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For women, especially, screening for hormone imbalances, thyroid function, and overall stress load can make a significant difference in how well fasting is tolerated

Patients should also be monitored for gastrointestinal symptoms, hypoglycemia risk, and signs of gallbladder disease or pancreatitis

Vitamin B12 deficiency that cannot be remedied with nutrition

Key takeaways Cleveland Clinic real-world data presented at ASCO 2026 found patients who started a GLP-1 receptor agonist (semaglutide or tirzepatide) after a breast cancer diagnosis were about 43% less likely to progress to Stage IV disease than patients who started a DPP-4 inhibitor (hazard ratio 0.57, 95% CI 0.46 to 0.71