I wanted to thank reader Sully for sending a link to the Time Online article on the use of ketogenic diets and cancer treatment. The article is surprisingly well written and informative…I wonder if the author has a personal interest in the topic as the usual counter point, mainstream prattle was refreshingly absent. I guess that exposes a bias on my part…I’ll flesh out from where that bias arises on both an emotional and logical level later, but right now I want to point out a few nuggets in the paper. Before I do that, lets quickly review what ketosis is.
Ketosis In 100K Words Or Less
I could just say ketosis is a metabolic state the 99.9% of doctors and registered dieticians CAN NOT ACCURATELY DEFINE OR DESCRIBE, but that does not help much as to details and mechanisms now does it? Ketosis is the state in which glucose is relatively limited or lacking as a fuel and cells begin to use fat as a primary fuel source. Not dissimilar to the formation of lactate from glucose, ketone bodies are the incompletely metabolized remnants of fatty acids. Ketones have the interesting characteristic of being water-soluble and thus are capable of passing through cell membranes, including the blood brain barrier. This is handy since the brain does need SOMETHING to run on and if glucose is in short supply, ketones work remarkably well, in fact better than glucose in nearly every conceivable way. That is a brief run down on ketones, if you want to geek out on the topic you need to read Dr. Eade’s post on ketones. I really want to emphasize the point that ketosis is a normal metabolic state. I’ wager THE DEFAULT metabolic state in humans but this is going to be a long enough post without that side diversion. So, back to that link to the Time article! Here is the main point I want to make from that paper:
“…we are only allowed to enroll patients who have completely run out of all other therapeutic options.” That means that most people in the study are faring very badly to begin with. All have exhausted traditional treatments, such as surgery, radiation and chemo, and even some alternative ones…”
I guess my point is actually a question. WHY? Why are the sickest people, who have exhausted every conventional option, many of which are VERY dangerous, why is a safe nutritional intervention handled like it is an atomic bomb? Theories concerning the potential of a limited carbohydrate diet as a cancer treatment have existed since the 1960’s. A few animal studies exist on the topic and a one or two human trials…but this potential therapeutic intervention has been avoided like the plague. This is just baffling, especially when we look at the “safety” of modern chemotherapeutics.
Chemotherapeutics: Toxic is better!
To understand what scientists are looking for with regards to chemotherapeutics you need to understand a few of the mechanisms underlying cancer. Very generally cancer has an initiation phase, typified by damage or changes to the DNA, a growth phase in which otherwise well-behaved cells begin to push out against other tissues, and finally spreading or metastasis in which cancer can disseminate throughout the body. Keep in mind this is a generalization and does not describe all cancers or scenarios.
Many chemotherapies target the DNA of cancer, either preventing the replication or actually attempting to damage the DNA to such a degree that apoptosis (programmed cell death) occurs. In one case specific enzymes involved in the DNA replication process are the targets for chemotherapeutics. The premise being: stop all cellular replication and you stop cancer. This works…kind of. Unfortunately cancer is enough like us that drugs that stop “IT” from replicating also stops stuff like our gut lining, hair and other goodies from replicating. This is where folks loose their hair and shed their intestinal and mouth linings after the use of folate blockers like Methotrexate. Did I mention that folate (folic acid) is a potent up-stream PREVENTION of DNA damage and CANCER formation? Yep, one of the mainline defenses AGAINST cancer is a drug that not only causes you to shed your GI lining, but it also disables one of your primary systems for preventing FUTURE cancer.
A second class of drugs goes right to the heart of the matter. Drugs like Cisplatin actually DAMAGE DNA! These substances rate remarkably high on the AMES test. The AMES test, developed by Bruce Ames, is a measure of the mutigenicity of a given substance. In simple terms is how much DNA damage a substance can be expected to exert in a living system. If you recall from above, rapidly growing things require loads of DNA synthesis. If you want to kill something, why not destroy the DNA? It’s a great idea, but then again you are subjecting people to a substance that is KNOWN to promote cancer formation. Mutagens are typically CARCINOGENS.
A third class of drugs attempts to stimulate apoptosis of cancer by disrupting cellular stability. Paclitaxel (Taxol) is perhaps the best known of these drugs and acts on the microtubules. The theory again, is that rapidly dividing cells will be preferentially targeted in this process.
The real problem with all these approaches, and in fact the major thrust of cancer research is that cancer is US. It is not a foreign invader; it is a modified version of us. How do you kill just a little bit of yourself? This is one element of the problem facing cancer research and this may be born of our success with antibiotics. Prior to penicillin, death from pneumonia and simple infections was horribly high. Folks just do not remember this and few people appreciate how powerfully this affected the collective psyche of medicine. People who otherwise would have died are now saved with a pill. Unfortunately the magic bullet has never materialized in the case of cancer.
By now you may be thinking: “OK, Robb needs to cut back on the Americanos and chill out! I mean this is SCINECE and MEDICINE! This stuff must be helpful to someone despite the ominous spin Robb is putting on this…” Well…despite the fact that the “War On Cancer” was declared in the 1960’s things have not improved…at all. Don’t believe me? We will look at some statements from the medical establishment itself. In a few instances some cancers are much more effectively treated than they were 30 years ago. Unfortunately this is the exception, not the rule and all this while cancer rates in total have increased. Much of the supposed success trumpeted by researchers and drug companies is an outgrowth of improved imaging and diagnostic techniques. This has simply shifted the time people know they have cancer forward but it has done little to improve actual survival. People are also being diagnosed with “cancer” when it is pre-cancerous tissue that may or may not ever advance into full-blown cancer. It does wonders for survival statistics to diagnose and subsequently “cure” folks of a disease they would never have died from.
From JAMA
Are Increasing 5-Year Survival Rates Evidence of Success Against Cancer?
H. Gilbert Welch, MD, MPH; Lisa M. Schwartz, MD, MS; Steven Woloshin, MD, MS JAMA. 2000;283:2975-2978.
You can read the abstract here but I’ve pulled out the results and conclusion for a closer look:
Results From 1950 to 1995, there was an increase in 5-year survival for each of the 20 tumor types. The absolute increase in 5-year survival ranged from 3% (pancreatic cancer) to 50% (prostate cancer). During the same period, mortality rates declined for 12 types of cancer and increased for the remaining 8 types. There was little correlation between the change in 5-year survival for a specific tumor and the change in tumor-related mortality (Pearson r=.00; Spearman r=-.07). On the other hand, the change in 5-year survival was positively correlated with the change in the tumor incidence rate (Pearson r=+.49; Spearman r=+.37).
Conclusion Although 5-year survival is a valid measure for comparing cancer therapies in a randomized trial, our analysis shows that changes in 5-year survival over time bear little relationship to changes in cancer mortality. Instead, they appear primarily related to changing patterns of diagnosis. Emphasis mine.
Like I said above, all that is happening here is folks find out they have cancer sooner and begin treatments that appear to do nothing. The high carb, low fat diet is perhaps the only instance I can think of that has this type of society wide paralysis or selective memory occurring. Imagine a sports team or legitimate non-governmental business trying to run for 30 years with nothing to show for it’s efforts but failure. Amazing.
There IS awareness within the medical establishment that our present course is not working, it just continues to be ignored. This piece from the Journal of The Royal Society of Medicine came out in 1991 and has it mostly right. Even these folks were duped by the colon cancer/fiber shtick. The whole text is available and the paper is actually quite good. The authors make the point that our understanding of the molecular underpinning of cancer has exploded; yet this has translated into few advances in treatment or survivability. The authors also make the point we have plenty of information to make lifestyle and environmental changes that will dramatically reduce the OCCURANCE of cancers. Aside from smoking little effort has been placed in the prevention category. The author makes the telling prediction that if we attack the “Western Diseases” we will see a dramatic improvement in health and consequent reduction in cancers…I suspect however the solution would be a low fat, heart healthy diet! The low carb solution is ignored again and the researchers fumble about for another 20 years looking for the solution that is sitting in their laps. Oy vey!
I want to briefly look at the therapeutic potential of a ketogenic diet, possibly with adjunctive techniques such as caloric restriction and intermittent fasting. My interview with Dr. Thomas N. Seyfried of Boston College on the topic of cancer, ketosis and metabolic control analysis is a good place to start. A google or pubmed search for ketosis or ketogenic diet will generate some interesting returns.
I want to make the point that I do not think ketosis is the cure for all cancers…but it might be for some, for others it may dramatically slow progression and all without the dangers inherent in modern chemotherapeutics. The point must be made however that preventing a disease is much easier than treating a disease…what if periodic bouts of ketosis/fasting or caloric restriction could dramatically reduce the occurrence of cancers? There is much to be learned here but no one is much interested due to the lack of money to be made from a low carb diet vs. drugs.
Personal bias
Now, it may be obvious that I have a pretty strong bias on this topic. Some of this I’d like to think is the result of being a critical thinker, looking at the data and empirical evidence and drawing sound conclusions. I worked in and around cancer research for quite some time and I have my leanings towards evolutionary medicine and the notion that an ancestral diet is likely the best one for optimum health. That’s all the intellectual bias I bring to this topic. My emotional bias started on January 4th, 1988 when my girlfriend, then 16 years old, died from complications due to an astrocyte brain tumor. Her name was Stacy Barnett, she was class president, a cheerleader, 4.0 student…and a pretty damn cool chic. She was first diagnosed with a brain tumor at the end of 8th grade and was not expected to make it to the 9th grade. Her cancer went through 3 different remissions before the final growth that started in Oct, ’87. Astrocyte brain tumors are thought to be particularly responsive to ketosis. 15 years later I can only wonder if a ketogenic diet might have saved her life. I’d like this information to be more available and better researched…I’d like simple, safe interventions to be considered in preference to approaches that are known to be both dangerous and ineffective. I don’t think that’s an un-reasonable desire.
In the photo (scanned, sorry for the quality) you see Stacy at Children’s Hospital at UCSF. She has her trademark scarf that covered the bald spot where the first surgery removed the tumor. In the other photo we are headed to the movies. Stacy was on high dose prednizone in an attempt to reduce the swelling caused by the re-growing cancer. She HATED how the prednizone made her cheeks puffy.
About the author
I remember JV Askem went on a zero sugar, and maybe a zero carb diet before he died in an effort to stave off his brain cancer.
I’ll have to dig around to see if I can find it.
Shaf-
JV went sugar free but he still had whole grains in the mix. I emailed him about the potential of a ketogenic diet but never received a response. In the Times paper they mentioned some folks who improved on the diet, others experienced no direct benefit. It is thought however that a KD with calorie restriction and or intermittent fasting is more effective than a ketogenic diet alone. JV was a great guy…I never got up to Squim to train with him despite living in Seattle.
Robb
Hmmm particularly relevant right now Robb. Very nice post.
Very helpful and sad post Rob.
The most sobering thing I read about all this was in the Male Pattern Fitness blog. He said: ” It reminded me of a really sad story from a few years back: An acquaintance was diagnosed with cancer, but rather than going through chemotherapy, decided to “heal” his body with a macrobiotic diet, all fruits and vegetables with little protein or fat. The cancer took him in what was probably record time. If this theory is correct, he was right about diet being a weapon against his cancer. But he was dead wrong about the diet he chose.”
I put some more on this on my blog:
http://conditioningresearch.blogspot.com/2007/09/ketogenic-diet-and-cancerold-news.html
Chris-
The ketogenic approach is counter to just about everything we hear about. From the GOV to pesky vegetarian doctors. Things will shift eventually…I hope!
Great Site BTW
Robb
Robb,
Thanks for another great article. I’ll be sending it along to some of my mom’s friends who have cancer. The ‘establishment’ will pick this stuff up in a few decades like you said.
According to the keto-test strips anyway, I’m currently in ketosis. Been keeping carbs to a 30g ceiling daily and only vegetables, 1/2 cup fruit. Could I make this the new ‘normal’ and stay on it indefinitely?
Rob-
I believe so. I have dipped in and out of ketosis for years (testing with keto strips occasionally). The folks who wrote Lights Out recommend going keto something like October through June (for the northern hemisphere. Fall through winter) so a significant protion of the year. This is one of the things I’ve tried to reconcile with regards to performance and training…how much high intensity activity can a ketogenic diet support? Results appear to vary!
Robb
Does anyone have experience with curamin? Any insight on the good, bad, or ugly would be appreciated. Thanks in advance.
No clue on the Curamin. I suspect it is a curcumin extract. I really like Zyflamend from New Chapter.
Robb
Robb- I know you are too scientific for this game but T.S.
You’ve been tagged. Here’s the info. http://coachrut.blogspot.com/2007/09/jen-made-me-do-it.html
Best,
Rut
LOL! Ok, but just to clarify…is that 5 things you don’t know about me or 5 things I don’t know about me?
Ok, here tis:
1-I met Axl Rose in a strip club (7th Veil) on Thanksgiving day 1991.
2-I strongly dislike touching dirty windows.
3-Nicki’s sister kicks my ass at chess and checkers.
4-I have eaten dishes prepared with several types of reptile, rodent and insect in Mexico and SE Asia.
Ahem….I only count 4 things there…
Back to the topic though:
I thought I recalled there was some discussion on how long a person should stay in a ketogenic state? Is there any time limit at all or is this more related to the individuals lifestyle? Obviously if you are trying to recover from cancer I don’t think beating your PR in Fran or something is at the top on your list of things to do. But for others like amateur/recreational athletes? Things then change if you are talking about the health/longevity bias too.
Allen-
No limit that I know of.
Robb
Hi Robb,
I’ve been following your writings for some time. but have never commented till now.
I’ve learned so much from you, and appreciate your sharing so much with us.
I’m passing along this link to a physician client of mine who has renal cell carcinoma.
Best,
Coop
Coop-
Glad the information is valuable. keep me posted on your friend.
Robb
Hi Robb,
Good stuff. However, I wanted to add a note of caution. Unlike adult cancers, chemotherapeutic agents have proven remarkably effective against most childhood cancers–many of which now have cure rates upwards of 90%. As I understand it (simplifying), the reason for this is that standard chemo agents interfere with quickly reproducing cells. The assumption is that cancer cells reproduce more quickly than normal cells. It turns out that this assumption is not so good when it comes to adult cancers, but does accurately characterize most childhood cancers.
Marc-
Great to hear from you. I’m going to copy your comment in another post and expand on things a bit.
Robb
Rob
another related study just reported:
http://conditioningresearch.blogspot.com/2007/11/more-on-low-carb-diets-for-treating.html
Chris-
Thanks Amigo! Great link as always.
Robb
Hi Robb,
Just found you through this link I posted on the CF boards:
http://board.crossfit.com/showthread.php?t=23875
I’ve got a lot of reading ahead, but I wanted to say “Thank you!” for writing this. I’ve been wandering aimlessly until now.
Robert-
Thanks for the kind words but that’s a lot of pressure! I do a lot of aimless wandering!
Robb
I enjoyed the linked article for a number of reasons: a ketogenic diet may be responsible for the success I have had in dealing with my own cancer, the study is being funded by a food company that has a stake in the outcome of the study and soy products are being used as a protein source (can you imagine feeding soy to a cancer patient?). Something else caught my interest: many of these terminal patients couldn’t give up the sweets.
Thank you for posting this. It’s helped me make a choice that I think is right for me. Hope to post again, with a report, say, in 90 days.
Laurie-
Please do keep me updated.
Hi Rob
Vary interested in your post of cancer and ketogenic diets since my Dad has cancer. He had primary Liver cancer, which is unusual since he hardly drinks and doesn’t have a Liver disease, and now has secondary cancer growths in the Obmentum ayear after his operation to remove the Liver cancer
He had the original Liver cancer removed along with his gall bladder and 2/4 of his Liver. My question is can he still go on a ketogenic high fat diet without a gall bladder as the Doctors say he should avoid fatty foods since he doesn’t have a gall bladder to make bile. Are they correct or can he use good fats over bad fats and still follow a keto diet. We live in New Zealand so all our meat is grass fed if this makes a difference.
He started chemo this week and I am looking for some sound advice to help his battle as they have caught the cancer early, albeit the prognosis still isn’t great.
Thanks
Mike
Mike-
Can you get me the exact type of cancer? Like Hepatoblastoma…this can help me figure out how much help ketosis might be. In short he could still do a ketogenic diet unless his liver function is impacted. He would need to take oxbile to help digestions.
Thanks, for the reply. I will find out the exact type of cancer soon, however, the docs say the Liver is functioning fine and his berrilium level is good. His biggest problem is extreme itching and feeling very cold especially at night, even though it is summer here. He isn’t running a temperature and the Docs don’t know why he is itching so much. Could it be bile salts under the skin due to no gallbladder?, although I suppose it could be the chemo or cancer. He has cut out a lot of carbs, has 3 tsp of fishoil + regular oily fish but hasn’t stoppd the morning porridge aaaargh. I was thinking perhaps he should increase his fat intake if the bile salts are building up but I’m not sure
[...] "Cancer & Ketosis" [...]
[...] Robb Wolf on Cancer and Ketosis [...]
Any news about studies on effect of ketogenic diet on cancer?
[...] cancer and ketosis [...]
[...] 9. Cancer & Ketosis [...]
There is now a body of work by MP Lisanti where he is promoting the idea that Ketones are ‘super-fuel’ for cancer. His model is mainly breast cancer. I have started to slog through this literature. Be interested in your take.
I would not be surprised if there are cancer variants that do better on ketones, but it would be news to me.
Jimmy Moore jumped on the Ketone fueling story already….
http://www.livinlowcarbdiscussion.com/showthread.php?tid=5657
Jeff-
Did you notice that my post pre-dates Jimmy’s by over a year?
Hi Robb – you probably don’t remember but a couple of years ago I asked you about the Budwig diet re cancer as I had been diagnosed with malignant fibrous histeocytoma of the sphenoid none and you pointed me in the direction of the ketogenic research and Dr Seyfried. I contacted him and he was very helpful.
Just wanted to say 2 1/2 years after diagnosis and having turned down radiotherapy I am still going strong much to surprise of my oncologist. The tumour is still there but not doing anything. I mix my diets, but primarily lo carb / paleo with a little Budwig and some intermittant fasting. Also work on managing stress with exericise and meditation. I’m 2 1/4 stone lighter than when I finished chemo. An ex work colleague of mine said seeing me again was like watching the Curious Case of Benjamin Button. Also despite a discectomy at L5/S1 in October last year I am finally back to consistent Crossfit training.
Thanks for input as it has influenced my nutrition and I believe my current good health
Awesome stuff Paul! If you;d liek to write this up in the hopes of helping other folks I;d love to have it on the blog.
I would love to. It’s something I’ve been meaning to do for a while. Should I just email it to you. What sort of word limit would you want?
Less than 10^23
I’m on it. Could be a while if I let it get that long!
Robb,
Thanks for the great post. My mom had melanoma (treated and cleared 3 years ago) and now is concerned they may have found cancer in her salivary gland. Is a ketogenic diet appropriate here?
I am getting her started on the paleo diet with the help of your book.
Thanks for your time and effort,
merm
It’s how I’d do things, you guys have to make that decision as best you can.
[...] Cancer & Ketosis. Robb Wolf, who obviously knows a lot about current cancer treatments and the drugs involved, responding to that Time article. At the end of that post, you'll get a very real and tragic sense of the source of Robb's interest. [...]
[...] Cancer and Ketosis [...]
Hello Rob
Thanks for all this great information.
I have been on a very low carbohydrate diet for 4 years now…but not as it relates to cancer. I have found it to be extremely effective as I am in the fitness industry and it has allowed to remain muscular and very lean (about 5%-7% body fat) year round…without have to do hours and hours of cardiovasular exercises to burn fat.
HOWEVER…I have found that with this diet has come the following:
1). Less strength in weight lifting exercises.
2). Less energy / stamina (primarily during exercising activities)
3). I developed large kidney stones in BOTH kidneys.
4). Over the last year I have developed what appears to be symptoms of arthritic in my spine.
In doing research I have run across many articles that seem to suggest that these “low carbohydrate diets” are so extremely acidic that they “open the door” for many diseases including arthitis and cancer.
In addition there seems to be a growing trend towards alkaline products..ie. alkaline waters (for the very purpose of reducing the acidity in the blood).
By the way….I eat lots of meat, eggs, chicken, cheese, and drink about three cups of coffee per day.
What are you thoughts on this….do you think I need to look at adjusting my diet to remain low carb but just find more healthy low carbohydrate food alternatives? Also, in your research have you been able to confirm or debunk the idea that keeping the body in ketosis (long term) is tied to these other symptoms I have been experiencing?
Thanks!
Drew
Of course you will have low strength and energy on a ketogenic diet. Low body fat and high performance output require different dietary needs, specifically post workout. Robb has talked about this a lot here is an article from 2008 http://www.robbwolf.com/2008/11/03/post-wo-nutrition/
If you adjust your pre and postworkout nutrition you should be able to get better performance without sacrificing body composition. If you want to say at <7% body fat consistantly an intermitten fasting regiment like at leangains.com might be something that is more sustainable.
[...] Cancer & Ketosis – I wanted to thank reader Sully for sending a link to the Time Online article on the use of ketogenic diets and cancer treatment. The article is surprisingly well written and informative…I wonder if the author has a personal … [...]
[...] Cancer & Ketosis – I wanted to thank reader Sully for sending a link to the Time Online article on the use of ketogenic diets and cancer treatment. The article is surprisingly well written and informative…I wonder if the author has a personal … [...]
I stumbled across this post becuase a family member was recently diagnosed with cancer. I also found a comprehensive review of CHO restriction for treatment and prevention of cancer here http://www.nutritionandmetabolism.com/content/8/1/75 for anyone else that is interesed in treating and preventing cancer with REAL nutrtional information instead of the misconception to “avoid red meat”.
Hi Robb,
I have been diagnosed with an Oligodendroglioma Grade II brain tumor and have already been through Chemo and Radiation Therapy with only stopping the tumor growth and no reduction.
I have recently begun the Low Carb High Fat (LCHF) diet (ketosis.)
I won’t know anything about the current size of the tumor until my next MRI (the beginning of March 2012)
I do know that before the diet I was having daily headaches. After starting the diet five weeks ago, my headaches have disappeared which makes me think it is doing something good in my brain. I am very hopeful that it has started apoptosis of the tumor. I will return to this site and keep you informed of my tumor regression to this diet as time progresses.