Cancer Part III–Dietary Treatments

cell bullseye

The Big C 

There’s something special about cancer.  Few, if any other diagnoses cause so much emotional distress, both for people with cancer and for their loved ones.

{Please note, this is part 3 of a 4-article series; to begin with article #1, please click HERE.}

 

 

This is partly due to the potentially deadly nature of the condition, and partly due to the misery associated with most conventional cancer treatments—surgery, chemotherapy, and radiation.  However, I’d add one more powerful emotional factor to complete the trio of terror:  if you’re told you have an incomprehensibly complex genetic disease that even doctors don’t understand, you are placed in a position of powerlessness—you may feel like a helpless victim.  We are fond of saying that people “fight” against cancer, and that they are brave.  How exactly are you supposed to fight a disease caused by genetic mutations that have already occurred?  I can completely understand why some people lose hope when they are given a diagnosis of cancer.

Standard Dietary Recommendations 

To add to the potential for despair, there is tremendous confusion around the simple question of what people with cancer are supposed to eat.  The people in my life who have cancer are told they should eat lots of cancer-fighting, antioxidant-rich vegetables, low-fat protein sources, whole grains, nuts, seeds, and colorful fresh fruits.  Many people believe that a low-fat vegan diet is the healthiest diet for cancer.  However, as soon as chemotherapy starts causing scary, rapid weight loss, people are told to eat whatever they can to keep to keep up their calorie intake and maintain their strength—everything from sweetened energy drinks and smoothies to carbohydrate-rich comfort foods.   Some patients are even fed high-sugar solutions through I.V.’s or G-tubes.  Given everything I know about nutrition and everything I have learned from Dr. Seyfried’s extensive work, nothing could be worse for you if you have cancer. 

Cancer has a sweet tooth 

Nearly all tumors depend heavily on glucose for survival, which is how PET scans are able to find many tumors hiding in normal tissues. PET scans follow radioactive glucose as it travels through the bloodstream.  Radiolabeled glucose accumulates in tumor tissue more than in the normal tissues surrounding it, and lights up on the scan. 

There is a strong connection between high blood sugar (hyperglycemia), diabetes, and cancer.  It is well-documented that the growth of brain tumors is more accelerated and prognosis is worse in animals and humans with higher blood glucose levels.  Hyperglycemia is directly linked with poor prognosis in humans with malignant brain cancer and is connected to the rapid growth of most malignant cancers. 

High blood glucose raises insulin levels, which stimulates cancer cells to take in and use more glucose—this makes it easier for cancer cells to nourish themselves.  Insulin also turns up the activity of the fermentation pathway that was described in article 2 of this series, and fermentation leads to additional cellular damage.

High blood glucose also raises levels of another circulating hormone called IGF-I (Insulin-like Growth Factor I).  Cancer cells with receptors on their surfaces for this hormone grow more rapidly.  IGF-I turns on a chemical pathway that drives tumor cell growth [for you cell biology buffs out there, this is the PI3K/Akt/HIF-1alpha pathway].  This pathway sets the stage for cells to multiply, escape death (“apoptosis”), and recruit their own blood supply (“angiogenesis”).  Angiogenesis is required for tumors to grow beyond 2 millimeters in size (2 mm is a little less than 1/10th of an inch).

To make matters worse, the genes for this growth pathway are also turned up by the fermentation process.  More glucose = more fermentation AND more insulin AND more IGF-I = more tumor growth.

In short, cancer is a disease of growth, and insulin is the mother of all growth hormones (see my carbohydrates page).

Cancer’s Achilles Heel 

Regardless of which type of cancer you have, what grade or stage it might be, or which mutations (“genetic markers”) it might have, the hallmark of all cancer cells is damaged mitochondria (see article 2).  According to Dr. Seyfried, cancer is not a collection of  unrelated diseases that each need to be treated individually, cancer is one disease—a mitochondrial disease—and diseased mitochondria prefer glucose and glutamine for fuel.  This is cancer’s Achilles’ Heel.  Healthy cells with healthy mitochondria are flexible and can adapt to just about any fuel source, but not cancer cells.  In fact, the majority of cells in our body function best when they burn fat for energy.  Cancer cells are bad at burning fat, because fat burning requires respiration, which requires healthy mitochondria.  Excellent.  We’ve got ‘em right where we want ‘em.

How does dietary restriction work? 

If food is restricted enough to lower blood glucose, then insulin and IGF-1 levels will also be lower, quieting the tumor driving genes and pathways described above.  This means that fermentation sputters, it becomes harder for tumors to recruit new blood vessels, and tumor growth slows.

Under low blood glucose conditions, insulin’s opposite hormone, glucagon, kicks in.

Glucagon stimulates fat burning, which raises ketones and fatty acids in the blood.  Ketones and fatty acids are just breakdown products of fats.  Ketone bodies and fatty acids cannot be fermented; therefore cancer cells cannot use them for fuel.  Glucose restriction stresses cancer cells.  However, most healthy cells prefer to use fatty acids and ketones for energy.  Glucose restriction is good for healthy cells.

Glucagon also keeps your blood sugar from dropping too low by turning on a process in the liver called “gluconeogenesis” (making glucose from scratch).  This is why we never need to eat any carbohydrates—we are always able to make all the glucose we need out of proteins and fats.  The brain cannot burn fatty acids but it can burn ketones, and under low glucose conditions, the brain gradually shifts from burning mostly glucose to burning mostly ketones (to read more about why this is good for the brain, click here).  The brain may still require a small percentage of glucose to function at its best, but there is always enough glucose in the bloodstream because of glucagon, and most other organs will pass up glucose under these conditions in order to let the brain have first dibs.

Cancer cells and healthy cells both have a molecule on their surfaces called GLUT-1.  This glucose transporter ushers glucose out of the bloodstream and into cells.  Interestingly, under low glucose conditions, healthy cells will create more of these transporters and display them on their surfaces so as to optimize their ability to obtain glucose.  Even more fascinating is that cancer cells, which are damaged, and therefore less flexible and adaptable, are not able to do this.  In fact, when glucose levels are low, cancer cells are even weaker than usual; not only can they not raise their GLUT-1 levels, their GLUT-1 levels actually drop.  This is one more way that glucose restriction impairs cancer cells.  Even though there is always some glucose in the bloodstream because of gluconeogenesis, cancer cells are less able to access it than healthy cells because they are damaged.

The oxidation/inflammation connection

When ketones are burned for energy instead of glucose, fewer reckless “reactive oxygen species” (ROS) are generated.  These are wild free radicals that cause “oxidative damage”—a type of damage that has been associated with numerous chronic diseases.  This means that shifting the body from being a carbohydrate-burning machine to becoming a fat-burning machine reduces oxidative damage, and therefore potentially reduces risk for numerous chronic diseases.  Diets that raise blood levels of ketones are considered by neurologists to be “neuroprotective.”  That is to say, they protect brain cells from harm.  I would actually state it the other way around:  glucose burning is “neurotoxic” and burning ketones instead simply restores the natural, healthy level of disease resistance we inherited from our ancestors.

One reason why “ketogenic diets” (diets that force the body to burn ketones instead of glucose) are under consideration for the treatment of so many neurological diseases–from autism to Alzheimer’s to multiple sclerosis to epilepsy to Parkinson’s Disease– is that the transition from glucose burning to ketone burning is powerfully anti-inflammatory.  Seyfried writes:

“There is no drug therapy that I am aware of that can target as many proinflammatory mechanisms in the microenvironment as can DER (dietary energy restriction).  I think real progress in tumor management will be achieved once patients and the oncology community come to recognize this fact.”

In fact, Dr. Seyfried says that it is inflammation which damages mitochondria and respiration in the first place, and therefore inflammation may be the true cause of cancer.

How to starve cancer cells 

Food restriction reduces the incidence of both inherited and acquired cancers in laboratory animals.

Now, most cancer cells grow best when they have access to a combination of glucose and the amino acid glutamine (see article 2).  However, there are some types of cancer cells which do just fine without any glucose as a food source, because they are especially good at burning glutamine.  Dr. Seyfried argues that this is why BOTH glucose (from dietary carbohydrates) AND glutamine (from dietary protein) need to be restricted in order to best target cancer cells.

Dr. Seyfried recommends a specially-formulated low-calorie “ketogenic” diet consisting of 80% fat, with the rest (20%) being made up of protein + carbohydrate.  This diet forces your cells to burn fat for energy.  It contains enough protein for your cells to function properly, but no more.  Excess protein means excess amino acids, and glutamine is an amino acid (cancer cells like glutamine).  The ketogenic diet does not have to contain any carbohydrate (see my carbohydrates page), but, according to Seyfried, it is ok if contains significant amounts of carbohydrate, as long as calories are kept low.  According to Dr. Seyfried, blood glucose levels respond more to calorie intake than to carbohydrate intake.

The goal of this diet is to shift your body from burning mostly glucose (sugar) to burning mostly ketones (fat).  Fat molecules get broken down into 3 fatty acid chains plus one molecule of glycerol.  The fatty acids can be turned into ketones, and the glycerol backbone can be turned into glucose.  [This is why even eating too much fat can raise blood sugar a little bit in some people.  Carbohydrates are best at causing high blood sugar.  Proteins can raise blood sugar (although not as easily and not as steeply) because some amino acids can be turned into glucose.  Dietary fat is least likely to raise blood sugar, but it is not impossible, especially if you are eating more calories than you need.] The idea behind ketogenic diets is to restrict carbohydrate and protein so much that fat from the diet (and/or from excess body fat) is broken down into ketones (instead of being stored as fat), which are burned by healthy cells for energy.

Summary of Dr. Seyfried’s recommendations for cancer patients

People following strict ketogenic diets to control seizures or manage cancer need to weigh and measure everything they eat, and monitor their blood sugar and blood ketones daily.  Special meters are required for home testing.  The meters themselves are very inexpensive, but the test strips are very expensive (I own a Precision Xtra blood ketone meter and the ketone strips cost about $2.00 each).  Dr. Seyfried recommends that blood sugar levels be allowed to fall into the 55-65 mg/dL range, and that ketones rise to at least 4.0 mM.  He refers to this combination of values as “the zone of metabolic management.”  To give you an idea of the average person’s values when eating a typical diet, blood sugar levels tend to be in the 80′s and 90′s, and ketones are usually 0.3 mM or lower.

The quickest way to get into the therapeutic zone is by fasting (water only) for 3-5 days.  During the induction phase, (harmless) carbohydrate withdrawal symptoms may occur, which typically include lightheadedness, nausea, and headaches.

He offers an alternative to this fasting induction:  limit carbohydrates to less than 12 grams per day and limit protein to 0.8 to 1.2 grams per kg body weight per day (0.4 to 0.6 grams per pound body weight).  With this less extreme plan, he says it may take up to several weeks to reach the recommended therapeutic zone values.

Once you are in the zone, he recommends you use your daily test results to fine-tune your caloric intake–i.e. see how many calories you can get away with while staying in the zone.  Everyone’s metabolism is different, so some people can get away with more calories than others without falling out of the zone.  One source I read suggested an initial caloric intake of about 30% below your resting daily metabolic requirements (you can estimate your basal metabolic rate by using simple free calculators available on the internet).  If you are overweight and are losing weight with this plan, he recommends eating enough so that you’re not losing more than 2 pounds per week.  He also recommends supplementing your diet with a multivitamin, calcium, omega-3’s and vitamin D.

If your cancer would benefit from surgical debulking, he recommends waiting until you have been on the ketogenic diet for at least a few weeks before undergoing surgery, if you can afford to wait.  This is because the diet can reduce blood vessel mass, inflammation, and tumor size, making it easier for the surgeon to remove the tumor more cleanly.

Dr. Seyfried points out that vigorous exercise can raise blood sugar levels, and therefore he advises patients to “walk, not run.”  Strenuous muscle activity releases lactic acid into the blood, which can be converted into glucose by the liver and released back into the bloodstream.

NOTE:  Dr. Seyfried writes:  ”We do not believe that KD-R (restricted ketogenic dieting) alone will provide complete disease resolution for most patients.” He then goes on to discuss other strategies that can be combined with dietary restriction to optimize results–these will be covered in article 4.

Some Basic Precautions

All of your medications must be closely monitored by your physician because this diet can significantly affect required dosages.  For example, if you are taking a diuretic, you may no longer need it, since this diet has natural diuretic properties.  Another example: if you are taking insulin or any blood sugar lowering medicines for diabetes, you are likely to need much lower doses rather quickly.  It can be very dangerous not to pay attention to these factors.  Blood tests may be needed to monitor electrolytes and other important medical values.  Some people may need to begin this diet in a hospital or clinic setting for proper monitoring.

This diet will not work if you are taking steroid medications such as dexamethasone (Decadron), because steroid medications raise blood sugar.  It may also not work if you are receiving intravenous medications which contain glucose.

It is very important to have the support of your household and your physician if you embark on such a plan, because it requires close monitoring, discipline, and social support (hard to keep your hand out of the cookie jar when everyone else at home is enjoying cookies).

Designing a nutritionally adequate ketogenic diet is not easy, so make sure you take advantage of the experience of others who know how to do it properly.  There are a couple of good resources listed below to get you started.  You may even want to hire a nutritionist with expertise in medical ketogenic diets.  

Please know that I am not qualified to recommend any particular diet to anyone with cancer, and this summary of Dr. Seyfried’s recommendations is not intended as medical advice.  Ketogenic diets are very challenging and should not be undertaken without sufficient education, preparation, support, and medical monitoring.

So many remaining questions…do cancer treatment diets really need to be this strict?  What is the best diet for cancer prevention? 

To read the final article in this series, please click HERE.

To be notified of new blog posts as they become available, click here ↓

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Resources

Miriam Kalamian (www.dietarytherapies.com), Hamilton, Montana.  Master’s level nutritionist who used a ketogenic diet to help her 4 year old son with brain cancer.

The Charlie Foundation ,a website dedicated to the use of ketogenic diets in the treatment of children with epilepsy.

REFERENCES

Seyfried, Thomas N.  Cancer as a Metabolic Disease:  On the Origin, Management, and Prevention of Cancer.  Hoboken, NJ:  Wiley, 2012.

 

 

 

 

 

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  • Steve Parker, M.D.

    Interesting article, doctor.

    Last i heard, there were over 400 different types of cancer. I’ll be very surprised if they all share the same cause. You got me wondering if all cancers show up on glucose-based PET scans. You’d think they would if they were high utilizers of glucose as an energy source. Here’s a quote from the Mayo Clinic website:

    “PET scans must be interpreted carefully because noncancerous conditions can resemble cancer, and many types of cancer do not appear on PET scans. The types of cancer most likely to show up on PET scans include:

    Brain

    Breast

    Cervical

    Colon

    Esophageal

    Lung

    Lymphoma

    Melanoma

    Pancreatic

    Thyroid.”

    It’s interesting that prostate cancer isn’t listed. Prostate cancer is one that diabetes may be protective against.

    We need lots more scientific research before ketogenic diets can be widely recommended as the ideal “cancer diet.”

    -Steve

    • http://diagnosisdiet.com/ Dr. Ede

      Excellent points. I am not an oncologist, just reporting about Dr. Seyfried’s writings, so I looked into these questions in hopes of understanding the discrepancies better. He does make it clear that some cancer cells like glutamine more than glucose and vice versa, so that may be part of what is going on. Also, there may be issues of background signal in normal tissues that are very metabolically active or are inflamed, as glucose utilization would be higher in those tissues. I don’t know…

      As for prostate cancer, he writes on page 291: “Numerous studies show that dietary energy restriction (DER) is a general metabolic therapy that significantly reduces the growth and progression of numerous tumor types, including cancers of the mammary, brain, colon, pancreas, lung, and prostate.” Then on page 305 he writes: “DER also reduces angiogenesis in prostate and mammary cancer.”

      Also, I hope that my writing isn’t making it sound as if I believe that a ketogenic diet is definitely the ideal cancer diet. I don’t think we know enough yet to be sure. In fact, in my next article I will critique the diet itself…

  • http://www.facebook.com/pete.greenway Pete Greenway

    Thank you! I learn more with each article. As a layman, I appreciate your talent for making complex topics understandable.

    • http://diagnosisdiet.com/ Dr. Ede

      Thanks so much, Pete! Did it go where you thought it was headed? Where might it go next?

      • http://www.facebook.com/pete.greenway Pete Greenway

        I was thinking oxidative stresses; so reducing those from diet sources and increasing or stimulating free radical scavengers would be key.

  • Arthur Robey

    My father was diabetic. Whenever he had a wound to heal we would make him hypo. It worked like magic.

    • http://diagnosisdiet.com/ Dr. Ede

      Hello, Arthur
      That is so interesting. Dr. Seyfried writes on p 340: “Some tumors behave as wounds that do not heal.”

  • Melchior Meijer

    Hi Georgia and Dr Parker,

    Regarding prostate cancer, the Swedish urologist
    Dr Jan Hammarsten is a proponent of the ketogenic diet as an intervention in this
    disease, based on his research and clinical observations. In prostate cancer
    the main therapeutic effect seems come from the lowering of insulin and IL
    growth factors, if I’m correct. Hammarsten wrote about the role of metabolic
    syndrome in prostate cancer in Nature.

    http://www.nature.com/nrurol/journal/v8/n9/pdf/nrurol.2011.112.pdf

    Dr Andreas Eenfeld did an interview with Hammarsten.
    It’s a very interesting conversation, but you have to understand Swedish ;-) .

    http://www.youtube.com/watch?v=OJmOx2FqWLE&feature=player_embedded

    Thanks Georgia, for all the work you do! You
    have a knack for explaining complicated matters in a way lay people understand
    and you are sharp and brave!

    • http://diagnosisdiet.com/ Dr. Ede

      Dear Melchior,

      Thank you very much for this thoughtful and helpful information, and for your kind words. For those of you who can read Dutch (or enjoy Google translations of Dutch), Melchior’s website, called “The Paleo Perspective”, is excellent: http://melchiormeijer.wordpress.com/melchior-meijer/.

      I am a big fan of Dr Eenfeldt’s work, and wish I could understand Swedish! I read over the Nature article this morning, which is excellent. Below is an excerpt from the article:

      Key points

      ■ The metabolic syndrome is a cluster of disorders, including type 2 diabetes,

      atherosclerotic disease manifestations, hypertension, obesity and dyslipidemia,

      and is prevalent in countries with Western lifestyles

      ■ The most important common underlying endocrine aberration of these

      disorders is an increased insulin level, which is also linked to benign prostatic

      hyperplasia (BPH) and prostate cancer

      ■ Most aspects of the metabolic syndrome are risk factors for BPH and prostate

      cancer, which seems to suggest that these tumors are themselves aspects of

      the metabolic syndrome

      ■ The metabolic syndrome is also linked to other urological conditions, such as

      hypogonadism, nephrolithiasis, overactive bladder and erectile dysfunction,

      which could suggest that these conditions are also aspects of the disorder

      ■ Patients should be informed about these findings, while clinicians await

      a definitive answer of how we can reduce the incidence and control the

      aggressiveness of urological aspects of metabolic syndrome

      • Melchior Meijer

        Thanks, Georgia!

        Great summary. I also liked this short line toward the end of the article. “The most convincing evidence regarding the effect of diet is from studies showing that the fasting plasma insulin level is reduced by consuming a Paleolithic­type diet.”

        I find it also fascinatng that Hammarsten mentions urge incontinence as an
        epipehenomenon of the metabolic syndrome. Several people report return of bladder control and disappearance of inappropriate nocturia after going on a paleo diet and especially after eliminating wheat. Urge incontinence is rapidly increasing and hitting at younger ages (at least here in Holland). The most succesful treatment is neuromodulation. A ‘pacemaker’ in placed in the lower back. It stimulates a nerve, after which 80 percent of patients regain bladder control. How exactly the disturbed communication between bladder, brainstem and brain is restored, is unknown. Imagine if they would get the same result by ‘just’ eating a human diet.

        • http://diagnosisdiet.com/ Dr. Ede

          Yes, the whole article is beautifully-written, chock full of information (but easy to read) and well worth a click. I think men would also find the potential connection between high insulin diets and erectile dysfunction interesting, as well. I, too, believe that Paleo Diets are very healthy and have the potential to prevent and even treat many common health problems.

          • Melchior Meijer

            Someone very dear to my heart, 80 years old, recently reported the return of ‘a bodily function he had totally forgotten about’ ;-) . And he still smokes (albeit less)!

  • Ted Burke

    Thanks Doc, this is a great summary of what sounds like a fascinating book!

  • Susan

    Hi – I just subscribed to your blog after reading your comment on melanoma in the New York Times. After reading your article on What Causes Cancer I would like to know if it is bad to take l-glutamine as a supplement? Might it somehow promote cancer, in your opinion? Thanks.

    • http://diagnosisdiet.com/ Dr. Ede

      Hi Susan
      Thank you for subscribing, and your question is an excellent one. A couple of other people also asked this question, so I will try to get to the bottom of it. It may take a little time, but if I can discover anything worth sharing, I will write a blog post about it. Just on a common sense level, I would think that Dr. Seyfried would discourage the use of glutamine if one already has cancer (although whether it would make sense to continue its use in the case of chemotherapy-induced intestinal damage is harder to say), but whether a healthy person who does not yet have cancer is increasing his/her risk of cancer by taking glutamine is a different story. My general hunch is that it would be more important to restrict refined carbohydrates than protein/glutamine when it comes to cancer risk reduction, but I’m not sure yet.

  • John

    Re. “(2 mm is less than 1/100th of an inch).”
    Not quite! 2 mm is nearly 8/100ths of an inch, i.e. very roughly 1/10th. of an inch.

    • http://diagnosisdiet.com/ Dr. Ede

      Oops–right you are:) Thank you for catching this–I’ll correct it right now!

  • dMark Wheeler

    I think the effect of exercise needs more attention. I seem to remember hearing that weight training (which should fall in the “vigorous exercise” category) makes your mitochondria healthier (and possibly more plentiful). If exercise improves your overall metabolism, then shouldn’t it also help fight cancer? Wouldn’t the stress on the body’s system during exercise help destroy the weaker cancer cells? If you do an article about these questions, I would definitely like to hear more. Keep up the good work !

  • Kiki2014

    I agree that cancer is really a mitochondrial disease. However, I don’t agree that genetic mutations do not have a role. One of the more common genetic mutations that came forth from the Human Genome project is MTHFR that relates to one’s folate mechanism and methylation. Depending on the mutation, it makes people less able to handle/process toxins and repair their DNA. This genetically caused breakdown in methylation leads to all kinds of diseases including cancer. So while, for example, an MTHFR defect does not cause breast cancer, those with an MTHFR defect plus exposure to estrogen (time between first period and first baby for example, or birth control pills with estrogen or Hormone treatments) greatly increases the likelihood of breast cancer. Those with MTHFR who take folic acid during pregnancy (instead of MTHF or methyl folate) are 35% more likely to have premenopausal breast cancer. So I disagree that genetics do not play a role in the development of cancer. I also agree that there is no cure for cancer, only prevention and management. Talking about a cure for cancer is really not feasible, but preventing it and managing it is.