The Ketogenic Diet as a Cancer Therapy Aid

There are many studies coming out about the benefits of a ketogenic diet as an aid to cancer therapy. However, there is also a lot of incorrect information in this area. It is difficult to cut through the hype to decide if a high fat, low carb diet is the right choice for individuals who are fighting this potentially deadly disease.

The ketogenic diet has indeed been found to be effective as an adjunct treatment in the fight against cancer. In addition, several studies suggest that it may actually fight tumors and malignant cells on its own due to the unique metabolic and cellular effects of ketosis. Understanding the basic facts on cancer and keto is key to making an educated decision about whether this diet is the right choice for your unique health situation.

How the Ketogenic Diet Can Be Used As A Cancer Therapy Aid

Cancer: A Modern Epidemic

Cancer is one of the most common causes of death and disability in the world. Every year, around 12.7 million people are diagnosed with this disease. In the same year, around 7.6 million will die from it. The World Health Organization estimates that around one-third of these deaths are preventable. [i]

While many cases of cancer are preventable, the majority are not. Even healthy, active people who make good decisions can one day develop this devastating disease. This random nature makes it a particularly frightening illness, as there is no way to ensure that you will personally never face it.

There are a growing array of innovative treatments that can cure different cancers, including targeted surgeries, chemotherapy, radiation, and biologic agents that attack special pathways in malignant cells. In addition, new research is showing different lifestyle measures can have a positive effect. The keto diet in particular appears to have special properties that are beneficial to people battling this common and deadly disease.

What Causes Cancer?

Every cancer is unique. However, there are a few qualities that all or most tumors and malignant cells have in common. Healthy cells have several genetic factors and metabolic checkpoints that help them to differentiate into the right type of cell and also stop them from growing out of control.

Malignant cells are ones that lose the ability to control their growth. They grow out-of-control into tumors and later spread to other areas of the body. Because they are growing so quickly, they take up much of the body's available energy and crowd out healthy, functional cells. Over time, most malignant cells become undifferentiated and do not fulfill any identifiable purpose. They simply grow and take up an increasing amount of space and energy.[ii]

New Research on a Keto Diet as Cancer Therapy

The research on ketogenic diets as a cancer treatment has been promising. Several studies have found that ketogenic diets are effective as a secondary treatment for a variety of malignant tumors. [iii]

In addition, a keto diet appears to significantly improve quality of life in people who have tumors and other malignancies. Maintaining quality of life while undergoing cancer therapies can be a major challenge. According to research, people with advanced cancers had improved emotional functioning and reduced insomnia while eating a keto diet. In addition, these patients did not report any serious side effects from this diet. This can help patients to remain mentally and physically strong during long rounds of treatment. [iv]

How a Ketogenic Diet Fights Cancer: The Specifics

How can a keto diet as cancer therapy be effective? While there are likely factors that we do not yet know, there are a few mechanisms that studies have found to be important. Keto has many general health benefits, but it appears to be especially powerful in fighting malignant cells. In many ways, a ketogenic diet removes many of the factors that help malignant cells to sustain their uncontrolled growth.

Metabolic Benefits of Ketosis in Cancer Treatment

Every kind of cell has its own unique metabolic needs. Malignant cells are very different from healthy cells in key ways that can be used to fight them. This is the basis of many modern treatments for cancer. It also appears to be the reason for many of the benefits of a ketogenic diet as cancer treatment.

Most human cells can use a variety of different metabolic pathways to produce energy. They can live off glucose, fatty acids, or ketones. In most cases, glucose metabolism, or glycolysis, provides the most energy per calorie eaten. Because it is most efficient, fast-growing cells use glycolysis.

Because malignant cells are in a state of uncontrolled growth, they need a huge amount of energy. They shift most of their metabolism to glycolysis to support their rapid growth and division. As a result, these tumor cells depend on and thrive from glucose. Some malignant cells are actually incapable of using any other energy source, unlike healthy cells.[v]

Keto diets reduce blood glucose immensely and switch the body to a state of ketosis. This starves malignant cells, leaving them without the energy they need to grow and spread. Several studies on the ketogenic diet as cancer treatment have suggested that this may be an important consideration in fighting tumors and preventing the spread. [vi]

Removing Hormonal Support for Tumor Cells

Malignant cells rely on certain hormones to support their high levels of growth. Insulin and insulin-like growth factor 1 (IGF-1) encourage the growth of cells in the human body. These two hormones in particular appear to be important to helping tumor cells thrive, proliferate, and spread.[vii]

Insulin and IGF-1 both increase as a direct result of high carb meals, such as those that are commonly eaten in the standard Western diet. When there is ample carbohydrate for glycolysis, cells are signaled to grow rapidly. People on a standard Western diet eat these meals daily, providing the hormones and the food that tumors need to grow and spread. This is not healthy for the average person, but can be incredibly negative for someone fighting cancer. Starving cells of these hormones, by being on a ketogenic diet, appears to make it more difficult for tumor cells to proliferate and spread quickly.

Effects of Keto on Free Radicals and Oxidative Stress

Free radicals are believed to be one of the root causes of cancerous cells. These oxygen radicals occur both as a natural metabolic product and as a response to toxic substances. Over time, they can damage DNA, allowing the uncontrolled growth and lack of differentiation seen in malignant cells.[viii]

Ketosis is believed to reduce the risk of developing cancers because ketones reduce the rate of free radical production.[ix][x] Ketogenic diets may even reverse some of the damage done by free radicals, encouraging some tumor cells to begin acting more like healthy cells and growing at a slower pace. [xi]

In addition, these diets increase oxidative stress in tumor cells, which weakens them. They do not appear to have this effect in healthy cells. This targets malignant cells to make them more susceptible to conventional treatments such as chemotherapy and radiation.[xii]

Reducing Inflammation and Tumor Growth

Inflammation is believed to be another root cause of cancer. When our cells are chronically inflamed, they are more likely to undergo the mutations that eventually lead to uncontrolled growth. Fighting inflammation may not only reduce the risk of malignancy, but also prevent tumors from progressing as quickly. [xiii]

New medical research suggests that ketogenic diets reduce inflammation This may be partially due to the higher levels of healthy fats in these diets. While a keto diet offers ample amounts of fat, however, it is important to take in the right kinds of fats in order to get these anti-inflammatory benefits.

There are different kinds of fatty acids, classified by the number and type of bonds between different parts of the molecule. Omega-3 fatty acids are present in seafood, flaxseed, and several other plant oils. Common commercial oils such as soybean and canola oil have high levels of a different kind of fatty acid, which is called omega-6. Omega-3 fatty acids such as DHA and EPA have been found to reduce inflammation in addition to other health effects. Omega-6 fatty acids, which dominate the Western diet, appear to cause long term, low level inflammation. [xiv]

In order to get the anti-inflammatory effects of a keto diet, it appears to be especially important to eat a high ratio of omega-3 to omega-6 fatty acids. Experts currently disagree on the exact ratio that is most effective, but agree that most fatty acids in your diet should be omega-3. [xv]

Keto as an Adjunct Treatment

Keto diets are not currently being used as a primary treatment for cancer. However, they show great promise as an adjunct treatment. An adjunct treatment is one that is given along with traditional medical treatments to help them be more effective or to have fewer side effects. These treatments are important even though they do not directly kill tumor cells.

For instance, a ketogenic diet has been shown to make chemotherapy and radiation treatments more effective in lung cancers. This can give patients a better chance of winning their battle. If radiation and chemotherapy are more effective, patients may be able to get the same effects while using less of these treatments, which can improve quality of life. [xvi]

Ketosis also enhances the anti-tumor effects of radiation through metabolic changes to malignant cells. When malignant cells are starved of their primary source of energy, glucose, they appear to be more susceptible to radiation. [xvii]

There is still a great deal of study needed to determine how high fat, low carb diets such as keto can be helpful in the treatment of tumors and malignant cells. However, the current research is promising and indicates that these diets may have a measurable benefit. In the future, oncologists may "prescribe" ketosis as part of a treatment plan. Tumors and other cancers can be difficult to treat even with the best technology, so a diet that gives patients a better chance could potentially save lives.

Modifying a Ketogenic Diet to Enhance Treatment

Although keto diets have several benefits for people undergoing treatment, it is important to remember that these patients have special dietary needs. There are several ways that a ketogenic diet can be modified to be more ideal for those who are in treatment for tumors and other malignancies.

How a Normal Keto Diet Works

When we eat a meal containing carbohydrates, our bodies will burn the resulting glucose as an energy source. Insulin is released to allow glucose in the bloodstream to enter cells. Other hormones, such as IGF-1, are released to help the body store energy in the form of new fat cells.

When we do not eat carbohydrates, blood glucose remains at a lower level and insulin levels plummet. Instead of burning glucose for energy, the body burns an alternative energy source called ketones. Ketones are made from the breakdown of fatty acids stores in our adipose tissue, or from eating fats.

A ketogenic diet has a unique macro balance. Most people on this diet will eat high fat, moderate protein, and very little carbohydrate. This helps the body to stay in a state of ketosis, with low insulin and almost no glycolysis.

There are many health benefits to eating this kind of diet. However, there are modifications that should be made when using the keto diet as cancer therapy.

The Special Needs of a Body Fighting Cancer

Avoid Excess Protein

One of the main modifications in using a ketogenic diet as cancer treatment is in the amount of protein taken in. The average person eating keto will take in around 1.2 grams of protein per kilogram of body weight.

However, excessive protein can generate reactive oxygen species, also known as free radicals. These are very destructive to health cells. As a result, many doctors recommend that people in treatments such as chemotherapy and radiation take in far less protein, around 0.6 grams per kilogram of body weight. People using keto for special health needs should pay special attention to their macros, particularly protein intake. [xviii]

In addition, it is more important for people with cancers to keep their blood glucose as low as possible, as this starves malignant cells. Our bodies can use protein to make glucose in a process known as gluconeogenesis. High blood levels of ketones suppress this pathway. Thus, people fighting malignancy should keep even higher blood levels of ketones than someone using a ketogenic diet for other reasons.

Avoid Additives

Avoiding carcinogenic additives is another important consideration. Many oncologists recommend that people with cancers of all kinds avoid highly processed foods or foods with artificial ingredients. Some keto products on the market fall into this category, often including artificial sweeteners such as aspartame that have actually been linked to tumor growth. Or some people try to substitute aspartame since they can't have sugar, but this is a mistake.  If you have to, use all natural sweeteners instead.

Processed meats appear to be especially dangerous. Several studies have linked processed and smoked meats to different cancers. This may be due to questionable additives such as nitrates. A whole foods diet is important when your body is under stress.

Increasing Healthy Fats

Healthy fats have been found to reduce inflammation and lower the risk of developing certain cancers. As a result, eating high amounts of these fats can be beneficial.

However, many of the fats in the modern diet actually cause inflammation. Soybean oils and hydrogenated fats in particular should be avoided. Instead, a cancer-fighting ketogenic diet should include high levels of omega-3s, found in salmon and other fatty fish, as well as polyunsaturated fatty acids that are present in olive oil, unprocessed nuts, and coconut oil.

MCT oil and coconut oils will increase your ketones rapidly.  The more ketones available in your blood, the more your blood glucose is suppressed - therefore suppressing some of the tumor growth mechanisms we discussed earlier.  MCT oil or coconut oil will also help with the GKI discussed next.

Healthy Vegetables

Sometimes people forget to eat enough vegetables when they are concerned about eating low carb.  When fighting cancer, low carb vegetables should be a top priority!  Many vegetables have been found to have cancer fighting properties. Green leafy vegetables, for example, contain vitamin E, vitamin A, and other compounds that have been found to act as antioxidants. Brightly colored vegetables such as peppers contain phytochemicals that give them their rich colors while also acting as an antioxidant and anti-inflammatory.

Cruciferous vegetables such as broccoli and brussels sprouts in particular have been found to contain special compounds that are active against malignant cells. Many cruciferous vegetables are compatible with a ketogenic diet. [xix]

The ketogenic diet can be modified to provide the fresh, healthy foods that a person with cancer needs to maintain optimal health. It is important for people with health issues to get the wide range of fish, vegetables, and other whole foods that have proven health benefits.

Understanding the GKI Index

The glucose-ketone index, or GKI, is an important consideration when using a keto diet as cancer therapy. Lowering blood glucose to suppress tumor growth, also called metabolic therapy, requires keeping consistently high ketones and consistently low blood glucose. [xx]

The first step in calculating your GKI is to know your levels of blood glucose and blood ketones. There are monitors that can be used to test your blood at home so you can keep careful track of these numbers. The more sophisticated of these will test for glucose and ketones on the same monitor so you can then easily calculate your GKI.   These monitors can help people to see how their body and their glucose levels respond to different foods on a keto diet.

In general, the GKI is one's blood levels of glucose divided by the blood levels of ketones. However, it is important to make sure that these are in the same units before making this calculation. The exact conversion will depend on what units your particular monitor uses.  A lot of ketone monitors report the blood gluclose in mg/dl and ketones in mmol/L.  To convert the glucose number to mmol/L, simply divide the blood glucose number by 18.  This will give both ketones and glucose in units of mmol/L.  Then, you can divide the glucose by ketones to get your GKI.  Let's do an example:

 

Blood Glucose: 100 mg/dl

Blood Ketones: 1.0 mmol/L

Divide 100 mg/dl by 18 to get 5.55 mmol/L.

Then, divide this blood glucose number by blood ketone number.

Divide 5.55mmol/L by 1.0mmol/L to get 5.55 as your GKI.

A low number in this index indicates a higher level of ketosis and less glucose to feed malignant cells. Ideally, you want your GKI to be around 1.  Thus, it is important for people in treatment for tumors to maintain as low of a GKI as possible. This has been found to reduce the size of tumors in several different studies, especially in brain cancers.

Other Lifestyle Changes to Enhance Treatment

Fighting tumor growth often requires a multi-faceted approach. In addition to keeping a keto diet and following the treatment regimen prescribed by doctors, there are other things people can do to move the odds in their favor when using a keto diet as cancer therapy.

Can Intermittent Fasting Starve Tumors?

Intermittent fasting has been found to have metabolic effects that can be beneficial in fighting tumors. Restricting calories periodically reduces the mTOR pathway. The mTOR pathway is important to cancerous cells and tumors because it regulates cell growth and division. It is often defective in malignant cells, which is why they grow without restriction. Reducing the activity of this pathway can slow the growth and spread of tumor cells.[xxi]

In addition, intermittent fasting reduces the numbers of reactive oxygen species, or free radicals, in cells. This allows healthy cells to remain healthier while undergoing the significant physical stress of surgery, radiation, chemotherapy, and other treatments. The state of ketosis induced by intermittent fasting (as well as a keto diet) has also been found to make chemotherapy more effective.[xxii]

Why does fasting help to fight tumors? In addition to shifting cell metabolism from glycolysis to ketosis. it appears to prevent many side effects of chemotherapy. Although chemotherapy targets malignant cells, normal cells also can be affected. This is the reason for the nausea, hair loss, and other side effects of chemotherapy. Reducing these side effects allows patients to safely handle a higher dose of this treatment.

There are other mechanisms that are not as well understood. Fasting cycles appear to have anti-cancer effects that have yet to be discovered. In particular, scientists have discovered that some malignant cells grow more slowly and die more easily from chemotherapy during fasting cycles for reasons we do not yet know. [xxiii]

Healthy Lifestyle Is Key

Many healthy lifestyle measures have been found to be important in fighting tumors and other cancers. Exercise has been found to reduce cancer risk.  In addition, several new studies show that getting regular exercise while in treatment can reduce side effects and improve outcomes.[xxiv] Routine exercise also prevents the decline in fitness that is often seen during treatments such as chemotherapy and radiation.

There are several supplements that also appear promising as an adjunct treatment. Curcumin, the active ingredient in the spice turmeric, has been found to modulate cell growth and proliferation in malignant cells.[xxv]  Antioxidant vitamins also can aid in treatment by reducing free radicals in healthy cells.

Although modern people cover their skin to avoid skin cancer, direct sunlight in small to moderate amounts actually can help fight tumors. Our bodies rely on sunlight to synthesize the active form of vitamin D, called D3. Vitamin D3 has been found to protect against several different common cancers. It appears to slow the growth of malignant cells and to reduce the blood supply to tumors.

Will an Alkaline Diet Help?

There is a great deal of hype regarding the alkaline diet, especially in its anti-tumor effects. Malignant cells grown in labs die in highly alkaline environments, as do all human cells. As a result, many people wonder if a diet that turns their body more alkaline could be effective in fighting cancer and other chronic illness.

However, an alkaline diet does not actually change our body's pH. Our body keeps its pH within an extremely tight range. Our kidneys remove heavy loads of both acids and bases to accomplish this. Eating an alkaline diet thus can make your urine more alkaline, but will not change the pH of either healthy tissues or malignant cells.

The benefits and drawbacks of this diet have not been well-studied, so we do not yet know its full effects. There is currently no evidence to suggest that this diet impacts treatment or survival.[xxvi]

Fighting this disease effectively depends not just on high technology treatments, but on keeping your body healthy and strong. Lifestyle changes that support wellness and whole body health will help to fight tumor growth and reduce side effects from treatment.

Common Misconceptions About a Keto Diet

There are a few misconceptions about how a keto diet can affect the treatment and outcomes of different cancers. It is important to understand these issues in order to make an educated decision for your health.

While there is significant evidence that a keto diet can be improve survival rates, most of these studies focus on malignant cells or on very early stage cancers. The effects of a ketogenic diet on late stage cancers have not been as well-studied. Thus, the jury is still out on how a keto diet can affect more progressive cancers.

In addition, many people interpret the evidence behind a keto diet as evidence that it can be used as a primary means of treatment. This can be a dangerous mistake. Most studies focus on the benefits of a ketogenic diet as an adjunct, or complimentary, treatment. The current studies suggest a keto diet is most effective when used together with traditional treatments such as chemotherapy and radiation. We do not have solid data suggesting that it should be used alone.

Last, it is always important to talk to your physician before making any lifestyle changes, especially ones as dramatic as a keto diet. Your doctor can help you to make the decisions that will most benefit your individual health.

Top Tips for Starting a Ketogenic Diet

A keto diet is a dramatic change, especially when dealing with a serious diagnosis. The following tips may help to make the process easier.

  • Get your family and treatment team involved. The additional support and encouragement can only help.
  • Ask your chemotherapy center to keep keto-friendly snacks. Many of these centers keep mainly carbohydrates around as these are comfort foods for people undergoing chemo.
  • Plan your meals and snacks everyday, bringing food with you as necessary.
  • Ask family and friends to help prepare ketogenic foods when you are too tired to cook for yourself.
  • Consider a ketone supplement to keep your GKI in therapeutic levels.
  • Plan on drinking a great deal of water. Dehydration can be serious and even life-threatening in people undergoing chemotherapy and radiation.
  • Arm yourself with facts. People around you will be more supportive if they understand the evidence behind your decision to eat a ketogenic diet.

The Bottom Line on a Ketogenic Diet as Cancer Treatment

A wealth of evidence suggests that a ketogenic diet can be beneficial for people with cancer. It appears to reduce the growth of malignant cells, lower the levels of hormones that support tumor growth, and improve the effectiveness of treatments such as chemotherapy and radiation.

There are special dietary considerations for people who are using the keto diet as cancer therapy. In addition, there are several lifestyle changes that can improve your chances of winning this battle. Getting support from your loved ones and treatment team is essential.

Cancer is one of the scariest diseases in the modern world. However, new evidence is showing us more about how to fight this disease. A multifaceted approach combining traditional medical treatments and lifestyle habits will give you the best possible chance of living a long and healthy life.

 


 

Sources:

[i] http://www.who.int/mediacentre/factsheets/fs297/en/
[ii] https://www.cancer.gov/about-cancer/understanding/what-is-cancer
[iii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/
[iv] https://www.ncbi.nlm.nih.gov/pubmed/21794124/
[v]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276814/
[vi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267662/
[vii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267662/
[viii] . https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/antioxidants-fact-sheet
[ix] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276814/
[x] https://www.ncbi.nlm.nih.gov/pubmed/2083180
[xi] https://www.ncbi.nlm.nih.gov/pubmed/20831808
[xii]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/
[xiii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803035/
[xiv] https://www.sciencedirect.com/science/article/abs/pii/S0753332202002536
[xv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404917/
[xvi] https://www.ncbi.nlm.nih.gov/pubmed/23743570
[xvii] https://www.ncbi.nlm.nih.gov/pubmed/22563484
[xviii] https://www.ncbi.nlm.nih.gov/pubmed/27777385
[xix] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737735/
[xx]https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0009-2
[xxi] http://jcs.biologists.org/content/122/20/3589
[xxii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/ 
[xxiii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/
[xxiv]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522734/
[xxv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758121/
[xxvi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195546/

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