Ketogenic diets linked to tumor growth...
"Both of these experimental conditions (diabetes and fasting/starvation) are known to be highly ketogenic and, thus, are consistent with our current hypothesis that ketone production fuels tumor growth. Finally, given our current findings that ketones increase tumor growth, cancer patients and their dieticians may want to re-consider the use of a “ketogenic diet” as a form of anti-cancer therapy."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047616/
I wish the sources would bloody make up their minds. It's good, it's bad, it's confusing. Argh.
I'm running on about four hour's sleep over the last week, so if someone can make more sense of this than I can, please feel free to ...
Comments
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I really don't know what to think anymore. I tried intermittent fasting for a while, but had to stop (couldn't keep my weight up). At this point, I get my exercise, eat my veggies, drink some red wine and hope for the best.
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One of my naturopathics said that she attended a recent conference with plant based/vegan people on one side and Ketogenic people on the other side - she said tensions were high.
I'm sticking with my veggies, whole grains, nuts, seeds, and beans. And like Momine said, "and hope for the best."
I had my first glass of red wine in over a year, gosh it was soooo tasty!
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Thanks for posting this article...it sounds like the ketones not only fuel tumor growth but also promote migration/metastasis so that is not good news, makes me rethink the ketogenic diet option...Some of these research findings only add to the confusion and frustration...so I guess we do the best we can with what we know and, yes...have a glass of red wine and "hope for the best"
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I thought that is what it was saying, but - with the lack of sleep (I go through cycles of raging insomnia, have since I was a child) - I wasn't too sure. Also, I've seen various articles/studies stating that ketogenic can be good for some cancers, like brain cancer, but bad for others, like breast cancer. Only goes to show you how truly complex cancer can be and underscores that, what may be good for one type of cancer, may not be good for all types of cancer.
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Peace, isn't it just? The red wine, I mean
I also find that it is the only thing that gets rid of the joint pain from the stupid femara. That's my excuse, and I am sticking to it. -
Okay, here's what's confusing me (other than lack-of-sleep). The Metformin trial is testing the hypothesis that breast cancer cells may have insulin receptors, meaning that if blood glucose levels are kept stable, then - hopefully - breast cancer cells will not be able to use insulin as fuel.
But if ketones build up when there is not enough insulin in your blood, thereby fueling breast cancer cells, then how does all this fit together? Too much insulin = tumor growth? Too many ketones = tumor growth?
Which brings in the diabetes and breast cancer association. Is it high levels of insulin that is the link or high levels of ketones? Or both? The common denominator appears to be abnormal blood glucose, so how do we interpret this? And how do ketones and hormones interact?
Or should I just give up and go to bed?
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There are a number of pathways that normal cells use to metabolize energy - I'm not a physican but it's my understanding cancer cells work in a similar fashion.
These various pathways give rise to cell reproduction and are sources of treatment studies - I believe the drug Afinitor arose out of the discovery of one such pathway.
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It is confusing, isn't it? I will say though that I've been keto since 12/26/13 and have not had surgery and had no tumor growth that I can tell. I've lost 22 lbs on this and it's the only way I can lose weight and I've lost a considerable amount of belly fat--have lost 4 in off my waist vs 1.5 off my hips. That is with supermarket red meat on the menu--something I'm thinking I need to stop since red meat seems to be more carcinogenic even than sugar.
For those who are confused about the difference between ketosis and ketoacidosis--they are two totally different conditions and something Dr. Atkins has been trying to educate the public about for years. My understanding is that the keto diet is all about using fat for fuel, which your brain prefers btw, vs using glucose, and we know that glucose feeds cancer. So which fuels it more--sugar or fat?
Ketoacidosis otoh, is a condition sometimes suffered by untreated type I juvenile diabetics and is a runaway condition of extreme and uncontrolled ketosis that is potentially fatal. My understanding is that as long as your pancreas is producing insulin this will not happen. Interesting that in the study they only used one only used beta-hydroxybutyrate and not acetoacetic acid. I don't know if that makes a difference or not since ketones are composed of at least those two. Also interesting that they were looking at lactic acid as well--have heard that tumors produce it and grow from it but that exercise can carry it away in your lymph system, with rebounding being the best for that kind of detox.
Anyway, I've decided that I'm taking my chances. I figure that it was my overly active sweet tooth and lack of desire to eat veggies that got me in trouble, dietwise, so keto should help to undo some of that damage. I feel energetic and healthy on this diet, my desire for sweets is gone, and my mind is clearer. And my holistic doc 100% approves.
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Hi Pipers dream, your diet sounds promising and what I need could you let me know what you eat and portions or point me to a good website. As I've aged, my belly fat has come on in my 40s and I can seem to lose the weight/ So I dont hijack this thread, please feel free to PM me if you dont mind sharing your diet plan.
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piper,
juvenile mellitis diabetes goes through the honeymoon phase of slowing down insulin, sputtering until pancreas totally stops making insulin, hence the term, the honeymoon is over-ketoacidosis does kill type 1 diabetics. i have a son with type 1 and we volunteer for jdrf andhave witnessed many young souls passing from this and hypoglycemia
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Yikes vacation, had not heard of the honeymoon phase. I know of type I from the other side as my father had it and passed away at 57 due to complications. He drank alcohol though and sometimes to excess. Usually not but he had at least 3 beers/night and I'm sure that didn't help his health.
Bevin, I could describe my diet but Dr. Atkins could do it better. Mainly I've been low carb and try to keep dairy low as well. Will cut out red meat next unless grassfed. Looking for a source of grassfed raw dairy around here. Plan to grow an organic garden this summer. Also, I'm practicing intermittent fasting with very light breakfast and lunch and then a full supper. This seems to work well for me but still trying to get my veggies up and find cleaner sources of food.
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I don't understand why they are confusing "Ketosis" with "Ketones."
Two totally different things.
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ketosis is a state of high levels of ketone bodies, aka DKA or ketoacidosis, the term "ketosis" when referring to the ketogenic diet should be worded as "nutritional ketosis" which is a state of deliberately inducing a state of "ketosis"
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Vacationbound, that was my point....
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But the article is referring to ketones not ketosis, ".... ketone production fuels tumor growth...." and the recommendation is that a ketogenic diet should be avoided/re-considered as an "anti-cancer therapy" because of this alleged link. So they were, specifically, referring to inducing a "ketonic environment" via diet.
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And where does exercise fit into all this keto stuff? There's gotta be a link. For a whole year I did a kind of intermittent fasting, that is, eating only from 12 to 7, and exercising around 10 am (high intensity interval training and weights) without breakfast. I must have been in ketosis at least part of the day. My lunch, including simple carbs, would go directly to my energy-depleted muscles. At least I was hoping that was the case and not feeding cancer cells. I stopped the intermittent fast because I was starting to gain after a period of losing weight. It makes me think though that hungry muscles may be taking food away from hungry cancer cells. In particular, because certain forms of exercise increase muscle mitochondria, there is more demand for energy by those cells and maybe less fuel for tumor growth. Since other studies suggest that vigorous exercise is good, I won't worry about being in exercise-induced ketosis.
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I have worked with dieticians and nurses for years that work with a community where diabetes is rampant. They have taught everyone the harm that not eating in the morning causes the body. Our bodies compensate for starvation and the liver starts doing things that can be very unhealthy. I simply do not understand the principles that are being practised here and cannot see how it can be healthy. Can someone explain this better to me?? Do not sugar levels actually rise initially when we deprive our bodies of nutrition due to the liver compensating? Wish Sandi was here right now to help me explain all that she has "beaten" into us over the years
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Unfortunately there a lot of people, and some doctors, will take any study that is done and make it the basis of a 'treatment' claiming that it does X because the study says it does X. Not only do they use the results of one study done on mice, they extrapolate from the word tumor that whatever type of tumor is being talked about would apply to all tumors. If it were this simple, we would all know about it and it would be on the front page of every newspaper in every country in the world.
If there were a chance that a particular diet would prevent a tumor from growing it would be EASILY tested. All you would have to do is get 200 women measure their tumors, make sure they were sorted by as many variables as possible (weight, age, other types of treatment, etc). Put 100 in a group not on the special diet and 100 on whatever diet you choose & then measure the tumors at particular intervals & compare the results. It wouldn't cost much to do such a study (few hundred thousand at most). The alternative people should easily be able to come up with that - the problem is that then their 'treatment' would actually be tested & they could no longer sell their books, products, etc. that promote the use of an untested 'treatment'.
What diet should one eat? What if we just removed cancer from the equation & thought about what is generally healthy. At a minimum - since we actually know very, very, little about what foods or combinations thereof affect various cancers in what ways, we would be healthy in other ways which essentially make QOL better. But it seems pretty silly to think that whatever diet is being used is going to stop the cancer - because honestly - were there one that's known - seriously somebody would spend the few hundred thousand and do an actual clinical study because he or she would win a nobel peace prize and up a gazillionairre not to mention saving millions of lives.
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TB90... I'm struggling with that concept, as well, but there are interesting cases where a ketogenic diet is said to help: with epileptic children and with certain types of pediatric brain tumors, but it must be pointed out that the diets followed in those circumstances are very, very strict and hard to maintain for long periods of time. Moreover, it's unknown what harm/benefit can be derived from staying on such a diet long-term But there is very little evidence that it can help other types of cancer, including breast cancer and the above article is the first reference I've found suggesting that a ketogenic diet may, actually, do the reverse of what it's advocates say it does as an "anti-cancer" diet.
Ziggy... I'm kinda with you. After doing more research last night, I've - personally - come to the conclusion that pursuing a ketogenic diet is, probably, not a good substitute for healthy, balanced eating let alone an "anti-cancer" prevention. However, I remain open to reading further research if I can find it.
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I was aware of the benefit for children with epilepsy and recall clients in hospital feeding their children pure butter! It was very extreme and only used for very extreme cases and under very close medical supervision. Is this the same diet?? Well, if so, I certainly will not be jumping on board any time soon. I am very aware of that diet and did not even connect the two as being the same. Wonder how on earth it became a diet for the prevention of breast cancer? I missed that step. Thanks for your responses.
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TB90, the theory is that sugar feeds cancer so if you lower your BS as far as you can w/o going hypoglycemic (which is very damaging to the brain and probably other things too) then you can "starve" cancer. Your body can use ketones for fuel just as much as it can glucose and some say the brain "prefers" ketones. It is quite possible to make this a healthy diet by using a lot of vegetables, nuts, and clean, organic meat and dairy. My problem is obtaining those items even though I live in a rural area, but I have friends in the Ozarks who raise clean meat so I'm getting ready to buy a deep freeze and stock up. At the early stage of my dx, I figured that it was best to get my BS down as quickly as possible but in 10 more lbs I'm adding beans and some things like carrots and maybe a little fruit. For fats I only eat healthy ones and I take 2 T. of flaxseed oil/day+fish oil. So, the diet is evolving.
Oh and to answer your question: I don't think it's necessary to produce as many ketones as the epileptics do so no need to be quite that extreme.
One way I look at this too is that studies have shown that metformin has some benefit against BC--I have no idea if it benefits everyone equally or only those who had impaired glucose/insulin ratios, but if I had to guess it would be the latter. If metformin works with those people, why would the keto diet not work? Every book I've read has said that weight loss is important for those with BC, even after you get it, and I was borderline obese, so I figure I'm improving my chances considerably. It is only a part of my treatment however. Exercise and getting enough sleep are also on the menu.
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Well, I typed in "ketogenic diet" and "cancer" at clinicaltrials.gov and found 11 trials, so it looks like this is a hot research topic.
There do seem to be plenty of studies that show ketones have anti-cancer effects. This one: "Ketone supplementation decreases tumor cell viability and prolongs survival of mice with metastatic cancer." http://www.ncbi.nlm.nih.gov/pubmed/24615175
And this, "The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer." http://www.ncbi.nlm.nih.gov/pubmed/23755243
Both those studies used a brain cancer cell line.
I also found: "A low carbohydrate, high protein diet slows tumor growth and prevents tumor initiation"
http://www.ncbi.nlm.nih.gov/pubmed/21673053
But then I found this study which says the same thing as the study SelenaWolf posted, "just as ketones are a “super-fuel” under conditions of ischemia in the heart and in the brain, they could fulfill a similar function during tumorigenesis, as the hypoxic tumor exceeds its blood supply."
"The autophagic tumor stroma model of cancer: Role of oxidative stress and ketone production in fueling tumor cell metabolism." http://www.ncbi.nlm.nih.gov/pubmed/20861672
It seems that there has been a belief that cancer cells can't use ketones for fuel, but now there is some evidence to the contrary (doesn't surprise me, cancer cells are tricky bastards).
What I found even more disturbing from the study originally posted was this, "Finally, given the pro-metastatic activity of L-lactate, its medical use in cancer patients should be restricted. However, nearly every oncology surgeon worldwide uses “lactated Ringer's” (which contains 28 mM L-lactate) as an intravenous (i.v.) solution in cancer patients, before, during and after tumor excision and possibly during the entire extended post-operative hospital stay. Based on our current studies, the use of “lactated Ringer's” in cancer patients may unnecessarily increase their risk for progression to metastatic disease." Grrrreat.
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Selena - Don't get me wrong, I am a big proponent of research and trying to keep up with what is being studied and looked at.My point was more that these are very preliminary studies and to 'jump' from a study of mice or even several that suggest a certain thing to the notion that these studies are solid evidence (or even evidence at all) that these studies indicate something about particular cancers in human being is just a leap that can not be made.
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I admire what everyone is trying to do to improve their chances. I just wish it was more clear cut about what is good and what is not. Period! This brush with cancer has me no longer admiring the scientific community like before. Nothing is definite at all and just when we think it might be, it changes. Quite frankly, I am starting to understand why my dear neighbor with breast cancer is doing what she wants or desires to do rather than what she needs to do. If I have to watch her all summer sipping on that cool glass of white wine I am simply going to . . . . join her!! Good luck everyone with what you invest in. I am still searching for my way.
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Oops, meant to say in my earlier post that this diet is probably not for all of us. It is probably going to be most helpful for those with metabolic syndrome x--that is, impaired glucose/insulin ratios--both sugar and insulin make cancer worse. Also, those who overindulge in carbs tend to have a fatty liver and keto can turn that around pretty quick. If you are obese and HR+, you should know that fat cells produce estrogen, esp belly fat cells. My holistic MD said that he eventually wants me on a high complex carb diet with lots of beans and vegetables but that for now this keto diet is probably best. Once I get down 12 more lbs, I'll only be slightly overweight and can transition over to a healthier diet.
Heidihill, exercise comes in b/c there is no quicker way to reduce your BS levels than that. It also helps you to be less insulin resistant so you produce less of it, which is good b/c insulin is the "fat storage hormone." Also, some tumors have insulin receptors as well as ER/PR.
Anyway, I hope I'm not coming off as a know-it-all b/c that is certainly not my intention, but I have put a lot of thought into this and esp since the very same week I found the lump, I had just gone out and bought a glucose meter and tested my fasting BS and it was 126! Then I found the lump and I was totally freaking out but later I found out that my new meter was reading 35 pts too high and my FBS was only 91. LOL, so it wasn't so bad, but I sure did go thru a bad time and 91 was creeping up some, so glad I caught it in time. Wish my tumor was just a mistake too.
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pipers_dream--I just wanted to say I don't think you're coming off as a know-it-all in any way. I appreciate hearing from someone who's actually doing this diet. I just recently progressed to Stage IV and my naturopath has recommended I consider this diet but my main concern is that I wouldn't be able to stick with it for very long. Is there a book or website you're using for what to eat? As far as I know I'm not insulin resistant but I'm a lifelong sugar addict and I'm sure it would do me good to avoid as much sugar as possible.
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I went on a low carb diet in Dec 2012 as my weight had crept up over the past few years and I was about 12lbs overweight. I went in and out of Keto during my low carb regime. I dropped about 20lbs after 6 months and then started to ramp up my exercise regime with boot camp and boxing. 11 months later, on my 56th birthday, I was feeling awesome; fit, strong and 25lbs lighter, my perfect weight. 9 days later I was dx with BC liver mets after being NED for 9.5 years! No science, just anecdote!
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Fitzy, what a letdown after such a high! So sorry to hear that.
For whatever it's worth, ketone bodies are mainly produced in the liver so this may provide easy fuel for any cancer cells that may have wandered in there. This is according to the Lisanti group as referenced by Selena in a later article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117136/
The liver produces glucose, too, so it is hard to win. But glucose may be the gentler enemy. Who knows??
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Fitzy: I'm so sorry to hear about the mets. You're too young for this! No, we all are but I noticed you have the same dx as me and you're close to the same age. Your post does make me wonder if more liver support is needed on a keto diet? I'm not suggesting you did anything wrong, but it could be a possible direction for research.
Heidi's question also makes me wonder which is worse for feeding cancer--glucose, ketones, or insulin? One thing I think more and more, and esp with seeing my holistic doc, is that balance is key. I would imagine that keeping your glucose/insulin balanced and in a tight ratio would be better probably than producing ketones, though in my case it's the only way I can lose weight, so I needed to do this first. I might add that though I've had a weight problem for most of my adulthood, it was never very hard to lose it when I got really serious, but in the last maybe 3 years, that changed and it became almost impossible--I'm 54 so it could be hormonal issues or it could be insulin resistance. Or both.
Gem State, I was worried about not being able to stick to it either, but you'd be amazed at how motivated you can be when your life is on the line. At first this was really depressing but now I don't even think about those kinds of foods anymore. I hate to say it but I don't have much of an appetite these days and no food tastes as good as it used to, but that's a mercy right now. As for how to do it, Dr. Atkins is probably your best and easiest to obtain resource, but some folks on keto for cancer say you need to take out the dairy also, and Atkins can be heavy on the dairy. Then there is the admonition that red meat is very carcinogenic as well, though I do wonder if that only goes for conventionally raised meats and I do know that organic, grass fed meats have in them quite a lot more CLA, an anti-carcinogen. Either way, that doesn't leave many choices for what to eat, but this is temporary and I just went ahead and started the diet w/o the ideal foods and I'm slowly progressing towards getting the healthier choices added in. For now, whey seems a good way to get the protein and I buy the best brand I can get.
Momine, I'm ready to join you in that glass of wine!
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All this talk of ketones reminded me of the paper I read recently about the effects of ethanol (alcohol) on breast cancer metabolism. I went back and re-read it, and it has a lot to say about ketones:
"As predicted, ethanol induced the expression of several ketogenic enzymes in fibroblasts (HMGCS1/2/HMGCL/BDH1), and also resulted in elevated ketone production. These observations are consistent with the idea that ethanol is converted to ketones (acetoacetate/β-hydroxy-butyrate) in fibroblasts, as it is normally detoxified to acetyl-CoA (ethanol → acetaldehype → acetate → acetyl-CoA → ketone bodies)."
"We also observed that ethanol induced a loss of Cav-1 and an elevation of MCT4 in cancer-associated fibroblasts.This has important clinical implications, as we and others have previously shown that a loss of stromal Cav-1 in human breast patients is a strong predictor of early tumor recurrence, metastasis, tamoxifen resistance and overall poor clinical outcome.29-39 Similarly, elevated MCT4 in cancer-associated fibroblasts is predictive of a poor clinical outcome in breast cancer patients, and strictly correlates with a loss of Cav-1."
"Ketone body re-utilization has also been shown to confer tamoxifen resistance upon MCF7 cells, consistent with our current findings that ethanol can suppress ER-α expression in MCF7 cells during co-culture with fibroblasts.47 And, loss of stromal Cav-1 is a predictor of treatment failure in tamoxifen-treated ER(+) breast cancer patients.34 Consistent with these clinical findings, mammary fat pads derived from Cav-1-deficient mice show a 4-fold increase in ketone body production,48 and they promote tumor growth up to 5-fold, relative to wild-type mice.49 Similarly, I.P. injection of ketone bodies in tumor-bearing xenografted mice, increases tumor growth up to 2.5-fold, independently of tumor angiogenesis.50 Thus, ethanol and ketone bodies both function as onco-metabolites."
This is from "Ethanol exposure induces the cancer-associated fibroblast phenotype and lethal tumor metabolism."
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