"Is Keto an Effective Cancer-Fighting Diet?"
Blood sugar, also known as blood glucose,
is the universal go-to fuel for the cells throughout our bodies.
Our brain burns through a quarter pound of sugar a day,
it’s preferred metabolic fuel.
Our body can break down proteins and make glucose from scratch,
but most comes from our diet in the form of sugars and starches.
If we stop eating carbohydrates, or stop eating altogether,
most of our cells switch over to burning fat,
but fat has difficulty getting through the blood-brain barrier.
But our brain has this constant massive need for fuel,
one organ accounting for up to half of our energy needs.
Without it, the lights go out…permanently.
To make that much sugar from scratch,
our body would need to break down
about a half pound of protein a day.
That means we’d cannibalize ourselves to death within two weeks,
but people can fast for months.
The answer to the puzzle was discovered in 1967.
Harvard researchers famously stuck catheters
into the brains of obese subjects who had been fasting
for over a month and discovered that ketones
had replaced glucose as the preferred fuel for the brain.
Your liver can turn fat into ketones,
which can then breach the blood-brain barrier
and sustain your brain if you’re not getting enough carbohydrates.
Switching fuels has such an effect on brain activity
that it has been used to treat epilepsy since antiquity.
The prescription of fasting for the treatment
of epileptic seizures dates back to Hippocrates.
In the Bible, Jesus seems to have concurred.
To this day it’s unclear why switching
from blood sugar to ketones as a primary fuel source
has such a dampening effect on brain overactivity.
How long can you fast though?
To prolong the fasting therapy, in 1921 a distinguished physician
scientist at the Mayo Clinic suggested trying
what he called a “ketogenic diet,”
a high-fat diet designed to be so deficient in carbohydrates
it could effectively mimic the fasting state.
“Remarkable improvement” was noted the first time
it was put to the test—efficacy that was later confirmed
in randomized, controlled, trials.
Ketogenic diets started to fall out of favor in 1938
with the discovery of the anti-seizure drug
which would become known as Dilantin,
but ketogenic diets are still in use today
as a third- or fourth-line treatment
for drug-refractory epilepsy in children.
Oddly, the success of ketogenic diets against pediatric epilepsy
seems to get conflated by “keto diet” proponents
into suggesting a ketogenic diet is beneficial for everyone.
But you know what else sometimes works for intractable epilepsy?
Brain surgery.
But I don't hear people at the gym clamoring
to get their skulls sawed open.
Since when do medical therapies
translate into healthy lifestyle choices?
Scrambling brain activity with electroshock therapy
can be helpful in some cases of major depression.
So what…pass the electrodes?
Ketogenic diets are also being tested to see
if they can slow the growth of certain brain tumors.
Even if it works, you know what else
can help slow cancer growth?
Chemotherapy.
So why go keto when you can just go chemo?
Promoters of ketogenic diets for cancer,
paid for by so-called “ketone technology” companies
that will send you salted caramel bone broth powder
for a hundred bucks a pound.
Or companies that market ketogenic meals
report “extraordinary” anecdotal responses in some cancer patients,
but more concrete evidence is simply lacking.
Even the theoretical underpinnings may be questionable.
You know, a common refrain is that “cancer feeds on sugar.”
But all cells feed on sugar.
Advocating ketogenic diets for cancer is like saying Hitler breathed air—
so let’s boycott oxygen.
Cancer can feed on ketones too.
Ketones have been found to fuel human breast cancer growth
and drive metastases in an experimental model,
more than doubling tumor growth.
Some have even speculated that may be why breast cancer
often metastasizes to the liver,
the main site of ketone production.
If you drip ketones on breast cancer cells
in a petri dish directly, the genes that get turned on and off
make for a much more aggressive cancer,
associated with a significantly lower
five-year survival in breast cancer patients.
Researchers are even considering designing ketone-blocking drugs
to prevent further cancer growth by halting ketone production.
And think about what eating a ketogenic diet might entail.
High animal fat intake may increase the mortality risk
among breast cancer survivors and potentially play a role
in its development in the first place through oxidative stress,
hormone disruption, or inflammation.
Men, too.
A strong association has been found
between saturated fat intake and prostate cancer progression.
Those in the top third of consumption
of these kinds of fat-rich animal foods
appeared to triple their risk of dying from prostate cancer.
Not necessarily fat in general— no difference in breast cancer
death rates based on total fat intake—
but saturated fat intake may negatively impact
breast cancer survival, a 50 percent increased risk
of dying from breast cancer.
There’s a reason the official American Cancer Society
and American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines
recommend a dietary pattern for breast cancer patients
that’s essentially the opposite of a ketogenic diet:
“high in vegetables, fruits, whole grains, and legumes,
meaning beans, split peas, chickpeas and lentils,
and low in saturated fats.”
So far, not a single clinical study has shown
a measurable benefit from a ketogenic diet
for any human cancer.
There are currently at least a dozen trials underway, however,
and the hope is that at least some cancer types will respond.
Still, even then that wouldn’t serve as a basis
for recommending ketogenic diets for the general population
any more than recommending everyone go out and get
radiation, surgery, and chemo for kicks.