In 1923 a German biochemist, named Otto Warburg, hypothesized that the primary cause of cancer was a dysfunctional metabolic process causing cancer cells to utilize large amounts of energy (glucose). Then, his theory was considered controversial and implausible, but over the last decade his theory has sparked new interest in the dysregulated energetics seen in tumor cells.
Warburg’s discovery, now termed The Warburg Effect, was that cancer cells preferentially take up an excess of glucose and convert it to lactate for energy (ATP) production. This dependence on glucose allows oncologists to use positron emission tomography (PET) scans to locate tumors within a patients body. By mixing radiolabeled dye with sugar (glucose) they can follow where the highest amount of glucose is being consumed in the body.
The same year that Warburg made his discovery the Ketogenic diet was discovered to be beneficial for epilepsy. The ketogenic diet was designed to mimic the effects of starvation on the body, when it was discovered that fasting helped to relieve difficult to control seizures.
The ketogenic diet is composed of a high fat (~90%), low protein (~7%), low carbohydrate (~3%) caloric breakdown that forces the body into starvation mode. When this happens all sources of glucose are utilized within the body and it is forced to produce a new source of energy. This replacement energy source is suitable for heart, muscle and brain cells, which have very high glucose demands. However, it is not suited to meet the high energy demands of tumor cells the way that glucose does.
With more scientists and clinicians looking for new and innovative treatment options for cancer patients the idea for a ketogenic treatment of cancer came to be. Through nutritional manipulation the body can starve tumor cells while maintaining its other tissues through protective compensatory mechanisms.
This theory has been tested on a case-by-case basis with the first publication in 1995 of two young patients receiving an MCT (medium-chain triglyceride) based ketogenic diet therapy. Both patients had high-grade brain tumors (astrocytomas), unresponsive to standard treatments, and were expected to succumb to these tumors. Under dietary treatment alone both patients experienced long-term tumor management without the need for further chemo- or radiotherapies. Through the use of PET imaging, doctors were able to conclude that the patients tumors were indeed taking up less glucose and ultimately shrinking in size.
In 2007 the University Hospital of Wuerzburg in Germany published the first 16-patient pilot study looking at the effects of a ketogenic diet on patients with advanced metastatic brain tumors. All patients on the diet experienced no adverse effects from the treatment and improved all aspects of quality of life in most of their patients. They concluded that the ketogenic diet is ultimately a suitable treatment for even the most advanced of cancer patients.
In 2010 (nutritionandmetabolism.com) a case report was published from Arcispedale Santa Maria Nuova hospital in Reggio Emilia Italy of a 65-year old woman who presented with a high grade astrocytoma causing neurological deficits in memory, headaches and nausea. this patient was immediately started on standard of care as well as a restricted ketogenic diet. She experienced complete remission of her tumor, confirmed through PET imaging as well as MRI. Only when the she suspended the ketogenic therapy did the tumor recur. Their findings are in line with all other published reports of patients receiving a ketogenic based cancer therapy.
With the growing amount of evidence that diet based therapies for cancer patients can yield high rewards with low patient risks has prompted research groups to test the ketogenic diet in phase 1 clinical trials. Starting with the first in 2007 looking at patients with advanced stage brain tumors (glioblastomas) and continuing since 2010 with 6 studies currently recruiting patients with brain, lung, pancreatic and advanced stage tumors.
All of this evidence demonstrates that there is a clear and present need for nutritional assistance when considering the long-term treatment of cancer. The Charlie Foundation has resources to assist nutritionists and their cancer patients with dietary therapy.