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Tailoring Your Plate to Your Treatment

Updated: Jan 17

I was very excited to see the publication in Frontiers in Nutrition of a review article by Dr Nina Fuller-Shavel and her team in December 2025, which outlined specific nutritional, metabolic, and lifestyle strategies currently showing potential for cancer patients receiving targeted therapies.


The analysis focused on interventions that help minimizing treatment toxicities and the development of resistance, while encouraging beneficial therapeutic synergies, and optimising clinical outcomes.


What targeted therapies?

The review focused on immunotherapy (ICIs), PI3K inhibitors, and EGFR-tyrosine kinase inhibitors (EGFR-TKIs). You can see the main features for each therapy in this summary table:


Infographic comparing immune checkpoint, PI3K, and EGFR-tyrosine kinase inhibitors.

What are the practical, evidence-based implications for patients navigating these treatments?

I listed the key strategies under analysis below, but before we delve into those, I want you to really understand what these findings mean in terms of taking nutritional and lifestyle support to the next level for patients.


While these interventions are are well known to cancer-focused nutritional therapists, as well as patients who adopt an integrative approach to their care, this analysis goes a step forward.


This is 'precision nutrition' at its best, which is founded on the premise that there is no 'one-size-fits-all' dietary approach to cancer support.


So, not only any nutritional strategy needs to be tailored to the patient's individual circumstances. In addition to that - and this is the important bit - any strategy needs to be aligned with the specific biological mechanism and toxicity profile of the chosen - as much as possible targeted - medical treatment.


So, let's see what the analysis highlighted.


Immunotherapy

Your gut microbiome is your most powerful ally in helping the treatment ‘see’ and attack cancer cells and for controlling inflammation.

Boost Your Microbiome

Specific support incudes:

  • High fibre intake is consistently linked to better treatment responses, they suggest aiming for 30–50g of fibre daily (as tolerated).

  • A wholefood, polyphenol-rich Mediterranean-style diet helps foster a healthy gut environment; conversely, too many saturated fats and ultra-processed foods are linked to poorer outcomes

  • Consumption of fermented foods is a promising strategy to enhance the activity of immune cells that are crucial for treatment success, further research is undergoing

  • A ketogenic diet shows preclinical promise for creating an immunogenic environment, however more patient data is needed in this context

  • Nightly fasting: preliminary evidence suggests that fasting overnight up to 14 hours may improve disease control for certain patients

  • Vitamin D: maintaining levels of at least 75 nmol/l is essential for supporting the immune system during therapy

  • Specific polyphenol-rich plant extracts and medicinal mushrooms have shown potential to activate T-cell responses and alleviate dysbiosis

  • Medication awareness: the use of Proton Pump Inhibitors (PPIs) and antibiotics is linked to a significantly higher risk of disease progression and mortality, as they disrupt the microbiome.


PI3K Inhibitors

The primary challenge with this targeted therapy is hyperglycaemia (high blood sugar), which occurs in over 60% of patients. This happens because the drug blocks insulin signalling, leading to insulin resistance.

managing blood sugar

Specific support includes:

  • A low-glycaemic index, lower-carbohydrate diet, with minimal refined sugars and flours to help manage this side effect and potentially improve the drug's effectiveness.

  • Proactive monitoring of HbA1c and fasting glucose is very important (this may involve coordinated care with endocrinologists to use insulin-sensitising agents like metformin, when necessary)



EGFR-TKI Therapy

The focus is on maintaining body weight, preventing muscle loss (sarcopenia), and managing gut sensitivity. Specific support includes:


  • Prioritising protein, to maintain strength and treatment tolerance - at least 1.4 grams of protein per Kg of body weight, where possible.

  • Managing gastrointestinal side effects: small, frequent meals of easily digestible, low-fat cooked foods alongside optimal hydration.

  • Avoiding trigger foods like spicy dishes, sugar-free beverages (containing sugar alcohols), and alcohol


weight maintenance and gut health management


Bringing the findings to patients in real life


In addition to the enhanced level of precision that can be adopted in personalised treatment support, there is another noteworthy message that emerges from this analysis.


Which is the confirmation, once more, that cancer patients don't need to be passive bystanders in their treatment. Managing the ‘body terrain’ through nutrition and lifestyle interventions can be a decisive factor in creating the optimal conditions for medical therapies to succeed.


If you are looking to implement some of these strategies, please consult with your oncology team, and find a qualified nutritional therapist to personalise these findings to your specific needs.


And if you already have this information but need help implementing changes sustainably in your life, a health coach that specialises in supporting recovery from complex illness can be a great asset as part of your multidisciplinary team. 



Health Coaching & Mentoring is a safe space where your are held, guided and empowered to make the own choices and take the meaningful actions that best suit your personal pathway to recovery, your values and needs, your health goals and quality of of life, from a place of balance, resilience and calm energy.


Get in touch if you wish to know more, or to arrange an exploratory call silvia@silviagrisendi.com




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