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.
“One trait shared by virtually all tumor cells is altered (dysregulated) metabolism. Tumor cells have an increased reliance on glucose, suggesting that treatments affecting cellular metabolism may be an effective method to improve current therapies. Indeed, metabolism has been a focus of cancer research in the last few years, as many pathways long associated with tumor growth have been found to intersect metabolic pathways in the cell. The ketogenic diet (high fat, low carbohydrate and protein), caloric restriction, and fasting all cause a metabolic change – specifically, a reduction in blood glucose and an increase in blood ketones. (Wolf, Scheck, 2014).
The Ketogenic Diet is composed of a high fat (~90%), low protein (~6%), low carbohydrate (~4%) 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.
“Pioneering work by Seyfried et al. (2011) over the past decade has shown that animals with experimentally produced brain tumors placed on a KD exhibit markedly decreased tumor growth rates, and these remarkable effects appear to be a consequence of calorie restriction (i.e., reduced blood glucose levels) rather than KD-induced ketosis. Further, in a pilot trial of the KD in 16 patients with advanced metastatic tumors, six individuals reported improved emotional functioning and less insomnia, indicating that in some instances, the KD may lead to improved quality of life (Schmidt et al., 2011).
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.
“It may be that distinct tumor types within different organ systems may respond differently to the ketogenic diet or other dietary treatments and that such differences may reflect variations in the metabolic vulnerability of specific tumor types, perhaps through intrinsic differences in the expression of metabolism-related genes (Stafford et al., 2010)”.
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. “While the mechanisms through which the KD, caloric restriction and other potential metabolic therapies are not completely understood, the animal model data strongly suggest that metabolic alteration may be a highly effective adjuvant to the current standard of care for malignant brain tumors. “ (Wolf,Scheck, 2012).
Think the Ketogenic Diet is right for you? Talk to your doctor before adopting a Ketogenic Diet, or connect with one of our qualified diet professionals to determine a course of action that is right for you.
What are the benefits of Ketosis?
Achieving a state of ketosis can have many benefits from treating chronic illnesses to optimizing performance. While the benefits are well documented, the underlying mechanism of action is not entirely known. The diet seems to enhance the ability of mitochondria, the power plants of our cells, to deliver our bodies’ energy needs in a manner that reduces inflammation and oxidative stress. Through optimizing the way our body uses energy, we fortify our bodies’ ability to take on the ever-growing stressors of our modern way of living.
Can a high fat diet be healthy?
According to David Diamond PhD, “Saturated fat does not clog the arteries: Coronary heart disease is a chronic condition, the risk of which can be effectively reduced from healthy lifestyle interventions. We have known for 150 years that a high carbohydrate diet contributes to fat in the blood and contributes to obesity.” He goes on to say, “the poor science that was used to support the idea that increased fat intake increases cholesterol and damages arteries was authored by Ancel Keys who had no background in nutrition, but did have a BA in Economics and a PhD in Fish Physiology. Keys’ theory that fat in diet causes increased risk for high cholesterol and heart attack was based on extremely flawed science and “became dogma without ever being rigorously assessed.” “A generation of citizens has grown up since the Diet/Heart Hypothesis (of Ancel Keys) was launched as official dogma. They have been led by the greatest scientific deception of our times: the notion that consumption of animal (saturated) fat causes heart disease.” George Mann MD, Nutrition Today, 1985. “The belief that atherosclerosis is due to high cholesterol has been perpetuated by powerful forces using tactics to preserve the profits and reputations of those who promote them.” Paul Rosch M.D, Scandinavian Cardiovascular Journal, 2008. “The diet heart hypothesis is sustained by social, political and financial institutions which have little to do with science and established success in public health.” Uffe Ravnskov MD PhD, 2008.
Ready to get started? Learn the basics…
The Ketogenic Diet, also referred to as the ketosis diet, or Keto for short, is a way of eating that mimics the effects of fasting. By consuming a diet rich in quality fats, adequate in protein, and low in net carbohydrates (total carbs minus fiber), the body’s metabolism begins to utilize fat as its main source of fuel, rather than carbs. This shift has profound effects on metabolism for both the sick and healthy alike. The diet shows promise for improving or reversing many neurological conditions and metabolic disorders. For the healthy, the diet represents a tool for preventing chronic disease, as well as optimizing cognition and body composition (i.e. fat loss).
What is ketosis?
The term ketosis refers to a byproduct of the breakdown of fat into useable energy, called ketone bodies, or ketones for short. This fat can be derived directly from the food we eat, or adipose tissue stored throughout your body (otherwise known as body fat). Ketones are used directly by the body to power itself. This breakdown of fat into useful energy is similar to the process that dietary carbohydrates undergo in producing glucose to fuel the body. In other words, ketones are to fat what glucose is to carbohydrates. Ketosis is defined as having blood ketone levels > .5 millimolar/L.
How do I get into ketosis?
There are two methods to make the metabolic shift from using glucose to ketones as your main source of energy.
Fasting – the method of complete cessation of caloric intake for a prolonged period of time has been used to treat disease as far back as 400 B.C. when Hippocrates, the Father of Modern Medicine, employed the method for a myriad of ailments. Though this should be done under medical supervision, fasting is a safe, effective (and, some would say, the easiest) way to get into ketosis, quickly. For the average adult, a 48-hour fast will generally result in ketosis. After this fast, adopting a Ketogenic Diet will allow you to stay in ketosis. We recommend starting the fast at least 3 hours before bedtime on the first day, and eating at the same time 2 days later. While fasting means many things to many people, we define it here as the total restriction of macronutrients. We recommend boosting water consumption in order to avoid dehydration, and many find black coffee or plain tea to help maintain focus and performance during the fast. Children go into ketosis much faster and therefore can be started on the diet without fasting.
Diet – adopting a high fat, moderate protein, and low net-carb diet, will result in ketosis, and will take 2-3 weeks to achieve this state, as defined above. The diet is most basically explained by the ratio of macronutrients (fat, protein and net-carbs) in your diet, as it relates to fat. A classic Ketogenic Diet has a ratio of 4 parts fat, to 1 part protein + carbs (referred to as a 4:1 ratio). This 4:1 ratio is the high end of the spectrum as it relates to fat intake, though modifications to the diet can see this ratio go as low as 2:1. The ratio you adopt depends on the therapeutic benefit you are trying to achieve as well as the diet that is achievable for your lifestyle. We will go into diet options below, but you can also link to them here.
How long should I be on the diet?
We at the Charlie Foundation believe that a 3-month commitment to the diet is a minimum commitment to allow your body to fully acclimate to the new fat based fuel source. Since most people following a western diet are not proficient at metabolizing fat optimally, this period allows the body time to become “fat-adapted”, utilizing dietary fat efficiently and effectively. There are a variety of nutritional plans that will enable a ketogenic lifestyle, and flexibility is one of the hallmarks of the diet that make it easy to adopt as a life-long tool to enhance your health. Our nutritionists can help figure out both the short and long-term options best suited for you and your lifestyle.
Am I a candidate for the Ketogenic Diet?
While the short answer is yes for the majority of people consuming a western diet, we urge you to consult your general practitioner prior to making the switch to Keto. The Charlie Foundation will provide you with the information and tools necessary to adopt the diet, and partnering with your doctor during this process will ensure the most therapeutic outcome. We also suggest that you connect with a diet professional who can help you form a plan in collaboration with your doctor, who may be less familiar with the diet.
Types of Ketogenic Diets
There are a variety of diets that will allow you to get into ketosis. The major differentiating factor between them all is the amount of calories that come from protein, carbs and fat, which are what we call “macronutrients”, or nutrients in our food that have a caloric value. The three macronutrients differ in many ways, namely, their caloric values, as well as how the body uses them. Fat is the most calorically dense macronutrient, having 9 calories per gram, compared to 4 calories per gram for both carbs and protein. In a homeostatic state, the body utilizes fat and carbs for energy production, while it uses protein to rebuild the cells of our body. While this is generally the case, an overconsumption of protein can lead the body to break down the excess protein into glucose (which is what carbs break down into)
- Classic Ketogenic Diet
- Modified Ketogenic Diet
- MCT Oil Diet
- Modified Atkins
- Low Glycemic Index Diet (LGIT)
- Intermittent Fasting
If you think you can benefit from adopting a Ketogenic Diet, we encourage you to consult one of our dietitians, visit a participating hospital, or contact us so that we may guide you towards the most fruitful option given your specific needs.