Researcher:
Amber Kleckner, PhD, assistant professor
Areas of Expertise:
Kleckner specializes in nutrition science, symptom science, cancer-related fatigue, cancer survivorship, mitochondria, and circadian rhythms.
The BIG Idea:
People undergoing chemotherapy, radiation, and other treatments for cancer endure a large symptom burden, including fatigue, cognitive impairment, pain, and gastrointestinal issues. Unfortunately, these symptoms can persist long after the cancer has been treated and can sometimes prevent people from returning to work, family roles, hobbies, and other activities that define their identity. Treating the side effects of cancer drugs with other drugs can have their own side effects. But nutritional interventions can improve overall health, enhance the ability to heal, and increase resilience against further adverse conditions. Based on a large and growing body of research into nutrition and cancer, Kleckner, a nutrition scientist, designs and tests nutritional programs to help address these symptoms and help people attain the quality of life they had before their cancer diagnoses. These programs include both what people are eating and when people are eating.
Time-restricted eating is a popular new form of intermittent fasting. It entails only eating during a defined window during daytime hours, since in human circadian biology, energy consumption and utilization coincide with those hours. Thus, deliberately eating food within a 10-hour eating window, for example 9 a.m. - 7 p.m., ending approximately three hours before bed, is hypothesized to help improve circadian rhythms, sleep quality, and energy levels during the day. In the context of cancer survivorship, Kleckner theorizes that time-restricted eating can help mitigate cancer-related fatigue through strengthening circadian rhythms.
Why does the research matter?
Cancer is one of the most prevalent chronic diseases in the world. With technological advances in treatments over the last few decades, there are more cancer survivors than ever. However, many people live with persistent symptoms such as cancer-related fatigue.
“We still do not understand the underlying mechanisms of cancer-related fatigue and other related symptoms,” Kleckner says. “Because we don’t understand why the symptoms occur, it makes it difficult to discover preventive treatments for these ailments. With each of our studies, we are helping to understand how cancer-related fatigue is associated with mitochondrial function, gene expression, circadian rhythm, and other processes, as well as how nutrition is affecting these processes. That way, we can optimize our nutritional programs to confer the greatest benefits.”
Who does the research matter to?
Kleckner’s research matters to patients with cancer and their caregivers, as well as to oncology clinicians. “Despite widespread dietary recommendations and supplements for patients with cancer in the media, there are very few evidence-based dietary guidelines,” Kleckner says. “Even among the guidelines that exist, it is difficult for people to adhere to them. We are helping to define what dietary patterns are best during and after treatment so that people can tolerate treatment and heal from the experience as fast as possible.”
What are the clinical applications of the research?
Kleckner’s research thus far suggests that following a Mediterranean Diet, a pattern of eating that focuses on fruits, vegetables, whole grains, beans, nuts, legumes, lean proteins from fish and poultry, good fats from olive oil, and some dairy, while limiting consumption of sweets and red meats, during cancer treatment will lessen symptom burden, especially for people whose diets differed most from the Mediterranean Diet before their diagnosis. She and her team are also gathering data to evaluate their hypothesis that chemotherapy and/or radiation disrupts circadian rhythm and contributes to fatigue, and time-restricted eating can help restore circadian rhythm and reduce fatigue. “Our future goals are to thoroughly evaluate these hypotheses so that nutritional recommendations can be incorporated into oncology clinical guidelines,” Kleckner says.
“Nutrition is really understudied when it comes to cancer-related fatigue,” she says. “Nutrition as far as cancer prevention? That’s a very well-studied area. People know ‘eat fruits and vegetables, don’t eat a lot of refined sugars and refined carbs, don’t eat junk food,’ all the ways to prevent cancer. But after the cancer is diagnosed, people really want nutrition prescriptions. They want to know what they can eat so that they can beat this cancer and get back to life before cancer.”
That’s when patients turn to the internet, which is full of non-evidence-based nutrition research “because the research hasn’t been done,” Kleckner says. “There’s a huge need from clinicians, a huge demand for more specific nutrition information post-diagnosis.” Kleckner notes, however, that some herbal supplements can interfere with chemotherapy’s ability to fight cancer; thus, it is recommended not to take herbal supplements during treatment.
“Nutrition plays a powerful role because eating in a healthier dietary pattern is something people can do,” Kleckner says. “Often a patient’s treatment is out of their hands. There are so many questions and so many unknowns, but what you’re having for lunch? That’s something you can plan, that’s something you can do, and it can be really empowering.”