Kohlenhydratarme Diät, Kurzzeitfasten und palliative Chemotherapie beim Bronchialkarzinom
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Abstract
Studies indicate that a ketogenic (low-carbohydrate) diet and fasting could increase chemotherapy tolerability and thus improve quality of life. This pilot study was therefore conducted to test the tolerability, feasibility and acceptance of a combination of a low-carbohydrate diet and short-term fasting during chemotherapy.
A total of 14 patients with advanced small and non-small cell lung cancer who were receiving an outpatient palliative treatment concept consisting of a platinum-based chemotherapy were recruited for this feasibility study.
The nutritional intervention consisted of three days of low-carbohydrate diet before and 24-hour short-term fasting on therapy days and was repeated for each new chemotherapy cycle. The study period lasted an average of four months. All treatment decisions were made in accordance with medical guidelines and were not influenced by the dietary intervention.
Side effects were recorded using the GASE-P (Generic Assessment of Side Effects – Patient Version) questionnaire. Weight progression and phase angle measured by using bioelectrical impedance analysis were documented. Quality of life was analysed in various dimensions (Hospital Anxiety and Depression Scale: HADS, Functional Assessment of Cancer Therapy – Lung: FACT-L). Low-carbohydrate diet was documented in a food diary and ketone bodies were measured in urine.
The dietary concept proved to be feasible in eight of 14 patients. At the beginning of the study, six patients dropped out due to different reasons. The termination criteria were not met in these cases.
In this pilot study three patients gained up to 8.9 % in weight over the course of the study and five patients lost up to 7.9 %. There was a tendency towards a decrease in phase angle, which is to be expected under chemotherapy. In all eight patients, the albumin value was within the normal range during the course of the study.
During the study period, the side effect fatigue, listlessness occurred most frequently. Constipation was the most common gastrointestinal side effect.
At the start of the study, two patients were diagnosed with an anxiety disorder and four with depression using HADS questionnaire.
Quality of life, measured with FACT-L questionnaire, increased over the course of the study in relation to bronchial carcinoma in two patients, in two patients there was no change and in four patients it decreased.
The evaluation of the food diaries revealed that three patients were on a low-carbohydrate and high-fat diet, three patients partially adhered to the low-carbohydrate diet and two patients ate too many foods rich in carbohydrate. Short-term fasting was implemented correctly more often. Positive ketone bodies were rarely measured.
Instead of only tumor stage IV, tumor stages II and III could also be included. This would increase the heterogeneity of the sample, but would make it easier to recruit a sufficiently large number of subjects.
Low-carbohydrate diet requires a high degree of patient compliance, which could be improved by additional administration of high-calorie, high-fat and low-carbohydrate drinks. A ketone body measurement in the urine carried out independently at home could provide direct feedback as to whether the low-carbohydrate diet has been successfully implemented. A more precise measurement of ketone bodies would also be possible in blood serum. In order to quickly recognize a calorie deficit, the total number of calories per day should be recorded and also counteracted by nutritional drinks.
A planned larger randomized controlled study could show differences between the intervention and control groups and answer the question of whether the nutritional intervention can improve the tolerability of chemotherapy.
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