cancer part 4: got hope? cancer treatments:standard therapies vs. dietary therapies conventional treatments can help in the short-termbut can cause problems in the long-term. chemotherapy is toxic to healthy cells andcan breed resistance among cancer cells, increasing the risk of more aggressive cancers if relapseoccurs. radiation turns up the activity of the tumorgrowth pathway (pi3k/akt/hif), which promotes not only tumor growth, but also recruitmentof new blood vessels (angiogenesis) and drug resistance.radiation increases fusion activity between cells, which means that normal and healthycells can merge into hybrid cells and become more aggressive.radiation directly damages mitochondria, which
increases risk for cancer in the future.both radiation and immunosuppression therapy (drugs that suppress the immune system) canincrease the incidence of metastatic cancers (cancers that spread).steroids such as dexamethasone (decadron), often used to reduce inflammation, raise bloodsugar levels, feeding tumor cells and enhancing their survival. der (dietary energy restriction) triggerscancer cell death via apoptosis (programmed cell suicide), which is a natural, noninflammatoryprocess that happens from within the cell, causing no collateral damage. conventionaltreatments kill cancer cells via necrosis, an inflammatory process that happens fromthe outside and is locally destructive. tumor
cells that are being fed glucose/glutamineare resistant to apoptosis, but under ketogenic conditions, they become better able to undergoapoptosis again. der and chemotherapy can both cause weightloss. however, the weight loss associated with der is healthy and does not weaken people,whereas chemotherapy-induced weight loss is unhealthy and weakens people. dr. seyfried wonders if some of the benefitthat some people obtain from chemotherapy may be due to the calorie restriction thatoccurs due to loss of appetite. he notes that drug studies don�t usually take this possibilityinto consideration. �der (dietary energy restriction) can beconsidered a broad-spectrum, nontoxic metabolic
therapy that inhibits multiple signaling pathwaysrequired for progression of malignant tumors regardless of tissue of origin. it is notclear to me why so many oncologists have difficulty appreciating this concept.� �therapies that reduce glucose and elevateketones can starve glucose-dependent cancer cells while protecting and fueling healthycells. there is no other cancer therapy that can do this.�complementary cancer-fighting strategies dr. seyfried does not think that dietary restrictionalone is sufficient to fight most cancers, so he proposes some additional strategiesthat can be used in combination with dietary measures to optimize results:
�anti-glycolytic� drugs that reduce theactivity of the glycolysis (fermentation) pathway, which is the primary energy pathwayfor most cancer cells. ��anti-glycolytic drugs together withenergy-restricted diets could act as a powerful double �metabolic punch� for the rapidkilling of glycolysis-dependent tumor cells.� �cr-mimetic� drugs that mimic the effectsof calorie restriction by lowering glucose levels. these drugs should not be used withoutdiet, because they lower glucose without raising ketones. without ketones, healthy cells coulddie of energy failure�they would have neither glucose nor ketones for fuel.hyperbaric (high pressure, 100%) oxygen. excess oxygen reduces the activity of an enzyme calledhexokinase ii, which grabs onto glucose after
it enters cells and traps it inside so itcan be burned for energy. but standard treatment sometimes works anddiet doesn�t always work� we all know people who have undergone successfulstandard treatments and who have not had a recurrence of cancer. my own mother had cancertwice, decades ago, and has had no cancer since. in both cases surgery was curativefor her. if you are lucky enough to have a simple form of cancer in a body part thatcan be completely removed, and you catch it before it spreads, your prognosis is probablypretty good. chemotherapy and radiation can kill many cancer cells because (as discussedin article #1), they are more vulnerable to these agents than healthy cells, and if youhave a healthy enough immune system, your
own body may be able to take care of the rest.some people then never get cancer again�they may change their lifestyle after a cancerscare and start taking better care of themselves (my mother stopped smoking, for example).some adopt a healthier diet or start exercising. some may just be lucky. but clearly moderncancer therapies have made a difference for some people, including my own mother. so my mom is a cancer success story, but aclose family friend of ours who was diagnosed with glioblastoma multiforme (brain cancer)was not so lucky. she lived for only a few months, and those final months were of verypoor quality. she had smoked for years, but had quit long before her diagnosis. she lovedcandy. as kids we always looked forward to
her visits, because she always walked throughthe door with a big package of red licorice and a king-sized bag of m&m�s. and as soonas she ran out of treats, she�d say to my mother: �ain�tcha got somethin� sweet?�i have no idea why she got brain cancer, of course, but modern treatments certainly werenot able to help her. i do find it interesting that the second most common type of canceramong young people is brain cancer, and the brain just happens to be the organ most heavilydependent on glucose. could it be that the brain is especially sensitive to the damagingeffects of high sugar/high flour diets? case studies of dietary treatments linda nebeling, phd, mph, rd (now with thenational cancer institute) authored the first-ever
study of a ketogenic diet in human brain malignancy[nebeling 1995]. this was a landmark study of 2 young girls with advanced stage, inoperablebrain tumors that had not responded to traditional therapies. a 3 year old girl with stage ivastrocytoma and an 8 year old girl with grade iii astrocytoma were treated with a ketogenicdiet. both children responded well, and experienced long-term tumor management without furtherchemotherapy or radiation. pet scans revealed a 22% reduction in glucose uptake by tumorsin both girls. giulio zuccoli md (italian neuro-radiologist)and thomas seyfried phd published a case report [zuccoli 2010] of a middle-aged woman withglioblastoma (a form of brain cancer) who was treated with a 600-calorie/day ketogenicdiet. upon diagnosis, steroids (to control
inflammation) and anticonvulsant medication(to control seizures) were given. she underwent surgery, fasted briefly, and then began thediet. after 14 days on the diet, steroids were stopped, and chemotherapy and radiationtreatments were started. after two months, chemotherapy and radiation were discontinued.one week later, pet scan and mri were performed and no tumor tissue or swelling was detected.thepatient stopped the diet, and 10 weeks later, mri showed evidence that the tumor had comeback. this case report demonstrated that a) the ketogenic diet was well-tolerated; b)the diet may be a useful add-on therapy, as most tumors of her type do not respond aswell as hers did to standard treatments alone, and c) inflammation was well-controlled withoutthe usual need for steroids, supporting the
anti-inflammatory properties of the diet. eugene fine, md, professor of nuclear medicineat albert einstein college of medicine just published a 28-day pilot study [fine 2012]of a very low carbohydrate diet in 10 men and women ages 53-73 with incurable, advancedcancers of a variety of types (3 colon, 2 breast, 2 lung, 1 ovarian, 1 esophageal, 1fallopian tube). carbohydrate intake was about 9%, but protein and fat were not restricted.interestingly, those with high ketone levels (and low insulin levels) were the only oneswhose tumors either stopped growing or got smaller as evidenced by pet scan. a link tohis video presentation is below in the resources section. dr. fine�s study is groundbreakingbecause it may pave the way for additional
studies, which are badly needed. beth zupec-kania, rd is a nutritionist withthe charlie foundation (an organization dedicated to raising awareness of and providing supportfor the use of ketogenic diets in children with epilepsy). ten glioma (brain cancer)patients contacted her for help in using ketogenic diets in the treatment of their cancer. fourof them ultimately committed to a strictly supervised ketogenic diet. three of the fourpatients had stable or atrophied (reduced) tumor size documented by mri. two had beenon the diet for several years and were still alive despite having initially been givenonly a few months to live. one patient died; he had had advanced stage metastatic cancerprior to starting the ketogenic diet. he remained
active and alert until the last 2 months ofhis life, and outlived his prognosis by a year.obstacles to dietary treatments ketogenic diets are hard to follow. they requirecareful monitoring, tremendous self-discipline, and essentially require that people turn theirusual diet completely upside-down. you�ve got to be very motivated, and have the fullsupport of everyone who lives with you. even if everyone on the planet were 100% convincedthat a ketogenic diet is the best diet for cancer, i would eat my hat if everyone withcancer followed it. that would be unrealistic�changing diet is hard. ketogenic diets are, by nature, high-fat diets,and this will bother some people on a psychological
level, due to (unnecessary) fear of eatingfat. for more information, see my fats page and my cholesterol page. most physicians are taught next to nothingabout nutrition during medical training, and once in practice, are too busy to learn. nutritionaltreatments are not particularly sexy or high-tech and may not be of interest to some physicians.nutritional treatments may be viewed as slower to take effect, and as time-consuming to implement.but here is the most important obstacle�if a particular treatment is not sanctioned bythe medical establishment and does not have solid studies behind it, most doctors willbe afraid to recommend it or even support it, due to discomfort with uncertainty andfears of medical malpractice. doctors take
their responsibilities very seriously andwant to provide the best treatment they can. in today�s world, that means applying the�standard of care.� currently surgery, chemotherapy, and radiation are the standardof care. and what�s more, is that the standard of care is what insurance companies will payfor�they are unlikely to cover ketone meters, testing strips, special nutritional counseling,etc. is your doctor simply keeping up with thestandard of care or is he or she interested in being on the cutting edge? would your doctorbe willing to read dr. seyfried�s book, or at least his journal article? [see referencesbelow] the good news is you do not need your doctor�spermission to eat a ketogenic diet, only his
or her support and willingness to monitoryour progress. open-minded, patient-centered physicians should be on board with your effortsso long as you are willing to take responsibility for your care.do ketogenic diets really need to be so strict? if you read article 3, you may have been disheartenedto see how tough dr. seyfried�s dietary recommendations are. yet as draconian as hisdiet is, he doesn�t think it will work very well on its own without chemotherapy. whileno treatments of any kind are perfect, if dr. seyfried�s hypothesis about mitochondriaand diet are correct, shouldn�t they have the potential to work better than he thinksthey will? having read his book and heard him speak,i believe dr. seyfried is a brilliant scientist
and thinker. the only (gentle, constructive,but wicked important) criticism i have is the same one i have of most scientists whostudy diet�he thinks about diet as a simple collection of proteins, carbohydrates, andfats, and completely neglects the actual foods in the diet. dr. seyfried compared two different typesof chow in mice with cancer�one high-carb �standard� chow and one high fat �ketogenic�chow. he found that the ketogenic chow did not work against cancer if you let the miceeat as much as they wanted�their little blood sugar levels stayed high and their cancersgrew. he had to lower their calories to see benefits. he concluded that both diets workedequally well as long as you lowered calories�a
lot. this made me suspicious, so i visitedthe chow manufacturers� websites to see what the diets actually contained. i wonderif it will shock you as much as it shocked me. below is the standard high-carb food: prolab rmh 3000 (labdiet)�62% carbohydrate,22% protein, 5% fat, 5% fiber ingredients: ground wheat, dehulled soybeanmeal, wheat middlings, ground corn, fish meal, pork fat, alfalfa meal, calcium carbonate,brewer�s yeast, soybean oil, salt, vitamins, and minerals. the first four ingredients are refined grainsand legumes. nearly 100% refined junk (including
lots of refined carbohydrate) that no self-respectingmouse would naturally consume. no wonder he had to limit how much of this stuff the miceate by 30-60% in order to lower blood glucose. and here is the ketogenic food: ketocal (nutricia)�90% fat, 1.6% carbohydrate,8.4% protein ingredients: hydrogenated soybean oil, drywhole milk, refined soybean oil, soy lecithin, corn syrup solids. nice. processed soy, dairy, and corn syrup.poor little mice. if you have read my dairy page, you will knowthat the whey proteins in milk raise insulin levels, which can prevent ketosis. this mayhave been why he had to limit how much of
this stuff the mice ate to get good results. to dr. seyfried�s credit, he points outin his book that other researchers have been able to achieve good results in their animalcancer experiments without having to restrict calories and he is unable to explain why.let�s look at a mouse diet that worked without restricting calories: ketogenic bio-serv f3666�8.36% protein,0.76% carbohydrates and 78.8% fat ingredients: lard, butter, corn oil, casein,cellulose, mineral mix, vitamin mix, dextrose look, ma, no whey protein and no refined carbohydrate!the mice could eat as much of this (admittedly very weird) chow and get good results [stafford2010]. it makes me hopeful that even this
odd diet, which is a far cry from a healthymouse diet, delivered positive results. dr. seyfried also referred to another studythat used a high-protein, low-carb diet with unrestricted calories that also worked, buti could not locate the article in time to include it here. [ho 2011] i can�t help but wonder how these littlemice would have fared had they been fed real food that mice are actually supposed to beeating. so, do we need to restrict calories or not?it may depend on the composition of the diet�i think the jury is still out. however, peoplewho eat well-formulated ketogenic diets report a substantial reduction in appetite and tendto naturally find themselves eating quite
a bit less without having to count calories.metastatic cancer is different ninety percent of all cancer deaths are dueto metastatic disease (cancer that has spread to more than one organ). these are the badboys. once cancer is on the move it�s very hard to stop, which is why prevention is soimportant. but before we get to that, one of the most fascinating topics in dr. seyfried�sbook is his theory of how and why some cancers travel through the body to distant organs.he makes a compelling argument for the role of a particular kind of immune cell calleda macrophage in helping cancers to spread. the normal role of macrophages (macs) in ourimmune system is a very complicated and special one. these are amazing cells, with the abilityto change their personality, shape, and behavior
whenever necessary, depending on the localcircumstances. every macrophage begins its little life as monocyte, a round cell thatcan cruise the bloodstream. when trouble is lurking anywhere in the body�if there isinjury or inflammation or infection�monocytes heed the call of damaged tissues and travelto the troubled area. once they are close enough, they squeeze themselves out of theblood vessel and into local tissue, where they magically morph into macrophages so theycan to get to work. macrophages assess the situation and releaseall kinds of special chemical signals to help recruit other types of immune cells to thescene. but the coolest thing about macrophages is that they can swallow stuff whole. macattack! macs engulf our own used-up, damaged,
or dead cells, and devour bacteria that cando us harm. now these cells are our best friends in infection or wound healing, but if theybecome cancerous, they can become our worst enemy, because they are very active, can fusewith other cells, and they are mobile. now you�ve got macs gone amok. metastatic tumorcells of many types have been observed to have phagocytic behavior (i.e. they eat othercells�just like macs do). macs are often found mixed in among tumor cells, contributingto chronic inflammation in the area by triggering local immune reactions. these macs are calledtam�s, or tumor-associated macrophages. tumors containing tam�s have a poorer prognosis. macs tend to hang out more often in theirfavorite organs�they are especially drawn
to lung, liver, and bone. these also happento be favorite places for cancer to migrate to, as well. some cancers also like to spreadto injured or inflamed parts of the body, just like a mac would. plants and certainlower animals, which do not have macrophages, can also get cancer, but their cancers nevermetastasize. fascinating. how best to prevent cancer in the first place? since 90% of all cancer deaths are due tometastatic cancers (cancers that have spread to more than one organ)�and this estimatehas not changed in 50 years�early detection and prevention of spread plays a major rolein prognosis. but the good news is that most cancer is preventable.
about 5% of cancers are caused by mutationsthat are inherited at birth. about 15% of cancers are caused by viruses. the rest�afull 80%�are associated with the following risk factors: smokingalcohol obesityage radiation exposurecarcinogenic chemical exposure this means that the vast majority of cancersare preventable using lifestyle modifications. dr. seyfried writes (and i have read manypapers supporting this logic), that the best way to prevent cancer (and most chronic diseases,for that matter), is to avoid exposure to
things that cause tissue inflammation, andall of the above risk factors are directly associated with inflammation. two of the aboverisk factors are dietary�alcohol and obesity, so let�s zero in on those�this is a nutritionwebsite, after all. for more information about how alcohol and inflammation are connected,please see my alcohol page. but what is the connection between obesity and inflammation? the road to inflammation is paved with refinedcarbohydrates. to fully explain the science behind these connections here would take ustoo far off track, but suffice it to say for now that refined carbohydrates (such as sugarand flour) lead to high blood sugar and high insulin levels. these, in turn, increase theproduction of damaging free radicals within
the mitochondria, and also increase the productionof a molecule called nf-kappa-b, which turns on genes that promote inflammation. it wouldtherefore make sense, whether you are overweight or not, to minimize your exposure to refinedcarbohydrates. obesity is a major risk factor for cancer,and there is no question that diet is the most powerful tool available to manage weight.if you have been paying attention to thought leaders in the field of obesity, or you arefamiliar with the information on this website about obesity, or you have learned throughyour own experiences what works best, you know that the single most effective dietarystrategy for preventing and managing weight gain (as well as for preventing and managingmost chronic diseases of civilization) is
avoiding refined carbohydrates. refined carbohydrates(such as sugar and flour) keep blood sugar and insulin levels high, promoting inflammationand oxidation throughout the body�not to mention overeating due to loss of controlover appetite, which continues the vicious cycle. yet we all know people with cancer who arenot overweight and who seem to take excellent care of themselves. we even know of athleteswho don�t drink, don�t smoke, and are in excellent physical condition, who neverthelesshave come down with cancer. could it be that refined carbohydrate is the hidden risk factorin people like this? if you are curious to read more about the connection between carbohydratesand cancer, there is an excellent review article
available free on line: http://www.nutritionandmetabolism.com/content/8/1/75 in addition to avoiding inflammation, dr.seyfried recommends a 7-day, water-only fast once a year. his reasoning is that a totalfast forces the body to rid itself of damaged and weakened cells that may be pre-cancerous.with nothing else to eat, healthy cells turn to cannibalism, eating their vulnerable neighboringcells. how�s that for an image? the bottom line is that diet clearly makesa huge difference, but we don�t yet know what the ideal diet for cancer treatment is.there is no question in my mind at this point that carbohydrates are bad for cancer, butto what degree calories, protein and fat need to be restricted is unclear. we need morestudies, and they need to be more thoughtfully
designed. it seems that ketogenic diets havetremendous potential, but i don�t know if they need to be as strict as dr. seyfriedrecommends�people who design their ketogenic diet around healthy, whole foods and avoiddairy may be able to get away with more calories? i do think it makes sense for those of uswho want to reduce our risk for cancer to minimize refined carbohydrates, minimize dairyproducts (particularly those with high whey content), maintain our weight in a healthyrange, and choose whole foods over processed foods. since that dietary pattern is alreadyquite an improvement from the standard american diet, i have hope that it could make a bigdifference in our risk for cancer (as well as many chronic diseases).
however, if i already had cancer or were acancer survivor, i wouldn�t touch a carbohydrate with a 10-foot pole. dairy, being a growthformula (for baby cows), would also be off the menu.
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