's not a toxic, free treatment, for sure, but lot of the side effects can be, you know, managed. 

[00:10:53] Tina Kaczor, ND, FABNO: Yeah. And, and I just wanna say on the, uh, 'cause what's Integrative Medicine podcast? I just wanna say in the grand scheme, if someone's getting one of these treatments, we're gonna go into detail about the timing, but there is already evidence that things like regular exercise, eating a very colorful diet, ensuring your vitamin D is normal in the normal range on your blood work.

[00:11:16] Leah Sherman, ND: eating a. A fiber rich, fiber diverse diet.

[00:11:20] Tina Kaczor, ND, FABNO: Absolutely. Yeah. So the diversity of your gut microbiome has a lot to do with whether you respond to these treatments or not. So we've talked about that in other episodes, but there's clear data that when people get an antibiotic just before going on one of these checkpoint inhibitor immunotherapies.

They don't respond. They're less likely to respond than if they have a nice, diverse gut. So if you can not be taking an antibiotic just before you get onto one of these drugs, that's the ideal scenario. and there's a couple things to avoid, so minimize and avoid use of the antibiotic, like I just mentioned.

And the other thing that came up was cannabis. Cannabis seems to lead to less effective, immune checkpoint blockade agents. So

[00:12:03] Leah Sherman, ND: that's really interesting. Um, we still have been promising that we're gonna do an episode talking to an expert, a cannabis expert. So, 

[00:12:11] Tina Kaczor, ND, FABNO: still on our to-do list?

[00:12:12] Leah Sherman, ND: I, yeah, it's still on our to-do list, but you know, things are changing 'cause

[00:12:15] Tina Kaczor, ND, FABNO: Yeah.

[00:12:16] Leah Sherman, ND: all the information is changing. So, yeah, I think that's, that's a really interesting and important, point that it is still a relatively new so, yeah, just taking caution. Just don't be like, oh, well so and so took it for their chemotherapy. It, it, it's, immunotherapy is a new field. Like

[00:12:36] Tina Kaczor, ND, FABNO: Yeah,

[00:12:36] Leah Sherman, ND: still don't know.

[00:12:37] Tina Kaczor, ND, FABNO: yeah, yeah. And the thing about watching studies about recurrence or overall mortality is years have to go by in order to recruit for the study, watch the study, and literally watch a population over time. So it by its nature takes time to gather the evidence any in any direction.

All right. Back to the study.

[00:12:57] Leah Sherman, ND: Yeah, so with this study there was some criteria, um, patients, it was in patients who had solid tumors. Not any patient that had anything like leukemia or lymphoma. Um, everything was a solid tumor and that the patients also had good performance status.

[00:13:15] Tina Kaczor, ND, FABNO: Right, right. performance status is something we as clinicians use as a standard way of putting in the chart how someone is doing in their quality of life. So. A classic system is the ECOG system performance status of zero to five ultimately, but zero means they're fully active.

That's great. They're doing, there's no, no compromise. one is they're slightly symptomatic. They might have some side effects. They might be restricted to not be able to, you know, run up a set set of stairs, but ultimately they walk into an outpatient office, you know, no problem.

[00:13:51] Leah Sherman, ND: They're able to go to work. They're able to like do their day to

[00:13:54] Tina Kaczor, ND, FABNO: Yeah, so, so no, no life restrictions. They might be feeling less than stellar, but not life restrictions. And then two is, they're symptomatic to some extent. They're in bed for less than 50% of the day. Um, capable of all self-care. 

I. Three is a little worse. Symptomatic. They're in bed more than 50% of their waking hours, but they're not bed bound, so they're capable only of limited self-care, confined to bed or a chair, 50% or more of waking hours, and then performance status of four is bed bound. Completely disabled, cannot. Do any self-care and they're confined to their bed or a chair for the day.

Um, performance status is something that people will see in their charts. They might not know what that means, but now you do. 

[00:14:38] Leah Sherman, ND: then what's five?

[00:14:39] Tina Kaczor, ND, FABNO: if five, you're no longer with us. I,

[00:14:42] Leah Sherman, ND: Uh, that is so weird that they would even have a performance status for

[00:14:47] Tina Kaczor, ND, FABNO: you know, it's interesting I wasn't even gonna mention it. Yeah. Because I was like, well, we, I've never seen it. I don't think it's like relevant.

[00:14:53] Leah Sherman, ND: it's, it's, yeah, it just seems weird that they would have, yes. So anyways, yeah. So for this study, it was, they looked at studies of patients who were performance status zero, uh, to one.

[00:15:06] Tina Kaczor, ND, FABNO: Yes. So these are people who are relatively healthy, at least healthy looking. They might not be feeling a hundred percent, but they're doing well in the grand scheme, so they're relatively healthy. Individuals getting immunotherapy.

[00:15:19] Leah Sherman, ND: So what I've found super interesting about this study is that there are different parts of our immune system that at different times of the day are more active.

[00:15:31] Tina Kaczor, ND, FABNO: Yeah.

[00:15:32] Leah Sherman, ND: That's not something that somebody would think about. at, your day-to-day life, you're not thinking like, oh, well this part.

And it's not like, oh, your immune system in general is more active. It's like, no, there are different, you know, lymphocytes that are active at different points in, you know, your circadian rhythm. Like, so your circadian rhythm isn't just like your sleep. Wake like, oh, I'm going to sleep.

I'm waking up. It's your immune system is going to sleep, and waking up at different times too.

[00:15:58] Tina Kaczor, ND, FABNO: Yeah, in the inflammatory state tends to be a little higher while we're sleeping, which is one of the reasons that pain seems to be more acute or inflammatory pain than in particular, can seem worse when you're sleeping. Um, as far as this study that we're talking about that we already mentioned. The effect of immunotherapy infusion, time of day on survival of patients.

One of the studies or some of the studies that they looked at used a cutoff as the time of day 'cause they knew that vaccines were less. Um, or less, how do we say it? Stimulatory, A weaker vaccine response happened later in the day. So that has been established. So they consider weaker, vaccine responses happened later in the day, so they, they speculated that perhaps that was true for immunotherapy too.

Maybe later in the day we have less immune activity and so that. Is what created the cutoff on the, on the clock, like we're gonna consider later in the day, you know, after 2:00 PM or after 4:00 PM for example. so it's pretty clear that there is a circadian rhythm like you just said, to our immune system, and it's not functioning the same way all day long, which makes sense.

I mean, cortisol. It's highest in the morning and it goes down and down and it's lowest during the night, and cortisol is one of our natural anti-inflammatory hormones. 

[00:17:17] Leah Sherman, ND: I always think about is like if you have a cold or if you have allergies and then the sun, sun starts to set and you're like, why are my symptoms 

getting worse?

[00:17:25] Tina Kaczor, ND, FABNO: mm-hmm.

[00:17:25] Leah Sherman, ND: And that's when I think of like, oh, that's the

Yeah, yeah, yeah. It, those circadian clocks that we have are absolutely fascinating because they have. they have signals from our external environment, like light itself, light and dark, and fasting and feeding. You know, are you taking in calories? Are you not taking calories? Like your body's reacting to all of that.

And then there appears to be some that are completely independent of all exterior signals and are in our bodies. Literally no 24 hour rhythms even without light dark fasting and feedings, which I think is like kind of crazy. It's great. That's really neat. Like that we, our bodies could even sense time without any signals Anyways.

So what is the study basically, or you know, showing what is this meta-analysis showing?

[00:18:14] Tina Kaczor, ND, FABNO: so we mentioned most patients got a checkpoint inhibitor, almost all of them. Um, and it showed that of the 13 studies that that made up the 1600 plus people, they pooled them and early time of day groups had both longer. Overall survival. So they lived longer and they had longer progression-free survival, and it was highly significant, like 50% longer on average, and 50% more progression-free survival.

So it wasn't just like a marginal amount and it every single. Study showed it. And I should also mention just, I don't know if we said this already, but these were all retrospective evaluations. So they went back to the charts and looked at what time of day people received their treatment. so they weren't being told to come in later in, in the day or earlier in the day.

There wasn't like a randomization. so just a little aside, it's just a retrospective review of the data. And the cutoff if you wanna be safe. Um, I would put the cutoff looking at all of the data across the board at at least one o'clock, if not noon. Every study has its own cutoff. Some say noon, some say 1130, some say two.

I mean, they all differed, but certainly I would say just before noon seems to be a safe cutoff point to say, okay, you have a better chance of having a favorable benefit from your immunotherapy if you're in good health. That is a performance score of zero one. Zero, one, maybe two. Yeah. And you have to, so you have to be relatively healthy in the first place.

[00:19:51] Leah Sherman, ND: there a study that showed two 

[00:19:53] Tina Kaczor, ND, FABNO: the study that looked at people with performance status of two and three, they included people who were more ill in their study, found that those who were. Not relatively healthy. Their quality of life was impaired.

They were in bed most of the day. their performance score was more like two or three. Those people were the outliers in this scenario. Those people actually had better overall survival and better progression-free survival if they had their treatment later in the day. I don't know why that is. It's just what it is.

Take it at face value. We could, you know. Speculate all day long, but to me that just says, okay, if you really have a hard time moving, you're in bed, most of the day, just go at your pace, right? it's, it'd be hard to get to the infusion room by noon probably, anyways. Um, so don't feel badly and don't make it happen if it, if you're not feeling well enough.

But if you're otherwise feeling decently, go before noon. If you feel not so great, maybe the in the day is better 'cause it's a little less toxic later in the day So toxicity varies with time of day.

[00:21:01] Leah Sherman, ND: And then of course all of this kind of depends on your infusion center on when they're scheduling

[00:21:07] Tina Kaczor, ND, FABNO: Yes,

[00:21:07] Leah Sherman, ND: and how

[00:21:09] Tina Kaczor, ND, FABNO: I.

[00:21:09] Leah Sherman, ND: the infusion takes. And you know, some people are getting. Multiple medications and so

[00:21:15] Tina Kaczor, ND, FABNO: Yes, there are practical,

[00:21:16] Leah Sherman, ND: factors. Yeah, there's,

[00:21:18] Tina Kaczor, ND, FABNO: there are some practical logistics you gotta, you gotta deal with. But all else being equal, if you're relatively healthy, meaning you, you're walking in and out of your doctor's office and you are capable of self-care, then go before noon if you can. 

[00:21:30] Leah Sherman, ND: That's kind of the takeaway from that study.

[00:21:33] Tina Kaczor, ND, FABNO: I think so. Yeah. And again, it goes under the why not, I mean, in my mind I always have the why not column. It's certainly not gonna hurt you. Um, it could help you. Uh, and the data has been so consistent. 13 studies all showing the same trend in the same. Result is pretty convincing. None of those, it wasn't like we averaged out to be that time.

It was like every study that looked at it saw the same thing, and that was earlier in the day. People fared better, so doesn't hurt.

[00:22:04] Leah Sherman, ND: Okay, so when we come back, we're gonna talk about the effect of time restricted eating cancer survivors. 

[00:22:12] Tina Kaczor, ND, FABNO: On cancer fatigue specifically. Alright.

[00:22:21] Leah Sherman, ND: The second article that we're gonna talk about that has to do with timing is a study called Time Restricted Eating to address persistent cancer related fatigue among cancer survivors. And that's a, that was a randomized controlled trial. Um, it was a really small study. I think they had 30,

[00:22:42] Tina Kaczor, ND, FABNO: Looks like it.

[00:22:43] Leah Sherman, ND: 30 subjects that they

[00:22:44] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:22:45] Leah Sherman, ND: Really small study. Um. they looked at adult cancer survivors, and they were from two months to two years outside of treatment, it was okay if the person was still getting, what do they call, say, like a non-conventional. Chemotherapy. So like, they mean like immunotherapy. So if someone was on a, a maintenance immunotherapy, that was fine.

But, but mostly they were looking at, people who were outside of any sort of treatment, radiation, chemotherapy, or surgery. there were studies prior, this isn't like the first of its kind. There were other studies that had shown there may be a role for time restricted eating. time restricted eating. We kind of covered this in our fasting episode, but it's when you allot yourself a certain time of day to eat. you know, you could do 12 hour period where you have a 12 hour eating.

Window. Um, people talk about like the 16 eight where you have an eight hour eating window. This study looked at a 10 hour window, and so the subjects were able to pick their 10 hour window was, and then everyone in this study had access to nutrition counseling 

[00:23:55] Tina Kaczor, ND, FABNO: Okay.

[00:23:55] Leah Sherman, ND: So whether you were participating in the trial or you were the control, um, everybody got individualized nutrition counseling, which is kind of cool. 

[00:24:02] Tina Kaczor, ND, FABNO: So any 10 hours in a day, they could eat. And the other 14 hours they were fasting.

[00:24:06] Leah Sherman, ND: Yeah. 10 consecutive hours. It had to be consecutive.

[00:24:09] Tina Kaczor, ND, FABNO: seven to five?

[00:24:11] Leah Sherman, ND: Is that 10

[00:24:11] Tina Kaczor, ND, FABNO: Yeah. Eight to six. Yeah. Whatever They're, whatever they chose.

[00:24:15] Leah Sherman, ND: Yeah. Yeah. Whatever

[00:24:16] Tina Kaczor, ND, FABNO: Okay.

[00:24:17] Leah Sherman, ND: Uh, noon to 10, whatever. Yeah. And so the way that they evaluated the fatigue, there were a couple of different tests that they used they filled out initially and then I believe it's six weeks and then 12 weeks.

 So there is the facet test, and is functional assessment of chronic illness therapy. And it's specific for fatigue. And then there also is the brief fatigue inventory, which is a shorter test, and that's the BFI. Um, and we can put links to those if people want, like taking tests to assess their, um,

their, their fatigue levels.

[00:24:53] Tina Kaczor, ND, FABNO: Yeah. Well, can I interject there? I think it is good to take assessments 'cause it's hard, ' cause it's so subjective. So it's not a bad idea to kind of do it, or if you're helping someone so you can share your fatigue on a more objective basis. I don't know, it's just, it's, it'd be nice 'cause as a practitioner, I would use these kind of things to make sure that what we're doing is helping, and that we are not deluding ourselves into thinking things are better or that they are worse, or that it's just a bad, bad day you're going to, it's gonna look worse or a great day, you're gonna be like, ah, I'm great today.

And actually, you're really fatigued. 

 I've seen that at the cancer center where I used to work, and it could be helpful because someone could be like, well, I don't know, is my energy's better than it was last time?

[00:25:31] Leah Sherman, ND: And someone goes, well, last time it was a seven and now you're saying it's a five. So 

[00:25:35] Tina Kaczor, ND, FABNO: It's all subjective.

[00:25:36] Leah Sherman, ND: Okay, so basically, long story short, it was found in this very small study that, eating did play a part reducing their fatigue, so it did show benefit. What I didn't see is, and it may be in there, Specifically to see like what were they eating? Were they just eating their regular diet?

[00:25:58] Tina Kaczor, ND, FABNO: Mm.

[00:25:58] Leah Sherman, ND: I don't know if it was in that study, if they, if they talked about it. I mean, they get, they're getting nutrition counseling,

[00:26:03] Tina Kaczor, ND, FABNO: right.

[00:26:03] Leah Sherman, ND: but yeah. What are they eating?

[00:26:06] Tina Kaczor, ND, FABNO: Yeah. Yeah. I, it's a good question. I'm gonna guess that they didn't eat anything too differently or else the conclusion wouldn't be able to be made. It would be based on content, not just timing. Right.

[00:26:16] Leah Sherman, ND: Right.

[00:26:17] Tina Kaczor, ND, FABNO: And according to their abstract glucose parameters. tended to be lower and rest activity rhythms tended to indicate more regularity for those in the time restricted eating group versus the control group.

So that sounds like they had better metabolic, systems, like they were, their glucose was better controlled 

[00:26:38] Leah Sherman, ND: I.

That's sort of like already been established in other studies about time restricted eating, is that

[00:26:43] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:26:44] Leah Sherman, ND: improve metabolic function. Okay, so for the control arm, the participants talked about their eating habits and then they set goals based on their individual needs. And so they talked about, macronutrient needs, different food groups, what their preferences were. So on. And they were told not to change the timing and when they ate their meals. And then in the 10 hour eating window participants, they were encouraged to have the eating window be more during the day and to stop it like a few hours before bedtime. It does say, aside from water, which was always allowed, only unsweetened tea and black coffee were allowed before the eating window, which makes

[00:27:24] Tina Kaczor, ND, FABNO: Sure.

[00:27:25] Leah Sherman, ND: Um, calorie free foods and beverages such as chewing gum and diet soda were not allowed outside the eating

[00:27:32] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:27:32] Leah Sherman, ND: which is interesting. And then they also met with the nutritionist who talked about,

the goals that they were gonna try to achieve,

by eating within that, that window.

[00:27:43] Tina Kaczor, ND, FABNO: So the take home is try to eat in a 10 hour window if you can.

[00:27:47] Leah Sherman, ND: Yeah. Um, for cancer survivors, right? This was not for patients in active treatment,

[00:27:53] Tina Kaczor, ND, FABNO: Right, right. This is for cancer survivors.

[00:27:57] Leah Sherman, ND: for cancer survivors

[00:27:58] Tina Kaczor, ND, FABNO: Yeah.

[00:27:58] Leah Sherman, ND: Yeah. Or if you're getting, maintenance therapy,

[00:28:02] Tina Kaczor, ND, FABNO: Yeah, and I think eating in a 10 hour window is fairly doable for most people. I mean, I know people might have some hypoglycemia and other issues that they have to deal with, but if you can get yourself, you start at, you know, 12 hours and then go to 11 and then go to 10, that kind of thing can be done. I, I feel like it's.

Part of a normal circadian rhythm, right? So this is what we're supposed to be doing on some level, is eating when the light is out and our, we're moving about and fasting overnight. And that allows our metabolism, our endocrine systems, our hormonal systems, everything in us, our immune systems to be in a normal healthy rhythm.

So I, I put, put circadian rhythm just as a. It's right next to exercise, right? Normalize your circadian rhythm. Exercise, eat well. You know, normalizing your cian rhythm means sleeping well and addressing that if you don't sleep well. So.

[00:29:00] Leah Sherman, ND: And there was exclusionary, um, criteria, including anyone with a history of eating disorders. I don't believe you could be diabetic. Um, but general, time restricted eating has been shown, as we've said, to help people with metabolic syndrome.

 another thing about the exclusionary criteria is, In this study, they had a body mass index of greater than 18.5, that is important so that you're not underweight weight. the other exclusionary criteria was there was no surgery planned during the study duration, and then the. Contraindications are insulin dependent diabetes, if they're receiving enteral or parenteral nutrition. then any, it says a recent history of an eating disorder, but I would say history of eating

[00:29:56] Tina Kaczor, ND, FABNO: Mm-hmm.

That makes sense.

[00:29:57] Leah Sherman, ND: but for the study it says a recent

[00:29:59] Tina Kaczor, ND, FABNO: Yeah.

[00:29:59] Leah Sherman, ND: but yeah, I, I just think in general, anyone with a history of eating disorder should not do this on their own.

I.

[00:30:06] Tina Kaczor, ND, FABNO: Yeah. Yeah, I agree. Anyone with a history of eating disorder should be working with professionals, around eating, around diet. So yeah, we have seen that go. Wrong. Oh, and it happens, you know, we, we kind of attract that crowd in the naturopathic profession. We attract a crowd that, that will like to perfect their diet, which is why there is a term now called orthorexia, which is not a formalized diagnosis, I don't believe.

But orthorexia is a term for people who would like to eat perfectly. And so I think that sometimes we can get ourselves into a bit of a bind, trying to choose the perfect diet and. And people who have a history of eating disorders are more likely to fall into that, uh, feeling like they can't eat perfectly all the time.

[00:30:53] Leah Sherman, ND: So if this is something that a person is interested in doing, talk to your dietician at the cancer center. Or there now are programs where you can, um, have virtual meetings with dieticians and trained nutritionists. So that's kind of interesting too. Um. yeah, 10 hours is And I probably would tell people, because I know the 16 eight was really popular for a while, and we may have mentioned it in the fasting episode.

I don't find that women do well on that extended, know, fasting period. I think, yeah, the 10 hours, I probably wouldn't do more of a fasting window than 10 hours.

[00:31:37] Tina Kaczor, ND, FABNO: I don't think so either. I think that that's normal. Right? That's still within the bounds of, of a normal day to eat between 8:00 AM and 6:00 PM for example. Yeah.

[00:31:46] Leah Sherman, ND: Yeah, I mean it like I, looking at myself, it is really

[00:31:50] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:31:51] Leah Sherman, ND: because I like to eat when my husband gets home, and usually that means that the minute he walks in the door, I'm like, okay, sit down and eat. So it's not

[00:32:01] Tina Kaczor, ND, FABNO: Right?

[00:32:01] Leah Sherman, ND: possible. Um, and then that forces me to push my breakfast

[00:32:05] Tina Kaczor, ND, FABNO: Mm-hmm.

Yeah. Yeah.

[00:32:07] Leah Sherman, ND: so yeah, there, you know, you kind of think about that or the, you know, sometimes someone's like, well, I'm gonna be going out to dinner with friends and it's gonna go late.

You know,

[00:32:16] Tina Kaczor, ND, FABNO: Right. So it depends how you frame it, right? ' cause a 10 hour eating window is the same as a 14 hour fasting window,

[00:32:22] Leah Sherman, ND: Right. What I'm saying is that it, it may not always be consistent because it may, it may have to change on what is is going

[00:32:31] Tina Kaczor, ND, FABNO: Yes. So if you go out with friends and you end up eating at 8:00 PM you might have to wait a little longer the next day to make 14 hours. Yeah,

[00:32:38] Leah Sherman, ND: Right. I.

[00:32:39] Tina Kaczor, ND, FABNO: yeah, yeah, absolutely. That's the beauty of it. It can be kind of fluid. Yeah.

[00:32:43] Leah Sherman, ND: Unless you have like two different events. If you have a early morning breakfast meeting the next day, then, but you know,

[00:32:50] Tina Kaczor, ND, FABNO: Nobody's perfect.

[00:32:51] Leah Sherman, ND: nobody's perfect. And yeah, if it doesn't work every single day of the

[00:32:55] Tina Kaczor, ND, FABNO: Yeah,

[00:32:56] Leah Sherman, ND: too.

[00:32:57] Tina Kaczor, ND, FABNO: Exactly.

[00:32:58] Leah Sherman, ND: it was interesting that that helped to reduce cancer related fatigue.

[00:33:02] Tina Kaczor, ND, FABNO: Yeah. And it's so simple, you know? It's such a simple thing to do to adopt.

[00:33:07] Leah Sherman, ND: I like your idea of starting with a 12 hour window and then going to a 13 hour fasting window and then like increasing it

[00:33:14] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:33:15] Leah Sherman, ND: I mean, I find a 13 hour window, which is what I typically do, a 13 hour fasting window, a eating window. Um, yeah, that seems to be really easy.

[00:33:25] Tina Kaczor, ND, FABNO: Yeah.

[00:33:26] Leah Sherman, ND: I have been kind of pushing it, you know, to see how,

[00:33:29] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:33:31] Leah Sherman, ND: how much I can go. I'm a breakfast person. I like to wake up and have breakfast.

[00:33:37] Tina Kaczor, ND, FABNO: Oh, you do? You like,

[00:33:38] Leah Sherman, ND: love

[00:33:38] Tina Kaczor, ND, FABNO: oh, okay.

[00:33:39] Leah Sherman, ND: I love lunch and I love dinner,

[00:33:44] Tina Kaczor, ND, FABNO: So.

[00:33:44] Leah Sherman, ND: but I really like, I like, you know, like, what am I gonna have for breakfast this morning? You know, that kind of

[00:33:49] Tina Kaczor, ND, FABNO: Oh wow. Yeah. Hmm.

[00:33:51] Leah Sherman, ND: I think about food a lot.

[00:33:53] Tina Kaczor, ND, FABNO: Yeah.

[00:33:53] Leah Sherman, ND: when I do that ProLon, when I do the ProLon fasting

[00:33:57] Tina Kaczor, ND, FABNO: Mm-hmm.

[00:33:58] Leah Sherman, ND: like by day three I'm looking at cookbooks and like recipes online.

I'm planning like what I'm gonna be eating

[00:34:05] Tina Kaczor, ND, FABNO: When it's done.

[00:34:07] Leah Sherman, ND: Uhhuh.

[00:34:07] Tina Kaczor, ND, FABNO: Wow.

[00:34:08] Leah Sherman, ND: Oh yeah.

[00:34:09] Tina Kaczor, ND, FABNO: Yeah. I don't think about food very much. You wouldn't know to look at me, but I don't,

[00:34:14] Leah Sherman, ND: so interesting. Yeah.

[00:34:16] Tina Kaczor, ND, FABNO: no.

[00:34:17] Leah Sherman, ND: I'm big into, I'm big into that.

[00:34:19] Tina Kaczor, ND, FABNO: I probably could. I could do a couple meals a day, like two something around 10, something around three, and I'd be done. I don't do that because you know, I have a partner. We have three Square, but

[00:34:28] Leah Sherman, ND: wait a minute. You could, you can have your last meal at three.

[00:34:33] Tina Kaczor, ND, FABNO: Yeah. I often have my last meal, four or five. So three. I ideally when, yes, when I'm alone, I eat pretty early and then I'm done for the night.

[00:34:41] Leah Sherman, ND: Oh my God. I would have a blood sugar crash in the middle of the

[00:34:44] Tina Kaczor, ND, FABNO: Mm.

[00:34:44] Leah Sherman, ND: and wake up.

[00:34:45] Tina Kaczor, ND, FABNO: Yeah.

[00:34:46] Leah Sherman, ND: Fascinating.

[00:34:49] Tina Kaczor, ND, FABNO: All right. Well,

[00:34:51] Leah Sherman, ND: so, oh,

[00:34:52] Tina Kaczor, ND, FABNO: home in summary

[00:34:53] Leah Sherman, ND: in summary, for the whole

[00:34:55] Tina Kaczor, ND, FABNO: or as AI likes to say, in conclusion,

[00:34:57] Leah Sherman, ND: in conclusion. Talk to your doctor if you want to try any of these changes in timing.

[00:35:05] Tina Kaczor, ND, FABNO: I think you can try to institute this on your own.

[00:35:07] Leah Sherman, ND: Oh, for

[00:35:08] Tina Kaczor, ND, FABNO: Yeah. I mean,

[00:35:08] Leah Sherman, ND: just being like a

[00:35:09] Tina Kaczor, ND, FABNO: yeah, I know.

[00:35:10] Leah Sherman, ND: Well, you know, well, well, the thing with, you know, the immunotherapy, you might have to talk with your doctor, you know, depending on.

[00:35:16] Tina Kaczor, ND, FABNO: I mean, if you're already getting immunotherapy, you don't have to really consult to say, can I get it in the morning? Do you?

[00:35:20] Leah Sherman, ND: I think it depends on when doctors are around

[00:35:23] Tina Kaczor, ND, FABNO: Yeah. Well, yes, the,

[00:35:24] Leah Sherman, ND: scheduling it, scheduling at hospitals, you know,

[00:35:27] Tina Kaczor, ND, FABNO: the practical part, the logistics part, but not for their permission per se. I wouldn't,

[00:35:33] Leah Sherman, ND: I know, I'm just talking about the logistics

[00:35:35] Tina Kaczor, ND, FABNO: Yes. Logistics. Yes, permission.

[00:35:37] Leah Sherman, ND: I don't need your stinking

[00:35:38] Tina Kaczor, ND, FABNO: I don't need your stink and permission to do the best thing for me.

[00:35:40] Leah Sherman, ND: So on that note, I'm Dr. Leah Sherman,

[00:35:43] Tina Kaczor, ND, FABNO: And I'm Dr. Tina Caer,

[00:35:45] Leah Sherman, ND: and this is the Cancer Pod.

[00:35:46] Tina Kaczor, ND, FABNO: until next time.

[00:35:47] Leah: Thanks for listening to The Cancer Pod. Remember to subscribe, review, and rate us wherever you get your podcasts. Follow us on social media for updates. And as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The Cancer Pod is hosted by me, Dr.

Leah Sherman, and by Dr. Tina Kaczor. Music is by Kevin MacLeod. See you next time.