April 28, 2023
By Angie N Choi, EdD, Author of Whole New Me: Healing From Cancer in Body, Mind, and Spirit
The ketogenic diet starved my cancer cells of glucose and was an integral part of my healing from cancer. In 2021, I was diagnosed with ovarian cancer and had a total hysterectomy. Although the cancer was in an early stage, MRI images showed a shockingly large tumor, the size of a cantaloupe, on my left ovary. During the tumor debulking process, spillage occurred, so my oncologist recommended six rounds of chemotherapy. I was deeply disheartened to hear that I would need chemotherapy because my body is so sensitive. I knew chemotherapy would wreak havoc both physically and mentally, but initially, I agreed to chemotherapy and scheduled my first infusion. I had barely started recovering from abdominal surgery and was so weak that I could hardly stand up. I spent my days lying down in bed and contemplated and meditated much of the time. Day after day, my mind became quieter and still, which set the conditions for a life-altering intuition―not to do chemotherapy―to come forward. I wrote an article on my experience if you are contemplating fighting cancer without chemotherapy. It took courage to listen to my intuition and tell my oncologist my decision despite her disagreement. Once that was decided, I still knew I needed to do something but what should I do instead? The answer turned out to be a metabolic approach to cancer with a therapeutic ketogenic diet as the central strategy. The metabolic approach to cancer is a promising approach to treat cancer and has worked for many people for even the most aggressive and terminal cancers. To learn more, here’s another article I wrote on the metabolic approach to cancer and key metabolic cancer therapies.
The ketogenic diet starves cancer cells of glucose
A ketogenic diet is a high fat, moderate protein, and low carbohydrate diet that produces ketone bodies instead of glucose as fuel for the body. When we stop eating carbohydrates whether through a carbohydrate-restrictive diet or fasting, our bodies burn their glucose stores in the liver in the form of glycogen and metabolically switch over to using ketones for fuel.1 Humans have evolved to be able to survive on ketones when food is scarce as our early ancestors experienced when they could not obtain food. The body and the brain are able to utilize ketones for energy, but cancer cells are unable to effectively use ketones and prefer glucose instead.2 This metabolic inflexibility in cancer cells allows us to exploit this weakness by adopting a ketogenic diet.3 The diet effectively starves cancer cells of glucose, their primary fuel source which puts cancer cells under constant stress and makes them more susceptible to cellular death.
Working with a ketogenic dietary nutritionist
I was still recovering from surgery when I decided to change to a ketogenic diet and knew that I would need help. My energy level was low after surgery, and I had become underweight for my body mass and height. Nutrition was a major concern when I came home from the hospital. I needed to learn how to support my nutritional needs while on a therapeutic ketogenic diet for cancer, so I started working with Miriam Kalamian, nutritionist and author of Keto for Cancer. Miriam put me on a 1.2:1 ratio of fats to carbohydrates and proteins per meal with proteins not to exceed 30 grams per meal. This meant that roughly 70% of my calories per meal would come from fats (unsaturated, healthy fats, not saturated ones), 20% from protein, and 10% from carbohydrates. In order to put metabolic pressure on cancer cells, low protein and carbohydrate intake was necessary. Low protein, however, didn’t mean inadequate protein, because I still needed sufficient protein to prevent muscle mass deterioration.
Practically, a sample meal looked like eggs cooked in butter or coconut oil, olives, an avocado, MCT oil, macadamia nut butter, and kale. Each meal consisted of a protein (fat-heavy protein like wild-caught salmon, sardines, mackerel, or free-range eggs), cruciferous or low-carb vegetable, and other unsaturated fats. All fruits, grains, beans, legumes, dairy, and hidden sugars in condiments were banned until I was more acclimated to the diet. See my other article on keto cancer recipes for sample menus. Because I was trying to gain weight and reach 125 lbs (56 kgs), I needed to eat between 1800 – 2000 calories per day. This was challenging at first because I naturally wanted to only eat about 1000 calories per day. At that rate, however, I continued to lose weight, which I could not afford post-surgery. I needed to gain extra weight to compensate for weight loss that would occur over time on the diet. I wrote another article on working with cancer nutritionists or oncology dietitians if you’d like to read further.
Combining ketogenic and calorie restriction diets
Although the ketogenic diet is effective in managing cancer, its efficacy increases when combined with calorie restriction. In comparisons between caloric restriction and a ketogenic diet for brain cancer in mice, results indicated a synergistic effect between the two metabolic treatments. For example, when mice were fed a ketogenic diet but could eat as much as they liked, tumors did not shrink; however, if they ate a reduced-calorie ketogenic diet that lowered body weight, tumors reduced significantly.4,5 For human studies, there are several clinical trials underway evaluating the efficacy of ketogenic diets as an adjunct to standard cancer treatment.6 As always though with cancer, individuals may present with diverse physical, mental, and environmental conditions, and many may have undergone standard treatments like surgery, chemotherapy, or radiation, so the impact of dietary therapies must be considered within the parameters of individual conditions. Working with registered dietitians who specialize in the metabolic approach is highly recommended while also continuing to be monitored by conventional oncologists or doctors. Most oncologists will not have much advice about nutrition, but they probably won’t object to a therapeutic ketogenic diet either. Maintain relationships with all your healthcare providers and keep all informed if possible.
Ketogenic diet for cancer success stories
There have been several success stories of individuals using a ketogenic diet with different types of cancer ranging from brain to ovarian cancer. Some such as Pablo Kelly used the ketogenic diet to shrink brain tumors and keep them from growing so surgeons could operate more safely.7 Others like Martha Tettenborn used the ketogenic diet to suppress cancer growth combined with fasting to protect healthy cells during chemotherapy infusions.8 In my case, a therapeutic ketogenic diet in combination with antiparasitic medication was highly effective. Prior to my surgery to debulk the tumor, my cancer antigen levels were at 484. A normal range is from 0 – 35. After surgery, they went down to 243. After implementing the diet and antiparasitic medication, my levels reduced drastically to 14! Each quarterly check afterwards reduced even further to 3.9 and remained low to the present (2.5 years). If you’d like to read more inspiring stories, here’s another article I wrote about ketogenic diet cancer success stories for different types of cancer.
The ketogenic diet is an effective dietary strategy to manage cancer and allows patients to continue to take in nutrients unlike long-term fasting. In some cases, it may help keep cancer from spreading further thereby providing time to try additional treatments. In other cases, the diet may be combined with standard treatment for greater results, and in still other cases, it may be effective as the main therapy or in combination with other metabolic approaches. All people present differently and need individualized approaches based upon their cancer stage, nutritional needs, support, environment, and willingness to adhere to the diet. It may be challenging for some patients to remain on a ketogenic diet as it requires discipline, but it does work and gets easier over time. As conditions change and further improvement occurs, some patients may be able to switch to a low-carbohydrate diet that is less restrictive.
References
1Longo VD, Mattson MP. Fasting: molecular mechanisms and clinical applications. Cell Metab. 2014 Feb 04;19(2):181-92.
2Poff AM, Ari C, Arnold P, Seyfried TN, D’Agostino DP. Ketone supplementation decreases tumor cell viability and prolongs survival of mice with metastatic cancer. Int J Cancer. 2014 Oct 1;135(7):1711-20.
3Seyfried TN. Cancer as a Metabolic Disease: On the Origin, Management and Prevention of Cancer. John Wiley & Sons; 2012.
4Seyfried, TN, Sanderson, T., El-Abbadi, MM, McGowan, R, & Mukherjee, P. (2003). Role of glucose and ketone bodies in the metabolic control of experimental brain cancer. British journal of cancer, 89(7), 1375-1382.
5Zhou, W., Mukherjee, P., Kiebish, M.A. et al. The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer. Nutr Metab (Lond) 4, 5 (2007).
6National Institute of Health. U.S. National Library of Medicine. https://clinicaltrials.gov/ct2/results?cond=&term=ketogenic+cancer&cntry=&state=&city=&dist. Accessed April 27, 2023.
7Pablo’s Brain Journey. Pablo’s journey through brain cancer. https://www.pablosbrainjourney.com. Accessed April 27, 2023.
8Hacking Chemo. https://www.marthatettenborn.com. Accessed April 27, 2023.