Fatigue reduction diet in breast cancer survivors: a pilot randomized clinical trial
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Fatigue is a prevalent and burdensome effect of breast cancer. Fatigue has been linked to chronic inflammation, and diets high in antioxidant nutrients have been associated with lesser prevalence and severity of fatigue. Studies are needed, however, to test if antioxidant-rich diets could improve fatigue.
Pilot, randomized, trial conducted between January 2014 and April 2015, to investigate if a 3-month diet rich in fruit, vegetables, whole grains, and omega-3 fatty acid-rich foods, named the fatigue reduction diet (FRD), improved fatigue and sleep compared to an attention control, named the general health curriculum (GHC). 30 stage 0 to III breast cancer survivors, who had completed cancer treatments, were randomized: 15 receiving the FRD and 15 the GHC. Primary outcome was change in fatigue, as measured by the brief fatigue Inventory, from baseline to 3 months analyzed using linear mixed models. Secondary analyses were changes in sleep quality, serum carotenoids, and fatty acids.
From baseline to 3-month fatigue improved by 44 ± 39% in FRD compared to 8 ± 34% in GHC (p = 0.01); sleep quality improved by 2.5 ± 3.3 points in FRD, and diminished by 0.9 ± 2.3 in GHC (p = 0.03); serum total carotenoids (p < 0.01), β-cryptoxanthin (p = 0.02), lutein (p = 0.05), zeaxanthin (p = 0.01), lycopene (p = 0.05), omega-3 fatty acids (p < 0.01), and ratio of omega-3:omega-6 fatty acids (p = 0.02) were significantly increased, and percent saturated fatty acids were decreased (p = 0.04) in FRD; γ-tocopherol was significantly increased in GHC (p = 0.03), and there was a significant visit by group difference for α-carotene between the study groups (p = 0.05).
The FRD intervention improved fatigue and sleep in breast cancer survivors compared to the GHC. FRD diet could provide a non-toxic treatment strategy for persistent fatigue.
KeywordsCancer-related fatigue Sleep quality Breast cancer survivor Diet, omega-3 fatty acids Fruits Vegetables Whole grains Carotenoids
Fatigue reduction diet
General health curriculum
Healthy eating index
Brief fatigue inventory
Pittsburgh sleep quality index
Body mass index
Linear mixed models
Central nervous system
Michigan Clinical Research Unit
Interleukin 1 receptor antagonist
This study was supported by grants from the James Stuart and Barbara Padnos Research Funds for Cancer Research and the National Institutes of Health (NIH) CTSA Grant Number 2UL1TR000433-06. The funders had no role in the design of the study and collection, analysis, and interpretation of data, or the writing of the study. We would also like to thank Jianwei Ren for analyzing the blood samples.
Dr. Zick made substantial contributions to conception and design, data analysis and interpretation of data, and acquisition of data; was involved in drafting the manuscript revising the manuscript critically for important intellectual content and gave final approval of the version to be published. Dr. Djuric made substantial contributions to conception and design, data analysis, and interpretation of data, was involved in revising the manuscript critically for important intellectual content and gave final approval of the version to be published. Dr. Colacino made substantial contributions to conception and design, data analysis and interpretation of data, and he was involved in revising the manuscript critically for important intellectual content and gave final approval of the version to be published. Ms. Brash, Surnow, Khabir, Cornellier, and Mr. Ren made substantial contributions to acquisition of data, and were involved in revising the manuscript critically for important intellectual content and gave final approval of the version to be published.
Compliance with ethical standards
Conflicts of interest
Drs. Zick, Djuric and Colacino and Ms. Cornellier, Surnow and Khabir declare that they have neither financial nor non-financial competing interest to disclose nor do they have any conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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