{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T00:27:54Z","timestamp":1774139274555,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Follicular lymphoma typically follows an indolent and relapsing course often requiring several treatment cycles to achieve remission. Some patients opt to use complementary and alternative therapies particularly when observation is a treatment option.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>Here we present a case series of three patients, a 50-year-old, White, Hispanic female, 56-year-old, White, non-Hispanic male, and 49-year-old, White, non-Hispanic male, who elected to undergo one or more prolonged water-only fasting and refeeding interventions to manage low to intermediate grade follicular lymphoma. Fasting was well tolerated in each patient. Each patient also experienced a reduction in the size and avidity of hypermetabolic lymph nodes as independently determined by their respective oncologists.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The reported cases demonstrate positive outcomes in low-grade follicular lymphoma coinciding with prolonged water-only fasting and exclusively whole-plant-food dietary interventions. These findings highlight the potential of such interventions and warrant further exploration through preliminary observational research.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-024-04609-w","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:02:10Z","timestamp":1719964930000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prolonged water-only fasting in the management of low-grade follicular lymphoma: a case series"],"prefix":"10.1186","volume":"18","author":[{"given":"Sahmla","family":"Gabriel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8328-7366","authenticated-orcid":false,"given":"Toshia R.","family":"Myers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan C.","family":"Goldhamer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"issue":"11","key":"4609_CR1","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1182\/blood.2020010263","volume":"139","author":"C Casulo","year":"2022","unstructured":"Casulo C, Dixon JG, Le-Rademacher J, et al. Validation of POD24 as a robust early clinical end point of poor survival in FL from 5225 patients on 13 clinical trials. Blood. 2022;139(11):1684\u201393. https:\/\/doi.org\/10.1182\/blood.2020010263.","journal-title":"Blood"},{"issue":"10","key":"4609_CR2","doi-asserted-by":"publisher","first-page":"3291","DOI":"10.1111\/cas.15492","volume":"113","author":"S Tiwari","year":"2022","unstructured":"Tiwari S, Sapkota N, Han Z. Effect of fasting on cancer: a narrative review of scientific evidence. Cancer Sci. 2022;113(10):3291\u2013302. https:\/\/doi.org\/10.1111\/cas.15492.","journal-title":"Cancer Sci"},{"issue":"22","key":"4609_CR3","doi-asserted-by":"publisher","first-page":"4474","DOI":"10.4161\/cc.9.22.13954","volume":"9","author":"L Raffaghello","year":"2010","unstructured":"Raffaghello L, Safdie F, Bianchi G, Dorff T, Fontana L, Longo VD. Fasting and differential chemotherapy protection in patients. Cell Cycle. 2010;9(22):4474\u20136. https:\/\/doi.org\/10.4161\/cc.9.22.13954.","journal-title":"Cell Cycle"},{"issue":"4","key":"4609_CR4","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.tem.2018.01.008","volume":"29","author":"R Buono","year":"2018","unstructured":"Buono R, Longo VD. Starvation, stress resistance, and cancer. Trends Endocrinol Metab. 2018;29(4):271\u201380. https:\/\/doi.org\/10.1016\/j.tem.2018.01.008.","journal-title":"Trends Endocrinol Metab"},{"issue":"2","key":"4609_CR5","doi-asserted-by":"publisher","first-page":"434","DOI":"10.3109\/10428194.2014.916803","volume":"56","author":"S Rausch Osian","year":"2015","unstructured":"Rausch Osian S, Leal AD, Allmer C, et al. Widespread use of complementary and alternative medicine among non-Hodgkin lymphoma survivors. Leuk Lymphoma. 2015;56(2):434\u20139. https:\/\/doi.org\/10.3109\/10428194.2014.916803.","journal-title":"Leuk Lymphoma"},{"issue":"1","key":"4609_CR6","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12906-018-2136-6","volume":"18","author":"JS Finnell","year":"2018","unstructured":"Finnell JS, Saul BC, Goldhamer AC, Myers TR. Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting. BMC Complement Altern Med. 2018;18(1):67. https:\/\/doi.org\/10.1186\/s12906-018-2136-6.","journal-title":"BMC Complement Altern Med"},{"key":"4609_CR7","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2015-211582","author":"AC Goldhamer","year":"2015","unstructured":"Goldhamer AC, Klaper M, Foorohar A, Myers TR. Water-only fasting and an exclusively plant foods diet in the management of stage IIIa, low-grade follicular lymphoma. BMJ Case Rep. 2015. https:\/\/doi.org\/10.1136\/bcr-2015-211582.","journal-title":"BMJ Case Rep"},{"key":"4609_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2018-225520","author":"TR Myers","year":"2018","unstructured":"Myers TR, Zittel M, Goldhamer AC. Follow-up of water-only fasting and an exclusively plant food diet in the management of stage IIIa, low-grade follicular lymphoma. BMJ Case Rep. 2018. https:\/\/doi.org\/10.1136\/bcr-2018-225520.","journal-title":"BMJ Case Rep"},{"issue":"27","key":"4609_CR9","doi-asserted-by":"publisher","first-page":"3059","DOI":"10.1200\/JCO.2013.54.8800","volume":"32","author":"BD Cheson","year":"2014","unstructured":"Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059\u201368. https:\/\/doi.org\/10.1200\/JCO.2013.54.8800.","journal-title":"J Clin Oncol"},{"key":"4609_CR10","doi-asserted-by":"publisher","DOI":"10.3390\/nu14204313","author":"S Gabriel","year":"2022","unstructured":"Gabriel S, Ncube M, Zeiler E, et al. A six-week follow-up study on the sustained effects of prolonged water-only fasting and refeeding on markers of cardiometabolic risk. Nutrients. 2022. https:\/\/doi.org\/10.3390\/nu14204313.","journal-title":"Nutrients"},{"issue":"30","key":"4609_CR11","doi-asserted-by":"publisher","first-page":"3305","DOI":"10.1038\/onc.2011.91","volume":"30","author":"C Lee","year":"2011","unstructured":"Lee C, Longo VD. Fasting vs dietary restriction in cellular protection and cancer treatment: from model organisms to patients. Oncogene. 2011;30(30):3305\u201316. https:\/\/doi.org\/10.1038\/onc.2011.91.","journal-title":"Oncogene"},{"issue":"2","key":"4609_CR12","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1152\/japplphysiol.00209.2007","volume":"103","author":"KA Varady","year":"2007","unstructured":"Varady KA, Roohk DJ, Hellerstein MK. Dose effects of modified alternate-day fasting regimens on in vivo cell proliferation and plasma insulin-like growth factor-1 in mice. J Appl Physiol. 2007;103(2):547\u201351. https:\/\/doi.org\/10.1152\/japplphysiol.00209.2007.","journal-title":"J Appl Physiol"},{"issue":"1","key":"4609_CR13","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1038\/s41467-020-16138-3","volume":"11","author":"S de Groot","year":"2020","unstructured":"de Groot S, Lugtenberg RT, Cohen D, et al. Fasting mimicking diet as an adjunct to neoadjuvant chemotherapy for breast cancer in the multicentre randomized phase 2 DIRECT trial. Nat Commun. 2020;11(1):3083. https:\/\/doi.org\/10.1038\/s41467-020-16138-3.","journal-title":"Nat Commun"},{"issue":"12","key":"4609_CR14","doi-asserted-by":"publisher","first-page":"988","DOI":"10.18632\/aging.100114","volume":"1","author":"FM Safdie","year":"2009","unstructured":"Safdie FM, Dorff T, Quinn D, et al. Fasting and cancer treatment in humans: a case series report. Aging. 2009;1(12):988\u20131007. https:\/\/doi.org\/10.18632\/aging.100114.","journal-title":"Aging"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04609-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-024-04609-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-024-04609-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:02:13Z","timestamp":1719964933000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-024-04609-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,3]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4609"],"URL":"https:\/\/doi.org\/10.1186\/s13256-024-04609-w","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,3]]},"assertion":[{"value":"9 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This case series did not require ethics approval, but all patients consented to participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publications"}},{"value":"A.C.G. is owner of the TrueNorth Health Center. All other authors have no conflicts of interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"302"}}