Ketogenic Diets and Cancer – The Current State of Research

Girl With CancerThe growth of cells in the body is tightly regulated.

Various transcription factors and molecular mechanisms ensure that cells only grow and divide when appropriate.

But cancer cells are in many ways different than other cells.

Something in the regulatory mechanism breaks and they start growing and dividing rapidly.

The cancer cells start hoarding energy from the blood, then they manipulate their surroundings to support their rapid growth.

One interesting fact about the metabolism of cancer cells, is that most of them rely solely on glucose from the blood as a source of fuel. This is called the Warburg effect.

Cancer Cells Lack Metabolic Flexibility

Normal cells of the body have a certain metabolic flexibility. If insulin is low, they can start using either fatty acids or ketone bodies to provide energy.

Most cancer cells are unable to do this. They need glucose.

This has lead to speculation about whether a carb restricted diet can reduce the available fuel for the cancer cells, partly starving them and perhaps being of use alongside other more conventional therapies like radiation and chemo.

But it’s important to realize that even though dietary intake of glucose is low, the body will still make plenty of glucose via gluconeogenesis and cancer cells are particularly efficient at “stealing” the little glucose available from the blood.

So a carb restricted diet won’t starve the cells in this way.

It might reduce their available fuel slightly, while still providing plenty of energy for the other healthy cells of the body via fatty acids and ketones.

Other Potential Mechanisms

Low-carbohydrate diets also lead to lower levels of circulating hormones Insulin and IGF-1.

This may cause the cancer cells to get less signals to grow and divide.

Additionally, ketone bodies have been shown to inhibit the growth of cancerous cells in culture (1).

It is an interesting concept and ketogenic diets are currently being studied as potential treatments for cancer alongside other conventional treatments.

Current Research on Low-Carb, Ketogenic Diets and Cancer

There was a pilot study in 10 advanced cancer patients published last October. The patients did a very low-carb, ketogenic diet for 28 days.

According to a PET scan, 4 of the patients continued to have progressive disease, while 5 remained stable and 1 had a partial remission.

The patients who had the best metabolic response to the diet (that is, lowest insulin and highest ketone levels) saw the most improvement (2 – .pdf).

A Case Report of Two Girls With Brain Cancer

In 1995, a case report of two girls with brain cancer was published.

After 7 days on a ketogenic diet, blood glucose levels decreased and glucose uptake at tumor site decreased by 21,8%.

One of the girls had significant improvement in symptoms and her disease did not progress for the next 12 months (3).

Quality of Life in Cancer Patients

In a pilot trial of 16 advanced-stage cancer patients, a ketogenic diet did improve quality of life and stopped the progression of cancer for the 5 patients who completed the 12 week study (4).

What About Prevention?

Many types of cancer are associated with other diseases of civilization like obesity and diabetes.

Given that low-carb diets can in many cases drastically improve and even cure some of these diseases, it doesn’t take a big stretch of the imagination to see how this diet may reduce chances of developing cancer later in life.

Elevated blood sugar and insulin levels, high circulating IGF-1, these are all risk factors for cancer and are all improved on a low-carb, ketogenic diet.

This Needs a Lot More Research

Cancer is a nasty bitch. You can cut it away, radiate it and overload it with poison, but somehow it often still manages to survive and spread.

Ketogenic diets may turn out to be a useful weapon in the arsenal against this foul disease, but it is definitely premature to make any recommendations based on current research.

34 Comments

  1. Hi Kris, great article. I’ve been doing a ketogenic diet for a while now. I’ve lost plenty of weight and feel great actually. Had no idea that it could have an effect on cancer, that is a very welcome surprise.

  2. If most cancer cells rely solely on glucose for fuel does that mean they don’t contain mitochondria?

    • I believe they do contain mitochondria, but in those cases are not using them for some reason.

      I don’t really know much about cancer, if you ask this guy here then I’m sure he can give you a more satisfactory answer: http://rdfeinman.wordpress.com/

    • Cancer cells cannot use ketones for energy, but when they run out of glucose they just switch over to using latic acid in the blood for energy but at a much slower growth rate than with glucose, but the liver will turn protein into sugar for the cancer cells.

      Nice huh, but that can be defeated also by sweeping the blood of the vast majority of sugar by the use of diabetic drugs. But there’s one last step in killing the cancer… it’s desperate by now… you have to fool it into accepting a sugar analog (substitute). NOW you’ve killed it.

      Read the book, “How to stop cancer” you will be amazed.

    • You are correct, but they don’t need one, they just switch over to lactic acid for energy UNLESS you alter the pH of your blood and most people don’t.

      It can be done with simple bicarbonate of soda… that will neutralize the lactic acid in the blood.

      The cure has 5 stages, 1) less than 20 carbs per day, 2) proper amount of protein (a must) and fat, 3) changing the pH of the blood, 4) diabetic drugs to lower insulin to very low levels, and 5) a sugar analog to trick the cancer. Read the book “How to cure cancer.”

      • Hi Norm:

        Can you provide a link to the book “How to cure cancer”?

        Also — how do you come by all your knowledge on this subject? Are you a biochem major or MD or such?

        Regards,

        -SB

  3. Hi Kris.

    I have been an avid reader of your wonderfully informative site for a few months now. My question is I want to use a ketogenic diet (I know nothing has yet been proven) as a possible therapy for cancer and wonder how you can do it without losing weight. I have been to Dr Feinman’s site but have found nothing on maintaining weight. Any ideas would be appreciated.

    Thank you.

    • I’m not quite sure it’s possible. In one of the cancer studies they deliberately tried to overfeed the people so they wouldn’t lose weight and it didn’t work.

      Perhaps you could do it if you ate a lot of extremely high fat foods and use high-fat dairy products and other oils to add fat to your diet while keeping carbs extremely low and protein moderate. Drinking heavy cream might work to increase total calories.

      • Won’t work… the liver will start breaking down muscle protein to maintain a balanced blood sugar level. Oh, and the liver can also break down fats to try and maintain blood sugar levels, BUT at a very small rate not worth mentioning.

  4. Kelly Fitzsimmons says:

    Hey Kris,
    Thanks for posting this article.
    This is amazing stuff. Since reading this I’ve been reading non-stop about metabolic therapy.
    Yet another reason to go High-fat, low-Carb.
    Happy New Years,
    -Kelly

  5. Kris,
    Please correct what you wrote: “In a pilot trial of 16 advanced-stage cancer patients, a ketogenic diet did improve quality of life for those patients who managed to stick with the diet for 8 weeks.

    However, only 5 of 16 managed to stick to it and the diet did not slow the progression of their disease (4).”
    The fact is that 5 of the 16 patients had stable disease through the 12 weeks. The results section of the publishing was poorly worded. See table 4 and the paragraph that refers to it. The reality of this study is that basically 5 of the 10 people that followed the diet beyond a few weeks did well (stable disease). This, coupled with the results for the young girl with brain cancer, and the RECHARGE trial with Dr. Eugene Fine, show a lot of promise for the ketogenic diet to help treat cancer. There are several other ketogenic diet for cancer trials ongoing in the U.S. and abroad. Happy New Year!

  6. I got an interesting book today. About healing properties of buckwheat. I also learned that it is actually a fruit seed that is related to rhubarb and sorrel making it a suitable substitute for grains for people who are sensitive to wheat or other grains that contain gluten. Which means that it is ok to eat it, as it is not a wheat actually… Why I wanted to mention buckwheat at the first place was the fact that it is been said to fight cancer. There is plenty of information about it, if You find it interesting. I just thought I’d write something here about it.

  7. Kris,
    Thank you for this well written, well sourced report that summarizes reporting on the Ketogenic Diet. As resourceful as metastatic cancer cells normally are, I have to wonder if, over time, they wouldn’t time, they wouldn’t find a way around the ketogenic obstacle as well. Do you know of any long-term (several years) studies with metastatic patients… or of any 5-year follow-ups with patients who remained on the diet?

    • Hello CJ.

      Unfortunately, studies on ketogenic diets and cancer are scarce. Just a few small, albeit highly promising, studies.

      Hopefully we will see some more studies with a greater number of participants in the next few years.

  8. Hi Kris:

    You said this: “Quality of Life in Cancer Patients
    In a pilot trial of 16 advanced-stage cancer patients, a ketogenic diet did improve quality of life and stopped the progression of cancer for the 5 patients who completed the 12 week study (4).”

    I read the study and I do not see any statement that the ketogenic diet “stopped the progression of cancer for the 5 patients who completed the 12 week study”. How did you come to that conclusion?

    • I read the full text of the article and Jake’s comment — the report does state those 5 patients “were in stable disease” at completion — so disregard my question :)

  9. This is the only sensible article I’ve found on this subject. The theory that a ketogenic diet “starves cancer cells” is physiologic nonsense. No diet alters blood glucose concentration, which is carefully controlled unless you have diabetes or a pancreatic B-cell tumor. If this diet works it is because ketones are directly toxic to cancer cells, or possibly because insulin production decreases, as this article suggests.

    Where can one find the randomized, controlled, blinded trials, or even some reliable clinical data?

    • Another possibility for effectiveness is that although the blood sugar levels don’t change radically, the amount of insulin production is so reduced that the transport of that blood sugar is greatly impeded, so the flow of sugar into cells is vastly reduced. I don’t know this for a fact, but it is a possible model.

      Or perhaps there are other effects that impede tumor cells not well understood at this time.

    • I have read similar arguments about diet not being able to alter blood sugar before. However, that is not my experience.

      I have a normal ~90mg/dL value of blood glucose when on a regular diet having a blood test after a night fast.

      It goes down to ~70mg/dL when I’m on a ketogenic diet and have the blood test in the same circumstances (that is, one night fasting before the test).

      AND it drops to 45-50-mg/dL range when I’m in a ketogenic diet and fast for 40 hours before the test. (blood ketones goes really high in this scenario)

      I’m talking about actual lab results, no home tests for the blood glucose levels.

      Am I missing something here? What do you mean by “no diet can alter the blood glucose levels”?

      I would really like to understand your statement, since I am trying a metabolic approach to help fight cancer.
      Thanks!!

  10. Dr. Thomas Seyfried just release a book which goes into detail on the science and implementation of metabolic therapies for cancer. The book is titled “Cancer as a Metabolic Disease: On the Origin, Management and Prevention of Cancer”.

  11. Victor Walker says:

    Studies have shown that cancer cells consume up to 10 times the amount of glucose consumed by normal cells. “Starving” them can only be done using a ketogenic diet (simulating fasting), which reduces insulin-facilitated glucose metabolism inside of cancer cells where the glucose is burned for energy to stimulate fast cell respiration and regeneration. Chemotherapy is noted to be most effective when it makes the patient very sick with fever and can’t eat (curious that chemo method of action is always attributed to directly killing cancer).

    If you induce ketosis, cancer cell metabolism and reproduction must slow down and the immune system has a chance to induce spontaneous remission. Ketone bodies likely also facilitate DNA repair and histone acetylation and turning off de-repressed genes that give cancer its nasty, parasitic characteristics.

  12. Andraye says:

    My mother has been diagnosed with stage 4 stomach cancer two months ago. She has lost weight about 8 pounds and can’t afford to lose anymore I don’t think. We are thinking about the Ketogenic diet for her but I’m afraid of additional weight loss. Is this diet an ongoing diet or best if maintained for a short period of time and then watch carb in thereafter? My mother is 79 years old and 5 feet tall and weighs 131 pounds now.

    • Hello Andraye. She would probably lose weight on this diet, it is very hard to avoid. In one of the studies they tried to deliberately overfeed people to prevent weight loss but it didn’t work.

      I think you should definitely keep your doctor in the loop if you’re going to try alternative approaches like the ketogenic diet. In my opinion, in case of something like cancer it is best to listen to your doctor.

      I’m sorry to hear about your mother, I hope she will get better.

  13. I have a family member who was diagnosed with cancer last year. Although it was removed, she is still afraid it will come back, so to ease her fears we put her on this diet. She has been on this diet for a few days now and is doing wonderfully, but I am just wondering whether there is a certain recommended time period a patient must be on this diet to starve off the cancer. So far I have been researching this and have come up empty handed. Is this a permanent change on must make to their diet or should one stay on this diet for a few weeks/months and then go to a low-carb diet? Please help!!!

  14. I have stage IV brain cancer and I have been on this diet (ketogenic) for about 2 months now. My blood glucose level is half than what it was before. It is not lower than minimum though… I hope this diet adds to my life expectancy. I’m 34 and feel like I’m too young to die.

    • Hi Nadia, you are too young.

      I also have a brain tumor, and have now been on a low carb/ketogenic diet for going on 13 years, still going strong!

      Mine was diagnosed as untreatable, so years ago I did research and determined to starve the tumor as much as possible. It hasn’t shrunk, but hasn’t grown either…

      • Rick,

        Bravo for you! 13 years is wonderful and amazing. Keep up the good work.

      • That is wonderful news, I had a GBM removed a few months back, I had already started a low carb diet but went onto a full ketogenic diet once the results came back and I learnt about i’s potential benefits, I’m almost through the radiotherapy and feel in good shape, and intend to follow this diet as long as I can, my whole life if need be.

  15. I just wanted to say that far too often I have seen people posting comments online regarding treatment of some thing they are experimenting with and often, they never post again. It makes it very hard to follow the person, the disease or health recovery. Can I just encourage people to come back and actually update for others sake? You can help a lot of people when you’re checking back and letting them know if something is working. Or even if it isn’t. It all makes a difference. Please commit to posting back again and again.

    There is a lot of good information on here. The ketogenic diet is making a strong case. It’s still in the fine tuning stages. The combination of a ketogenic diet with hyperbaric oxygen therapy seems to be the most recommended protocol.

    There is also the use of metformin and I’ve also seen low-dose naltrexone referred to as being effective. I don’t know exactly what the Low-dose naltrexone does aside from boosting the immune system by stimulating opioid receptors. (Which seems to share something in common with the way in which cannabinoid receptors function. Known for it’s anti-cancer benefits and another area of significant interest).

    Cancer cells use glutamine as well as glucose for fuel, which is harder if not impossible to eliminate from the diet. I suppose this is where metformin could work by interfering with the mTOR pathway. Do I have this right? I have read studies where a calorie restricted diet may have similar activity. Both seem to restrict cancer cells ability to utilize glutamine.

    Metformin, rapamycin, resveratrol, melatonin and calorie restriction all have a shared potential in reducing igf-1, down regulating mTOR signalling and reducing carcinogenesis? Someone want to correct me or add some better understanding on this?

    To my mind, periodic fasting, combined with a ketogenic diet and hyperbaric oxygen therapy would be a powerful combination. With the possible added use of resveratrol and/or melatonin. Once glucose and glutamine are addressed and can be effectively controlled, then we’ll really have something. I think it can be done now for the most part.

    • I agree with Paul — followup of peoples’ progress would be extremely useful.

      My wife is on a ketogenic diet with the idea of longer remissions and assisting chemotherapy for ovarian cancer.

      She was prediabetic at one point (not sure if hereditary or due to IV nutrition w/insulin for 3 months while bowel perf) and her blood sugar resists going down much. But she is quite strict with the diet and under advice of a nutritionist at the HMO who does ketogenic diets, mainly for kids with epilepsy.

      Her ketones started at virtually zero and with much struggle got up to .4, then .8. I think the most she has measured with our meter (Abbott) is 1.6, probably after a hike.

      Her blood sugar typically measures around 99 at best on this ketogenic diet. I wish there were a way to measure her insulin levels.

      She is currently taking Doxil once a month for chemo, and her CA125 (cancer marker) is still rising slowly, so no remission likely without switching treatments. But we’re trying to extend the utility of the Doxil as long as possible, then perhaps the diet is helping.

      I should mention she is also taking Metformin, I think about half the normal dose for diabetic use.

      I will say she has lost a lot of weight, not all due to the ketogenic diet. But she probably lost another 6 pounds after starting the diet. My concern is maintaining muscle mass on the diet. A dietitian I spoke to cautioned that older people need to be more vigilant about a balanced diet with every meal to hold onto muscle and not damage organs — I don’t know. No doubt chemo causes loss of muscle mass; so especially don’t want to contribute to that.

      I have been on a greatly reduced carb diet myself to support my wife (as well as to curb my addiction to carbs). I’m not on a strict ketogenic diet – I get about 50 to 100 grams of carb a day compared to my wife’s 20 – 25 grams. But I experienced a definite loss of “oomph” in my muscles, lost weight, and maybe some muscle mass. I find I can eat 2000 to 3000 calories a day of nut snacks in addition to my meals without gaining weight.

      This is just to report our experience so far. No conclusions, but I have some concerns for the long term that make me interested in more data from other people and any news on long-term effects — including heart health because of increase of saturated fats and types of animal protein that accompanies the diet.

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