This is a much headier article than I usually put on my site, but I thought it was worth a read for anyone interested. The TL;DR is that a lot of tumors eat sugar and keto starves them to death and protects nerves and brain cells, in addition to all the other benefits of keto that we’ve seen, like weight loss and disease prevention.
I posted this article in my oncology forum. Note that this is for educational purposes and is not intended to be a replacement for medical advice. Enjoy.
With cancers that involve metabolic disregulation, the ketogenic diet (KD) shows its benefit. There is a hypothesis right now that KD can be very helpful in beating most cancers, alone or in concert with conventional therapies, and that it can help prevent the growth and spread of cancer in most people.
In an article by Woolfe, et al., Tumor Metabolism, the Ketogenic Diet and β-Hydroxybutyrate: Novel Approaches to Adjuvant Brain Tumor Therapy, the authors talk about the merits of KD on malignant brain tumors.
The basic principle of KD is that it is a diet high in fat, very low in carbohydrates, and moderate in protein. Many of the studies I have looked through claiming to be testing a KD are not actually achieving the proper macronutrient amounts for the patients, often going well over the carbohydrate intake necessary to achieve ketosis, or they are using a nutritionally suboptimal formula (seen in many of the childhood epilepsy studies), or they don’t achieve the timeframe necessary for a human to adapt to ketosis, therefore thwarting any benefits of the diet.
In this study, KD is seen as reducing angiogenesis, inflammation, peri-tumoral edema, migration and invasion in vivo as a monotherapy. The authors also note that in mouse models, KD prepares the cancer cells to be more susceptible to chemotherapy and radiation. It works in part by starving the tumor cells of glucose, an essential fuel for cancer. KD reduces blood glucose and increases blood ketones, causing the body to make a physiologic change in fuel sources. Normal cells readily utilize ketones as fuel and will up-regulate receptor sites to accept ketones more efficiently. Highly glycolytic tumors like malignant glioma display the Warburg effect, meaning that they need more glucose to survive due to their alteration in metabolism from normal cells.
In combination with other therapies, chemotherapy and radiation, KD aided in the survival of animal models, even after their normal diet was reinstated. KD and caloric restriction (CR) both help with healthy cell repair mechanisms after radiation. The difference however is that KD is more neuroprotective and immune-protective than CR is, thus is more effective. Add to that KD is shown to potentiate certain cancer therapies, so perhaps less of the drug or radiation would be necessary to achieve the same result.
Beta-hydroxybutyrate (BHB) is a main ketone body that is used as a substrate for energy in the body during KD. It is seen to have its own anti-tumor properties in vitro when used alone or as a supplement to enhance a KD. The authors state that even in the presence of high blood glucose, physiologically relevant doses of BHB actually reduced proliferation of several human glioblastoma cell lines, two human cancer stem cell lines, and a murine glioma cell line. Furthermore, BHB dosed pre-irradiation and pre-chemotherapy was shown to potentiate these treatments. More studies are needed to fully grasp this concept and my hesitation would be that adding ketones to high blood glucose could cause secondary problems, such as acidosis, without the full aforementioned benefits of the KD.
Human studies have shown some promise with end-stage cancers, with good diet tolerability, even with simultaneous CR, and increased survival rate. The pitfalls of some of the studies were due to patient variability and adherence over the long term. An interesting hypothesis from one of the research groups is that an analysis of ketolytic and glycolytic enzyme levels in tumor tissue may help identify patients that are more likely to respond to a KD, although this has yet to be proven.
The authors bring up some of the studies that have begun to include information on strict KD adherence and quality of life. This has always been something that I find troubling in disease treatment and use of KD. This diet does not have to be terrible for quality of life. Especially today, there are so many great recipes and resources for how to make KD a beautiful, bountiful feast of a diet and once adaptation is achieved it is much easier to avoid carbohydrate cravings. Is it not important to find the least harmful way of combatting cancer? What about that quality of life? Of course adding in corticosteroids is another consideration that makes it more difficult to adhere to any dietary strategy and corticosteroids are often used with cancers to reduce inflammation. The rub is that on KD a patient will reduce inflammation naturally as they combat cancer proliferation, so there shouldn’t be as great a need for corticosteroids.
If patients are educated on the benefits of KD and the medical community can have some more buy-in, it will make for a lot less death with patients succumbing to their disease. In a world where malignant gliomas kill children in 1.5 years on average, it is imperative to find the best, most efficient, and safest way to treat and even prevent cancers. I’d like to see more studies on other cancers with the Warburg effect so we can save more lives and do it humanely.
Reference: Woolf EC, Syed N and Scheck AC (2016) Tumor Metabolism, the Ketogenic Diet and β-Hydroxybutyrate: Novel Approaches to Adjuvant Brain Tumor Therapy. Front. Mol. Neurosci. 9:122. doi: 10.3389/fnmol.2016.00122
Important: The information on this page is meant to be educational. It is not a substitute for medical advice. The information may not cover all possible uses, actions, interactions, or side effects of this therapy, or precautions to be taken while using it. Please see your health care professional for more information about your specific medical condition and the use of this therapy.