Ketogenic Diet
Also known by these names
- Classical Ketogenic Diet 4:1
- Low glycemic index diet
- Medium chain triglyceride (MCT) diet
- Modified Atkins Diet
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Key Points
- This therapeutic diet was designed to induce ketosis and deprive cancer and cancer-associated stromal cells of glucose for energy production.
- BCCT’s interest in this therapy derives from preclinical animal studies and published case studies showing that a ketogenic diet may reduce tumor growth and improve survival.
- Limited human studies are available, most of which were not designed to measure effectiveness.
- Risk of nutrient deficiencies, unwanted weight loss and other potential side effects suggest using KD only under qualified medical supervision.
- Dietitian or qualified clinical nutritionist monitoring and support are suggested to improve adherence and outcomes.
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The ketogenic diet (KD) is becoming attractive to oncology clinicians and patients as a potential anticancer therapy. The goal is to alter the metabolism of cancer cells and their associated stromal cells by decreasing glucose and increasing ketones as available energy sources. KD can be implemented either with calorie restriction or as an isocaloric diet, with no change in total calories from the patient's previous diet.
While isocaloric KD may be somewhat beneficial, caloric restriction is considered an important component of an anticancer KD. Caloric restriction supports the body’s retention of ketones and also lowers caloric drivers of cancer growth pathways.
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Both a reasonable rationale and some encouraging evidence support its use in cancer, originating with malignant glioblastoma. However, researchers vary in their conclusions about KD’s safety and effectiveness for any single cancer diagnosis or as an adjunct therapy.
Increasing anecdotes of clinicians recommending and/or patients deciding to try KD without adequate assessment, individualization, education, monitoring and ongoing support raise concerns.
Ketogenic diets are medically regimented, high in fat, moderate in protein and low in carbohydrates. The goal of using KD in cancer is to reduce the energy production of cancer cells as well as tumor-associated stromal cells, thereby decreasing cancer growth and spread.
KD has been studied primarily in malignant glioblastoma. To date, few clinical trials using an isocaloric ketogenic diet as a therapy for cancer patients have been conducted. No clinical trials have been published to date on calorie-restricted KD.
While some reviewers conclude that insufficient clinical evidence supports recommending KD for any single cancer diagnosis or as an adjunct therapy, others suggest that even with limited human studies, animal studies “show that KD presents a viable option as an adjunct therapy for cancer” and can be a good option to complement other therapies, "depending on the situation and the extent of the disease.”
Treating the Cancer
Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action
Anticancer Action
Clinical Evidence
Case and pilot studies of the KD in cancer in humans:
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- Two pediatric patients with advanced glioma successfully achieved ketosis and had a reduction of glucose uptake at the tumor site on PET scans, with a significant clinical improvement in one patient.
- A 65-year-old with glioblastoma multiforme received KD both before and along with radiation and chemotherapy. Imaging studies suggested tumor regression, although MRI evidence of tumor recurrence was found 10 weeks after suspension of strict KD therapy.
- Case studies of patients with breast cancer showed improvement or complete responses to ketogenic diets in combination with other therapies.
- Ten subjects completed 26 to 28 days of the study diet. The extent of ketosis was associated with stable disease or partial remission.
- In 16 patients with advanced metastatic tumors, KD was associated with positive results in tumor regression and improved blood parameters.
- According to a 2016 review, the "available completed clinical trials focused mostly on safety and feasibility of the KD in cancer patients, with for the most part favorable and encouraging results.”
In a 2017 review of human studies using the KD in cancer, the reviewers cite some important limitations of clinical trials to date:
- Most didn’t or couldn’t evaluate anti-tumor effects of the KD.
- Non-rigorous study designs, small sample sizes and marked variations in patient and disease characteristics make comparisons and conclusions difficult.
- Only 37 percent of those on the KD were able to follow the diet for the duration of the study.
- No two studies used the same dietary protocol.
- In some studies, registered dietitians didn’t supervise the patients' diets.
In that same review, of the studies reporting anti-tumor observations:
- No correlations were found between clinical response and ketosis or glycemia.
- KD delivered through intravenous infusions showed no significant difference in tumor growth among three groups.
- Six (of 53) patients’ high-grade glioma treated with KD along with chemoradiotherapy and/or adjuvant chemotherapy produced no major complications, but too few patients were involved to make conclusions about survival or tumor growth.
Look Deeper
Inducing Ketosis: Countering the Warburg Effect; “Starving the Cancer”
Some cancer cells within tumors, as well as tumor-associated cells (such as fibroblasts and macrophages) undergo metabolic changes in response to hypoxia (low oxygen and oxidative stress) of the tumor microenvironment.
Read more A key alteration of these cells is to convert to a complete dependence on glucose for energy generation. These catabolic cells do not have intact mitochondria, and so normal energy production via citric acid cycling and oxidative phosphorylation is not available.
Cells with intact mitochondria can use various metabolic substrates including glucose, fatty acids, glutamine and even ketones to fuel energy production. Catabolic cancer cells and tumor associated stromal cells, on the other hand, lose the ability to make ATP in the mitochondria and instead rely solely upon metabolizing glucose via glycolysis in the cytoplasm to generate ATP. This is called the Warburg effect and is a known attribute of the tumor microenvironment. Thus a ketogenic diet, which severely limits the supply of glucose in favor of ketones ,can selectively starve these tumor cells.
Evidence suggests that some cancer cells appear less able to metabolize ketones compared with healthy cells, while other experiments show that some tumor cells are able to use ketones for energy. More recent preclinical research indicates that the impact of ketosis on cancer cells does not rely solely on the Warburg effect. The effects of ketosis may induce oxidative stress specific to cancer cells, which may potentiate the effect of chemotherapy and radiation.
Typical Western diets high in refined carbohydrates provide this glucose substrate as well as promote the insulin pathway, releasing growth factors that are associated with promoting cancer development and progression. KD is one potential means of minimizing dietary sources of carbohydrates and instead supply fats as the primary energy substrate.
Reverse Warburg Effect: Cancer Cells Adapt
More recently, researchers have proposed the reverse Warburg effect.
As tumor-associated cells such as fibroblasts and immune cells struggle under the highly oxidative tumor environment, these cells lose the ability to retain oxidative phosphorylation and, instead, revert to glycolysis for energy production and start to undergo autophagy, a process of self-digestion. The glycolysis and autophagy generate many energy-rich substrates such as fatty acids, lactate, and ketones which these tumor-associated cells release. These substrates are then taken up by growing (anabolic) cancer cells as fuel. In this way, tumor associated cells essentially feed growing cancer cells, the reverse Warburg effect.
In lab studies researchers have found that human breast cancer cells with an enzyme capable of re-using ketone bodies used nearby ketogenic fibroblasts to fuel their growth. The authors conclude that ketone production and re-utilization drive tumor progression and metastasis.
Huebner et al. note: “In vitro data showed that cancer cells not only adapt to the situation but develop mutations and characteristics of stem cells. One hypothesis is that the [ketogenic] diet puts the tumor under stress and thus selects for resistance and malignancy. In an experiment on mice, the tumors in the diet-treated group initially grew less but later tumor growth accelerated and exceeded that of the control group.”
Researchers propose that the Warburg and reverse Warburg effects are not totally competitive, but rather reflect the ability of cancer cells to use different metabolic substrates depending upon what is available and what mutations are present.
Yaojie et al. suggest that the glycolytic pattern is not the only way cancer metabolizes glucose, and therapeutics including the ketogenic diet targeting glycolysis in cancer patients have not always had positive responses.
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Lab and Animal Evidence
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In animal models, ketogenic diets decreased the initiation, progression and metastasis of cancer.
Animal studies indicate a ketogenic diet may reduce tumor growth and improve survival in these cancers:
- Malignant glioma
- Prostate cancer
- Gastrointestinal cancer, including colon cancer
- Slowed mammary tumor growth and increased tumor latency in mice, and this effect was increased when mice were also treated with metformin. However, human breast cancer cells with an enzyme capable of re-using ketone bodies used nearby ketogenic fibroblast cells to fuel their growth—ketosis was not successful in treating the cancer.
Enhancing Treatment
Lab and Animal Evidence
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- In animal model studies, KD acted synergistically with radiation, chemotherapy, or both.
- In mice with metastatic cancer, KD combined with hyperbaric oxygen prolonged survival compared to using either therapy alone.
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Clinical Evidence
Ketogenic diets may have a protein-sparing effect that preserves lean body mass, reducing the risk or severity of cancer cachexia (muscle wasting).
A small pilot study of patients with advanced cancer suggests KD is suitable even for advanced cancer patients. The authors didn’t observe any severe side effects during the three-month study period and concluded that KD might improve aspects of quality of life, such as improved emotional function and less insomnia.
Some studies point to the low rate of acceptance of the KD dietary restrictions by patients, which may indicate negative impacts on quality of life.
Access
A naturopathic oncologist, integrative oncologist or integrative medicine physician may be able to determine which patients might benefit from following a KD. Involving a dietitian or clinical nutritionist with experience with the KD is important to properly implement a KD. Participating in a clinical trial of a ketogenic diet for your type of cancer may be another source for a program (see the side bar on this page).
Although you can follow a ketogenic diet on your own, the complexity of following the diet and the possibility of side effects (see the Cautions section below) make this difficult and potentially dangerous. While web resources and books are available regarding this diet, they are not specifically tailored to people with cancer, nor do they include diet counseling or monitoring.
Cautions
KD is a complex diet to follow and may cause side effects, some of which may be serious (weight loss, nutrient deficiencies, and others). Many patients in studies discontinue the KD because of difficulty complying. Individualized close monitoring of the diet and ongoing education and support is recommended to improve safety and enhance your completion of the KD.
Moreover, many of the ketogenic diets focus on coconut oil, heavy cream, fatty red meats from conventionally-raised animals—including cured red meats such as bacon and sausage—to achieve high levels of fat. These are not recommended elements of a cancer-protective diet.
Adverse Events/Side Effects
Most studies don’t report serious side effects in cancer patients following a KD. However, Erikson, et al. advise, “As cancer patients are particularly susceptible to clinically significant malnutrition in the form of weight loss from both fat and muscle mass, this side effect should be most carefully evaluated before applying the diet in clinical settings.”
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Short-term effects in early implementation of this diet, usually transient and easily managed:
- Constipation
- Nausea and vomiting (most common)
- Gastro-esophageal reflux (heartburn)
- Acidosis (a condition resulting from blood being too acidic, especially due to dehydration)
- Hypoglycemia (low blood sugar)
- Dehydration
- Lethargy
- Weight loss: However, Fearon, et al. report that non-calorie-restricted ketogenic diets can slightly increase lean body mass
Other short-term effects observed in human studies:
- Anemia
- Decreased amino acid levels
- Functional changes in basal ganglia, granulocytes (neutrophils) and thrombocytes (platelets)
- Flu-like symptoms/fatigue
- Halitosis (bad breath)
- Hyperuricemia (high uric acid levels in blood)
- Hypocalcemia (low calcium in blood)
- Hypo- and hyperkalemia (low and high potassium levels in blood)
- Hypomagnesemia (low magnesium in the blood)
- Optic neuropathy (eye nerve damage)
- Pancreatitis
- Pruritis (itching)
- Swelling of feet
Common long-term effects:
- Hyperlipidemia (high blood lipids): most common (although with conflicting reports of improvement in lipid profile)
- Hypercholesterolemia (high cholesterol) (although with conflicting reports of improvement in cholesterol)
- Nephrolithiasis (kidney stones)
- Cardiomyopathy (disease of heart muscle)
Other long-term side effects observed in human studies:
- Arteriosclerosis
- Carnitine deficiency (a metabolic state in which carnitine concentrations in plasma and tissues are less than the levels required for normal function of the organism)
- Irregular menses (menstrual periods)
- Osteopenia, osteoporosis and bone fractures
- Decreased growth in children and adolescents
- Vitamin, mineral and enzyme deficiencies
Integrative Programs, Protocols and Medical Systems
BCCT staff, November 13, 2017: BCCT advises that those considering a ketogenic diet consult a clinician who has expertise in prescribing and monitoring ketogenic diets specifically for cancer patients. Additionally, work with a ketogenic-savvy dietitian or qualified clinical nutritionist for instructions and ongoing support. Look for “KD-savvy” professionals:
- Consider participating in a clinical trial, favoring those that provide a registered dietitian or qualified clinical nutritionist to provide education, monitoring and ongoing support.
- If considering trying the KD outside of the research setting,
- Find a doctor with expertise in ketogenic diets (such as an oncology naturopath or integrative oncologist) to determine if this is an appropriate therapy for you, set the plan and monitor your response. Favor clinicians who include a registered dietitian or qualified clinical nutritionist to counsel you.
- Work with a registered dietitian or clinical nutritionist experienced in KD counseling for the course of the KD therapy.
September 18, 2017: The potential that ketogenic fibroblasts may fuel cancer growth raises concern for some clinicians, such as naturopathic oncologist and BCCT advisor Lise Alschuler, ND, FABNO. Dr. Alschuler thinks a KD may benefit some cancer patients, but is concerned about using it long-term in someone with active cancer. She thinks there is a role for the KD, but that its usefulness may be limited in duration and may be dependent upon the type and nature of the patient’s tumor. Since not enough research is available yet to determine susceptible cancers, nor to guide dosing and duration of a ketogenic diet, Dr. Alschuler follows tumor markers and imaging to monitor the continued effectiveness of the KD. If tumor growth is detected, she takes the patient off of the KD and transitions them to a different, plant-based diet.
Non-cancer Uses of a Ketogenic Diet
Originally established as a non-drug treatment for intractable childhood epilepsy, the KD is being studied in other diseases including these:
- Diabetes mellitus
- Cardiovascular diseases
- Neurological diseases like Alzheimer’s and multiple sclerosis.
BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.
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Written by Laura Pole, RN, MSN, OCNS; Lise Alschuler, ND, FABNO; and Nancy Hepp, MS; most recent update January 6, 2020. BCCT is grateful for the review of this document by BCCT advisor Rebecca Katz, MS, director of the Healing Kitchens Institute.
- Smyl C. Ketogenic diet and cancer-a perspective. Recent Results in Cancer Research. 2016;207:233-40; Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Smyl C. Ketogenic diet and cancer-a perspective. Recent Results in Cancer Research. 2016;207:233-40.
- Branco AF, Ferreira A et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. European Journal of Clinical Investigation. 2016 Mar;46(3):285-98.
- Nebeling LC, Miraldi F, Shurin SB, Lerner E. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. Journal of the American College of Nutrition. 1995 Apr;14(2):202-8.
- Zuccoli G, Marcello N et al. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: case report. Nutrition & Metabolism. 2010 Apr 22;7:33.
- İyikesici MS, Slocum AK et al. Efficacy of metabolically supported chemotherapy combined with ketogenic diet, hyperthermia, and hyperbaric oxygen therapy for stage iv triple-negative breast cancer. Cureus. 2017 Jul 7;9(7):e1445; Branca JJ, Pacini S, Ruggiero M. Effects of pre-surgical vitamin D supplementation and ketogenic diet in a patient with recurrent breast cancer. Anticancer Research. 2015 Oct;35(10):5525-32.
- Fine EJ, Segal-Isaacson CJ et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012 Oct;28(10):1028–35.
- Schmidt M, Pfetzer N, Schwab M, Strauss I, Kammerer U. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot trial. Nutrition & Metabolism. 2011 July 27;8(1):54.
- Branco AF, Ferreira A et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. European Journal of Clinical Investigation. 2016 Mar;46(3):285-98, p. 289.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Martinez-Outschoorn U, Sotgia F, Lisanti MP. Tumor microenvironment and metabolic synergy in breast cancers: critical importance of mitochondrial fuels and function. Seminars in Oncology. 2014 Apr;41(2):195-216.
- Schroeder U, Himpe B et al. Decline of lactate in tumor tissue after ketogenic diet: in vivo microdialysis study in patients with head and neck cancer. Nutrition and Cancer. 2013;65(6):843-9.
- Liberti MV, Locasale JW. The Warburg effect: how does it benefit cancer cells? Trends in Biochemical Sciences. 2016;41(3):211-218; Zhao L, Mao Y, Zhao Y, Cao Y, Chen X. Role of multifaceted regulators in cancer glucose metabolism and their clinical significance. Oncotarget. 2016;7(21):31572-31585; Martinez-Outschoorn UE, Lin Z, Whitaker-Menezes D, Howell A, Sotgia F, Lisanti MP. Ketone body utilization drives tumor growth and metastasis. Cell Cycle. 2012 Nov 1; 11(21): 3964–3971; Warburg O, Wind F, Negelein E. The metabolism of tumors in the body. Journal of General Physiology. 1927;8(6):519-530.
- Zick SM, Snyder D, Abrams DI. Pros and cons of dietary strategies popular among cancer patients. Oncology (Williston Park). 2018 Nov 15;32(11):542-7.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Bonuccelli G, Tsirigos A et al. Ketones and lactate can actually “fuel” tumor growth, angiogenesis and metastasis: evidence that epithelial cancer cells use oxidative mitochondrial metabolism. Cell Cycle 2010;9:3506–14; Martinez-Outschoorn UE, Prisco M et al. Ketones and lactate increase cancer cell “stemness”, driving recurrence, metastasis and poor clinical outcome in breast cancer: achieving personalized medicine via metabolo-genomics. Cell Cycle 2011;10:1271–86.
- Bonuccelli G, Tsirigos A et al. Ketones and lactate “fuel” tumor growth and metastasis: evidence that epithelial cancer cells use oxidative mitochondrial metabolism. Cell Cycle 2010;9:3506–14.
- Huebner J, Marienfeld S et al. Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice. Anticancer Research 2014;34:39–48.
- Yaojie Fu, Shanshan Liu et al. The reverse Warburg effect is likely to be an Achilles' heel of cancer that can be exploited for cancer therapy. Oncotarget. 2017 Aug 22; 8(34): 57813–57825; Branco AF, Ferreira A et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. European Journal of Clinical Investigation. 2016 Mar;46(3):285-98.
- Yaojie Fu, Shanshan Liu et al. The reverse Warburg effect is likely to be an Achilles' heel of cancer that can be exploited for cancer therapy. Oncotarget. 2017 Aug 22; 8(34): 57813–57825.
- Zick SM, Snyder D, Abrams DI. Pros and cons of dietary strategies popular among cancer patients. Oncology (Williston Park). 2018 Nov 15;32(11):542-7.
- Maurer GD, Brucker DP et al. Differential utilization of ketone bodies by neurons and glioma cell lines: a rationale for ketogenic diet as experimental glioma therapy. BMC Cancer. 2011 Jul 26;11:315; Seyfried TN, Sanderson TM, El-Abbadi MM, McGowan R, Mukherjee P. Role of glucose and ketone bodies in the metabolic control of experimental brain cancer. British Journal of Cancer 2003;89:1375–82; Stafford P, Abdelwahab MG, Kim DY, Preul MC, Rho JM, Scheck AC. The ketogenic diet reverses gene expression patterns and reduces reactive oxygen species levels when used as an adjuvant therapy for glioma. Nutrition & Metabolism (Lond). 2010 Sep 10;7:74.
- Freedland SJ, Mavropoulos J et al. Carbohydrate restriction, prostate cancer growth, and the insulin-like growth factor axis. Prostate. 2008 Jan 1;68:11–9; Masko EM, Thomas JA et al. Low-carbohydrate diets and prostate cancer: how low is “low enough”? Cancer Prevention Research (Philadelphia, Pennsylvania). 2010 Sep;3(9):1124-31; Mavropoulos JC, Buschemeyer WC et al. The effects of varying dietary carbohydrate and fat content on survival in a murine LNCaP prostate cancer xenograft model. Cancer Prevention Research (Philadelphia, Pennsylvania). 2009 Jun;2:557–65; Allott EH, Macias E et al. Impact of carbohydrate restriction in the context of obesity on prostate tumor growth in the Hi-Myc transgenic mouse model. Prostate Cancer and Prostatic Diseases. 2017 Jun;20(2):165-171; Caso J, Masko EM et al. The effect of carbohydrate restriction on prostate cancer tumor growth in a castrate mouse xenograft model. Prostate. 2013 Apr;73(5):449-54.
- Otto C, Kaemmerer U et al. Growth of human gastric cancer cells in nude mice is delayed by a ketogenic diet supplemented with omega-3 fatty acids and medium-chain triglycerides. BMC Cancer 2008;8:122.
- Beck SA, Tisdale MJ. Nitrogen excretion in cancer cachexia and its modification by a high fat diet in mice. Cancer Research. 1989 Jul 15;49:3800–4.
- Gluschnaider U, Hertz R et al. Long-chain fatty acid analogues suppress breast tumorigenesis and progression. Cancer Research. 2014 Dec 1;74(23):6991-7002.
- Zhuang Y, Chan DK, Haugrud AB, Miskimins WK. Mechanisms by which low glucose enhances the cytotoxicity of metformin to cancer cells both in vitro and in vivo. PLoS One. 2014 Sep 25;9(9):e108444.
- Martinez-Outschoorn UE, Lisanti MP, Sotgia F. Catabolic cancer-associated fibroblasts transfer energy and biomass to anabolic cancer cells, fueling tumor growth. Seminars in Cancer Biology. 2014 Apr;25:47-60; Martinez-Outschoorn UE, Lin Z et al. Ketone body utilization drives tumor growth and metastasis. Cell Cycle. 2012 Nov 1;11(21):3964-71.
- ClinicalTrials.gov. US National Library of Medicine. Viewed June 12, 2019.
- Abdelwahab MG, Fenton KE et al. The ketogenic diet is an effective adjuvant to radiation therapy for the treatment of malignant glioma. PLoS One. 2012;7(5):e36197.
- Scheck AC, Abdelwahab MG et al. Abstract 638: Mechanistic studies of the ketogenic diet as an adjuvant therapy for malignant gliomas. Cancer Research. 2010 Apr; 70 ( 8 Suppl ):638.
- Allen BG, Bhatia SK et al. Ketogenic diets enhance oxidative stress and radio-chemo-therapy responses in lung cancer xenografts. Clinical Cancer Research. 2013 Jul 15;19(14):3905-13.
- Poff AM, Ari C, Seyfried TN, D'Agostino DP. The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer. PLoS One. 2013 Jun 5;8(6):e65522.
- Zick SM, Snyder D, Abrams DI. Pros and cons of dietary strategies popular among cancer patients. Oncology (Williston Park). 2018 Nov 15;32(11):542-7.
- Schmidt M, Pfetzer N, Schwab M, Strauss I, Kammerer U. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot trial. Nutrition & Metabolism. 2011 July 27;8(1):54.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Karen Collins, MS, RDN, CDN, FAND, Oncology Dietitian and Nutrition Advisor to the American Institute for Cancer Research. Presentation March 2017: “Culinary Translation in Breast Cancer Care and Survivorship” in Washington, DC; Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72; Oliveira CL, Mattingly S, Schirrmacher R, Sawyer MB, Fine EJ, Prado CM. A nutritional perspective of ketogenic diet in cancer: a narrative review. Journal of the Academy of Nutrition and Dietetics. 2017 Mar 30. pii: S2212-2672(17)30115-6; Winters N, Kelley JH. The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies. Vermont: Chelsea Green Publishing. 2017; Lise Alschuler, email communications, September 18, 2017 and October 24, 25, 26, 2017.
- Karen Collins, MS, RDN, CDN, FAND, Oncology Dietitian and Nutrition Advisor to the American Institute for Cancer Research. Presentation March 2017: “Culinary Translation in Breast Cancer Care and Survivorship” in Washington, DC.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Branco AF, Ferreira A et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. European Journal of Clinical Investigation. 2016 Mar;46(3):285-98.
- Fearon KC, Borland W et al. Cancer cachexia: influence of systemic ketosis on substrate levels and nitrogen metabolism. American Journal of Clinical Nutrition. 1988 Jan;47(1):42-8.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- Branco AF, Ferreira A et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. European Journal of Clinical Investigation. 2016 Mar;46(3):285-98.
- Sharman MJ, Kraemer WJ et al. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. Journal of Nutrition. 2002 Jul;132(7):1879-85.
- Sharman MJ, Kraemer WJ et al. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. Journal of Nutrition. 2002 Jul;132(7):1879-85.
- Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
- McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
- Lise Alschuler, email communications, September 18, 2017, and October 24, 25, 26, 2017.
- Branco AF, Ferreira A et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. European Journal of Clinical Investigation. 2016 Mar;46(3):285-98.
View All References
More Information
- Oncology Association of Naturopathic Physicians: Directory
- Nutritional Solutions
- ClinicalTrials.gov
- Winters N, Kelley JH. The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies. Vermont: Chelsea Green Publishing. 2017.
- Kalamian M. Keto for Cancer. Vermont: Chelsea Green Publishing. 2017.
- Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
- Zick SM, Snyder D, Abrams DI. Pros and cons of dietary strategies popular among cancer patients. Oncology (Williston Park). 2018 Nov 15;32(11):542-7.
- Townsend Letter: The Ketogenic Revolution in Cancer
- Barbara MacDonald, ND, LAc: The Breast Cancer Companion: A Complementary Care Manual: Third Edition
- Dwight McKee, MD, editor: Clinical Pearls
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Five to Thrive Live: Keto for Cancer
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