The ketogenic diet has surged in popularity in recent years, including in the context of cancer treatment. The low carbohydrate content of the ketogenic diet is the basis of the hypothesis that it may have anti-cancer properties. Normal cells grow and divide in an orderly manner, and generate energy through the process of oxidative phosphorylation. However, cancer cells take up large amounts of glucose and produce energy through aerobic glycolysis, also referred to as the “Warburg Effect.” This process allows cancer cells to grow and divide rapidly.
A ketogenic diet is high in fat, and low in carbohydrates. This pattern of food intake changes the body’s metabolism from “sugar burning” to “fat burning.” The decreased carbohydrate content of diet reduces glucose load in blood and also decreases the growth signals from insulin like growth factor. Ultimately this leads to a state of ketosis, in which fats are used to produce energy. By inducing a state of ketosis and decreasing the amount of glucose available in the bloodstream, cancer cells are “starved.” Whereas normal cells switch to fat burning in the setting of ketosis/starvation, cancer cells cannot. Therefore cancer cells may experience cell death in response to a sustained state of ketosis.
There is abundant information available on the internet regarding the benefits of a ketogenic diet. Unfortunately, at this time, high-quality scientific data from clinical trials are sparse. There is preclinical data to support the efficacy of a ketogenic diet in brain tumors, prostate cancer, and colon cancer, among others. A small number of human trials have also shown possible benefit in cancer patients. At the same time, there are concerns that a ketogenic diet may promote weight loss and cachexia in cancer patients, among other side effects. Many different clinical trials are ongoing, and the results are pending. As of 2018, ketogenic diets were not a part of evidence-based clinical guidelines to treat cancer. Therefore, randomized clinical trials will be needed before physicians can start making definitive recommendations about the benefit of a ketogenic diet.
Interestingly, certain aspects of the ketogenic diet overlap with other special diets. For example, the Mediterranean diet is also low on refined carbohydrates (like soda, candy, sugar) and high on healthy fats (like olive oil and fish). The dietary modifications of the Mediterranean diet are less extreme and may be easier to sustain over long periods. Although currently awaited, it is entirely possible that clinical trials will show definitive anti-cancer activity of the ketogenic diet in the near future. Until more data are available, it may be reasonable to consider the Ketogenic diet as a promising but experimental therapy in the context of cancer treatment.
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