| Rank |
Pathway / Axis |
Cancer Cells |
Normal Cells |
Label |
Primary Interpretation |
Notes |
| 1 |
Insulin / IGF-1 signaling |
↓ IGF-1 survival signaling (stress) |
↓ IGF-1 with adaptive protection |
Driver |
Differential stress resistance (DSR) |
Cancer cells fail to adapt to acute IGF-1 withdrawal; normal cells enter protective mode |
| 2 |
AMPK → mTOR nutrient sensing |
↑ AMPK; ↓ mTOR (growth crisis) |
↑ AMPK; ↓ mTOR (protective quiescence) |
Driver |
Catabolic enforcement |
Rapid mTOR suppression removes anabolic support from tumors |
| 3 |
Autophagy (ATG program) |
↑ autophagy → metabolic exhaustion |
↑ autophagy → cytoprotection |
Driver |
Catabolic stress vs survival recycling |
Autophagy is protective in normal cells but destabilizing in cancer cells |
| 4 |
Mitochondrial metabolism / flexibility |
↓ metabolic flexibility; ↓ ATP resilience |
↑ mitochondrial efficiency |
Secondary |
Energy crisis vs optimization |
Tumors struggle to switch fuels; normal cells adapt |
| 5 |
Reactive oxygen species (ROS) |
↑ ROS (secondary to energy stress) |
↓ ROS |
Secondary |
Metabolic redox divergence |
ROS increase is indirect, arising from metabolic collapse |
| 6 |
NRF2 antioxidant response |
↔ or insufficient activation |
↑ NRF2 (protective) |
Adaptive |
Stress buffering in normal cells |
Normal cells activate antioxidant defenses; tumors often cannot |
| 7 |
Cell cycle / proliferation |
↓ proliferation / ↑ arrest |
↓ proliferation (protective quiescence) |
Phenotypic |
Growth suppression |
Cell-cycle slowdown reflects upstream nutrient deprivation |
| 8 |
Therapy sensitivity (chemo / RT) |
↑ sensitivity |
↓ toxicity |
Phenotypic |
Differential stress sensitization |
STF selectively sensitizes tumors while protecting normal tissue |
| Fasting Type |
Definition |
Primary Metabolic / Signaling Effects |
Cancer-Relevant Mechanisms |
Evidence Base |
Relative Effectiveness* |
| Caloric Restriction (CR) |
Chronic daily reduction in total caloric intake (typically 20–40%) without malnutrition. |
↓ insulin, ↓ IGF-1, ↓ mTOR, ↑ AMPK, ↑ autophagy |
Reduces growth signaling; improves metabolic milieu; may slow tumor initiation/growth in models. |
Extensive animal data; observational human data. |
Moderate–High |
| Caloric Restriction Mimetic (CRM) |
Non-fasting interventions that mimic CR signaling without major calorie reduction. |
↓ mTOR, ↑ AMPK, ↑ autophagy; altered acetyl-CoA/epigenetic tone (context-dependent) |
Replicates key CR pathways while preserving nutrition; potential synergy with therapy (context-specific). |
Strong mechanistic + preclinical; growing human data. |
Moderate–High |
| Intermittent Fasting (IF) |
Regular cycles of fasting and feeding (e.g., 16:8, 18:6, 20:4). |
Periodic ↓ insulin/IGF-1; ↑ fat oxidation; mild ketosis (variable) |
Metabolic stress on tumor cells; improved insulin sensitivity; may modulate inflammation. |
Good animal data; emerging human data. |
Moderate |
| Alternate-Day Fasting (ADF) |
Alternating 24 h fasting with 24 h ad libitum feeding. |
Strong oscillations in insulin/glucose/ketones; improved metabolic switching |
Enhanced metabolic flexibility; may promote normal-cell stress resistance. |
Animal data strong; limited oncology-specific human data. |
Moderate–High |
| Short-Term Fasting (STF) |
Complete or near-complete fasting for ~24–72 h (often around therapy). |
Sharp ↓ IGF-1; ↓ glucose; ↑ ketones; ↑ autophagy |
Differential stress resistance (normal-cell protection) and potential tumor sensitization (context-specific). |
Strong preclinical; small human trials. |
High |
| Fasting-Mimicking Diet (FMD) |
Low-calorie, low-protein, low-sugar diet for 3–5 days designed to simulate fasting. |
↓ IGF-1; ↓ mTOR; ↑ autophagy; partial ketosis |
Similar benefits to STF with improved tolerability; may enhance therapy response in some contexts. |
Strong animal; increasing human interventional data. |
High |
| Protein Restriction (PR) |
Reduction in total protein or specific amino acids (e.g., methionine restriction). |
↓ IGF-1; ↓ mTORC1; altered amino-acid sensing |
Targets amino-acid dependencies and growth signaling; may synergize with selected therapies. |
Strong mechanistic; animal + early human data. |
Moderate–High |
| Ketogenic / Very-Low-Carb Diet |
Diet inducing sustained ketosis without fasting (variable protein content). |
↓ glucose; ↓ insulin; ↑ ketones |
May constrain glycolysis-dependent tumors; effects are heterogeneous by cancer type and context. |
Mixed animal data; heterogeneous human data. |
Low–Moderate |
| Time-Restricted Feeding (TRF) |
Fixed daily eating window (typically 6–12 h), emphasizing circadian alignment. |
Circadian stabilization; modest ↓ insulin exposure; partial metabolic switching |
Improves metabolic control; limited deep autophagy unless fasting is long (≥18–20 h). |
Early-stage; indirect oncology evidence. |
Low–Moderate |
| Water-Only Prolonged Fasting |
Extended complete fasting (>72 h). |
Deep ketosis; strong autophagy; high physiological stress |
Potentially strong tumor stress but higher risk and limited controlled oncology study. |
Limited / heterogeneous; safety considerations significant. |
Uncertain / Not Rated |